If you are listening to speakers representing U.S. leadership of global AIDS responses, usually you are likely to hear about the great success of efforts to prevent mother to child transmission of HIV, as evidenced by more than a million babies born uninfected with the virus, thanks to the President’s Emergency Plan for AIDS Relief.
On Friday, though, speakers that included a past PEPFAR leader and the present one gathered to discuss a population not helped by those efforts: The thousands of young women and girls of child-bearing age across southern Africa who become infected with HIV on a weekly basis, and who continue to deal with the impacts of early and unintended pregnancies.
The occasion was a discussion of a new initiative to reach girls and women, and of a recent report, Addressing HIV Risk in Adolescent Girls and Young Women from the Center for Strategic and International Studies, assessing what it will take to make the new approach succeed where previous responses failed. The ambition and scope of the new initiative is delineated by its target population: the most vulnerable of girls and women in the highest burden settings in 10 countries. The initiative’s full name and acronym also speak of its high hopes: “Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe” — “DREAMS.” Balancing those, however, is its current budget: $210 million, as well as the strategies it will employ, which are still in the works.
Add to that, as the report notes: “PEPFAR is unlikely to support cash transfer programs, pay for the drugs for PrEP demonstration projects, or provide contraceptive commodities other than male and female condoms.”
While those concerns are not minor, present PEPFAR leader Ambassador Deborah Birx stressed they have the potential to be strengths. The funding, $180 million of which comes from PEPFAR, $25 million from the Bill and Melinda Gates Foundation, and $5 million from the Nike Foundation, won’t go far, she noted. But she added, she thinks of Gates and Nike as “founding partners,” with the implication more will hop on board. As far as the strategies — they will be informed, built, and thus, bought into on the ground — “community by community,” she said.
Former PEPFAR leader, now Global Fund to Fight AIDS, Tuberculosis and Malaria director Mark Dybul pointed to the evidence backing “cash transfers,” (although he prefers the expression “incentives”) to help adolescent girls stay in school. Staying in school, he said, has been found to lower HIV risks by 60 percent (or, as he put it offers “60 percent protection”). Health and education, he added, are “the two fundamental determinants of the opportunities a young girl will have as a young woman.”
Put that way, it doesn’t sound like a hard sell — particularly, both Birx and Dybul stressed, if in-country ministries of finance as well as ministries of health are involved.
Judith Bruce of the Population Council also stressed the benefit that a measure of financial independence offers women and girls in poverty, among whom, 10 years into the global AIDS response early marriage and transactional sex are on the rise. “What can you give girls that no one can take away?” she asked.
With a starting budget of $210 million, in an arena in which both donors and partner governments have long resisted paying women for ongoing community based care efforts for which they make up the front lines, that remains a good question.