AIDS-related deaths have fallen by 45 percent since they peaked in 2005, and the rate of new HIV infections among adults has stopped increasing. But despite this and other areas of progress, adolescent girls and young women continue to be disproportionately affected by HIV in sub-Saharan Africa.

In fact, they account for 1 in every 5 new HIV infections in Africa and in some countries are up to 14 times as likely as their same-age male counterparts to be infected with HIV.

According to Nora Toiv, who is a gender adviser at the Office of the U.S. Global AIDS Coordinator and Health Diplomacy, HIV infection is linked to gender inequality partly because of gender norms that devalue women and a lack of knowledge that causes young people to engage in risky behavior.

There are “entrenched attitudes about women. The value that is associated with women and girls is much lower than that attached to boys — and that’s from birth on,” Toiv said. For example, “girls are expected to do all the chores, and if there’s money to go to school they send the boys.”

Woman walking away from camera carrying baby (© AP Images)
An HIV-positive mother carries her daughter in a Nairobi, Kenya, slum. Getting tested for HIV is easy in countries supported by PEPFAR. (© AP Images)

Also, there is a “huge taboo” surrounding sex and sexually transmitted diseases. “That’s why we’re doing parent and caregiver intervention … to help parents talk to their kids about sexual violence and to talk about HIV,” Toiv said.

Data from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)–supported Violence Against Children surveys in 11 countries found that an average of 1 in 3 young women reported their first sexual experience as forced or coerced. Toiv said many girls face “cultural pressure” to have sex at an early age. This leads to the “cycle of transmission” when young men who have had sex with an infected woman their own age are in turn infecting women who are often 10 years younger than they are.

Lack of economic access to jobs has caused some young girls to turn to sex work as well as transactional sex in exchange for food, clothing or other goods. This is also a driver for infection.

In addition to working to improve gender equality and education about the risks of HIV, “the one thing that everybody can do is get an HIV test,” Toiv said. This is easy in countries that are supported by PEPFAR.

The Office of the U.S. Global AIDS Coordinator and Health Diplomacy, which leads PEPFAR implementation, has a strategic partnership that seeks to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe). These countries accounted for nearly half the new HIV infections among adolescent girls and young women in 2014.

The partnership, DREAMS, leverages the resources and expertise of private-sector and philanthropic partners for greater impact and has so far reached over 1 million adolescent girls and young women with HIV-prevention services.