When Gugu was a 14-year-old girl in Johannesburg, South Africa, she was raped, shot and left for dead. Miraculously, she survived after spending three months in a coma, but when she woke up, the doctor had another potential death sentence to deliver: she had contracted HIV. And if that news wasn't enough to deal with, she was also pregnant.
This fate is unfortunately not rare for girls, especially in sub-Saharan Africa. And as it turns out, violence against girls and HIV are much more closely linked than we previously understood.
While we've made tremendous progress reducing new HIV infections—especially in infants—UNAIDS reports that adolescent girls and young women account for one in four new HIV infections in sub-Saharan Africa. Girls and young women are significantly more likely than males to contract it, largely due to their heightened risk for sexual violence. About one in three girls in sub-Saharan Africa experience sexual violence before turning 18.
For all of us working towards an HIV-free generation, these statistics are a wake-up call we can’t ignore. Until girls’ rights and needs are placed at the top of our agenda, we won’t get far in achieving our goal to stop HIV, not to mention many other critical public health issues.
Making the Connection and Finding a Solution
I first began working on the link between violence and HIV when I was with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The medicine used for treating AIDS can also prevent HIV in certain circumstances, but in the case of rape, it must be taken within 72 hours of exposure. To expand access to the medicine and comprehensive support for survivors of sexual violence, we launched a pilot project to establish post-rape care centers in two African countries. While the pilot itself was a success, the evaluation uncovered a major problem. We expected to see large numbers of women visiting the centers—but instead the vast majority of patients were children. Survivors ranged from very young children to older adolescents. Virtually no one above the age of 20 presented for care.
This information prompted me to begin working on a new partnership that had just been launched at the Clinton Global Initiative. Together for Girls, is dedicated to ending violence against children with a focus on sexual violence against girls. It’s a global public-private partnership between the U.S. government, five UN agencies, including UNICEF, UNAIDS, UN Women, UNFPA and WHO, and several private sector organizations, which works to addresses violence and its many public health, societal and economic consequences.
Together for Girls partners work with government leaders to collect national-level data on violence against children in their countries and then use that data to mobilize national action to respond and prevent violence. The Violence Against Children Survey (VACS) is a national survey of 13-24 year olds that assesses the magnitude, nature and consequences of violence against children. With strong support from the U.S. Centers for Disease Control and Prevention, PEPFAR and UNICEF, the governments of Cambodia, Haiti, Kenya, Swaziland, Tanzania and Zimbabwe, have all completed surveys and the results have been illuminating—and a call to action.
In Swaziland, the Violence Against Children Survey found that girls who experienced sexual violence before the age of 18 were 3.7 times more likely to report a sexually-transmitted disease, including HIV, and were also 3.5 times more like to have pregnancy complications likely due to their young age.
In Tanzania, the surveys revealed that after experiencing sexual violence, girls were more likely to engage in risky behavior, including having multiple sexual partners and infrequent condom use. In Swaziland, girls who experienced violence were also at greater risk for alcohol abuse, depression and suicidal thoughts. Once a girl's self-esteem is crushed, the effects are far reaching and long lasting.
The good news is that we know what to do. Violence and its consequences, including HIV, are preventable and the data from these surveys are mobilizing governments to take action. For example, In Tanzania, following the survey, the government developed a three-year national action plan to stop violence against children. In just one year, Tanzania trained 4,000 police, social welfare officers, primary school teachers, health workers, and district justice officials in child protection.
Investing in this work is incredibly smart. As country governments build their capacity to respond to and prevent violence, they are also protecting their citizens from a host of other negative health conditions, including HIV/AIDS, unintended pregnancy and the maternal deaths that young teen mothers risk. Taking on this egregious human rights issue contributes to an environment where children can grow up both safe and healthy.
Breaking the Silence and Stigma
This brings me back to Gugu. She is now in her 30s and is sharing more about her life raising a child while living with AIDS in the powerful photo essay, "Through Positive Eyes," published in Safe magazine this week. Developed by Together for Girls, Safe is the first digital magazine highlighting the survivors, heroes and solutions working to stop violence against children with the aim of breaking the silence and stigma around it and inspiring readers to take action.
In this issue of Safe, we explore both the immediate and long-term consequences of violence and how this global epidemic is fueling some of the world's most intractable public health issues. I invite you to keep exploring this topic in the pages of Issue II of Safe. It includes two powerful photo stories, a list of 50 global heroes finding solutions, and interviews with two U.S. ambassadors working at the intersection of HIV and violence. I hope you will find inspiration from those who grace these pages. Many of the answers to how we make the world better for children—and better for all of us—are contained here.
Michele Moloney-Kitts is the Director of Together for Girls, a global public-private partnership dedicated to ending violence against children, with a focus on sexual violence against girls. Together for Girls generates comprehensive data on the magnitude and consequences of this public health and human rights issue, mobilizing countries to lead a response and inform solutions that are evidence-based. The partnership includes five UN agencies led by UNICEF, the U.S. government and the private sector.