Adolescent girls and young women are disproportionately affected by HIV. Globally, almost 60% of new HIV infections amongst 15 to 24-year olds were amongst AGYW. Data from UNAIDS reports that in 2016, new infections amongst women aged 15 to 24 years were 44% higher than they were among men in the same age group. In eastern and southern Africa, young women aged 15 to 24 years accounted for 26% of new HIV infections in 2016, despite making up just 10% of the population. Young women aged 15 to 24 years in western and central Africa and the Caribbean respectively accounted for 22% and 17% of new HIV infections in 2016.
WHO defines adolescents as people between 10 and 19 years of age. The United Nations considers “youth” as those people between 15–24 years and “young people” as people between 10–24 years.This guidance document focuses on adolescent girls aged 15 to 19 years and young adult women aged 20 to 24 years, in line with UNAIDS guidance. Specific programmes, however, also include actions for adolescent girls aged 10 to 14 years and young adult women aged 25 to 29 years.
Key populations are defined population groups who, due to specific higher-risk behaviours, are at increased risk of HIV, irrespective of the epidemic type or local context. They often have legal and social issues related to their behaviours that increase their vulnerability to HIV. Key populations are defined in the Global Fund Key Populations Action Plan 2014-2017 as populations that have a high epidemiological impact from AIDS…, combined with reduced access to services and/or being criminalized or otherwise marginalized.
Key populations include populations that are stigmatized, discriminated against and marginalized by society, in law, policy and practice. They may also be criminalized in law. These populations may struggle to fulfil their human rights, including their rights to access health and social services. They live in environments of inequality where they are unable to thrive, feel safe and actively participate in all aspects of society.
Key populations in the HIV response include:
Adolescents and young people may belong to one or more of these key populations or engage in activities associated with these key populations. Punitive laws, discrimination and violence combined with the vulnerability of youth, power imbalances in relationships and possible alienation from families and friends means that young key populations face increased marginalization, hindering their ability to access HIV-related and other health services
In addition, women and girls experience increased biological vulnerability to HIV and are disproportionately exposed to violence and gender inequality that increase their HIV risk.
Note: Sex workers refer to those aged 18 years or older. Adolescents below the age of 18 who engage in sex work are considered to be sexually exploited, in accordance with article 34 of the Convention on the Rights of the Child, which ensures the protection of all children from all forms of sexual exploitation and sexual abuse.Global Fund (2016) Strategic Investments for Adolescents in HIV, Tuberculosis and Malaria Programs: Information Note
The 2016 UN Political Declaration on Ending AIDS reinforced the urgency of the HIV situation amongst AGYW. It set a specific target for reducing new HIV infections among adolescent girls and young women aged 15 to 24 years to fewer than
100 000 by 2020. The UN, governments and civil society stakeholders have all recognised the need to expand and accelerate HIV responses for AGYW, to protect and promote gender equality and human rights.
HIV programming for AGYW needs to address the numerous factors that cause heightened risk of HIV amongst AGYW. These include biological factors, as well as social, economic and cultural factors relating to gender inequality and human rights barriers experienced by AGYW.
Gender inequality limits access to education, resources and services for AGYW, preventing AGYW from being able to make decisions about, control and access health care services. A wide range of laws, customs and practices – for instance laws and norms allowing young girls to be married below the age of 18 years, laws that fail to criminalise the rape of a wife by her husband, laws and practices that prohibit women from owning or inheriting property or to having autonomous decision-making power within their relationships, and laws, policies and practices limiting adolescent girls’ independent and confidential access to sexual and reproductive health services - perpetuate gender inequality. These laws, policies and practices limit the ability of women and young girls to control their lives, including their ability to protect themselves from HIV exposure.For more information on understanding and responding to law, human rights, gender equality and HIV, see UNDP’s Capacity Development Toolkit: Critical Enablers
The Global Commission on HIV and the Law, a global commission of HIV and human rights leaders, experts and activists, led by UNDP and convened on behalf of the Joint United Nations Programme on HIV/AIDS (UNAIDS) undertook consultations and deliberations in seven regions of the world during 2010-2012. The consultations were accompanied by extensive research and analysis to examine the relationship between laws, policies, practices and HIV in six focus areas:
The Global Commission’s comprehensive review and report, Risks, Rights & Health found evidence of how bad laws, policies and practices were fuelling the spread of HIV, resulting in human rights violations for affected populations and limiting the efficacy and efficiency of HIV and health programmes. They also noted that protective laws and practices to promote human rights and gender equality strengthened the response. The report made recommendations for strengthened legal and policy environments to respond to HIV to increase access to prevention, treatment, care and support for all, including for key populations.
Global Commission on HIV and the Law (2012) Risks, Rights & Health