2022世界艾滋病日報告《危險的不平等》-80正式版

WORLDAIDSDAYREPORT|2022DANGEROUSINEQUALITIESDANGEROUSINEQUALITIES?JointUnitedNationsProgrammeonHIV/AIDS(UNAIDS),2022Somerightsreserved.ThisworkisavailableundertheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0IGOlicence(CCBY-NC-SA3.0IGO;/licenses/by-nc-sa/3.0/igo/).Underthetermsofthislicence,youmaycopy,redistributeandadapttheworkfornon-commercialpurposes,providedtheworkisappropriatelycited,asindicatedbelow.Inanyuseofthiswork,thereshouldbenosuggestionthatUNAIDSendorsesanyspecificorganization,productsorservices.TheuseoftheUNAIDSlogoisnotpermitted.Ifyouadaptthework,thenyoumustlicenseyourworkunderthesameorequivalentCreativeCommonslicence.Ifyoucreateatranslationofthiswork,youshouldaddthefollowingdisclaimeralongwiththesuggestedcitation:“ThistranslationwasnotcreatedbyUNAIDS.UNAIDSisnotresponsibleforthecontentoraccuracyofthistranslation.TheoriginalEnglisheditionshallbethebindingandauthenticedition”.AnymediationrelatingtodisputesarisingunderthelicenceshallbeconductedinaccordancewiththemediationrulesoftheWorldIntellectualPropertyOrganization(/amc/en/mediation/rules).Suggestedcitation.Dangerousinequalities:WorldAIDSDayreport2022.Geneva:JointUnitedNationsProgrammeonHIV/AIDS;2022.Licence:CCBY-NC-SA3.0IGO.Third-partymaterials.Ifyouwishtoreusematerialfromthisworkthatisattributedtoathirdparty,suchastables,figuresorimages,itisyourresponsibilitytodeterminewhetherpermissionisneededforthatreuseandtoobtainpermissionfromthecopyrightholder.Theriskofclaimsresultingfrominfringementofanythird-party-ownedcomponentintheworkrestssolelywiththeuser.ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartofUNAIDSconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbyUNAIDSinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters.AllreasonableprecautionshavebeentakenbyUNAIDStoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshallUNAIDSbeliablefordamagesarisingfromitsuse.UNAIDS/JC3068EWORLDAIDSDAYREPORT|2022DANGEROUSINEQUALITIESDANGEROUSINEQUALITIESTABLEOFCONTENSForeword4Introduction6References11GenderinequalitiesholdbacktheendofAIDS12Thevulnerabilityofadolescentgirlsandyoungwomen15NewHIVinfectionsamongadolescentgirlsandyoungwomenaredecliningslowerthanamongmalesofthesameageinsub-SaharanAfrica15PolicyreformandintensifiedinvestmentinHIVprogrammesforadolescentgirlsandyoungwomenareneededtoclosegapsintheAIDSresponse17Concreteactionbeyondthehealthsectoriscriticaltoreducingthevulnerabilityofadolescentgirlsandyoungwomen18MasculinitiesandHIVservices21Genderdisparitiesinserviceaccessandtreatmentoutcomes23AddressingtheHIV-relatedneedsofbothwomenandmenisanurgentpriority26References29Decriminalization,destigmatizationandinclusionofkeypopulations30NewHIVinfectionsinepidemicsthatareconcentratedamongkeypopulationsarenotdecliningglobally—onereasonwhytheglobalresponseisnotontracktoreachthe2030target32AccesstocombinationHIVpreventionandtreatmentservicesamongkeypopulationsremainslimitedacrossmostoftheworld36PrEPhasthepotentialtomarkedlylowerHIVincidence,butPrEPservicesarenotreachingkeypopulations412DANGEROUSINEQUALITIESWecanendepidemicsamongpeoplewhoinjectdrugs,butwearefailingtodosobecausewearenotensuringmeaningfulaccesstoharmreductionservices44WecannotendAIDSamongkeypopulationsunlessweeffectivelyaddressthesocietalfactorsthatincreasetheirvulnerabilityandblocktheirabilitytoaccessservices46References47EndingAIDSinchildren48Thetreatmentgapforchildrencanbeclosedifmorepregnantandbreastfeedingwomenandtheirinfantsaresupportedtoconfirmthechild’sHIVstatusatbirthandattheendofbreastfeeding.53Intensified,mother-centredstrategiceffortsareneededtopreventverticaltransmission.55Recentoptimizationofchildtreatmenthasledtoincreasesinviralloadsuppressionamongchildrenwhoarereceivingantiretroviraltherapy.57References61MobilizingtheresourcesneededtoendAIDS62Economicjoltsthreatentheworld’sabilitytomobilizeessentialAIDSresources65CountriesmustsummonthepoliticalwilltomakeessentialAIDSinvestments67ThedonoranddevelopmentpartnersbaseforAIDSandhealthmustbeexpanded69FundingpatternsthatcontributetoHIV-relatedinequalitiesmustbecorrected70References773DANGEROUSINEQUALITIESFOREWORDTheworldisnotontracktoendtheAIDSpandemic.NewinfectionsarerisingandAIDSdeathsarecontinuingintoomanycommunities.Thisreportrevealswhy:inequalitiesareholdingusback.Infrankterms,thereportcallstheworld’sattentiontothepainfulrealitythatdangerousinequalitiesareunderminingtheAIDSresponseandjeopardisingthehealthsecurityofeveryone.Thereporthighlightsthreespecificareasofinequalityforwhichconcreteactionisimmediatelypossible—genderinequalitiesandharmfulmasculinitiesdrivingHIV;marginalisationandcriminalisationofkeypopulations,whichourdatashowisresultinginstarklylittleprogressforthosepopulationsandunderminingtheoverallresponse;andinequalitiesforchildrenwhoselivesmustmattermorethantheirmarketshare.WinnieByanyimaButthisisnotacounselofdespair,itisacalltoaction.ThroughboldactiontoUNAIDSExecutiveDirectorconfronttheseinequalities,wecanendAIDS.TheworldwillnotbeabledefeatAIDSwhilereinforcingpatriarchy.TheonlyeffectiveroutemaptoendingAIDSandachievingthesustainabledevelopmentgoalsisafeministroutemap.Wecantakeactionnowtotacklegenderinequalitiesandpromotehealthymasculinities—totaketheplaceoftheharmfulbehaviourswhichexacerbaterisksforeveryone.Genderbasedviolenceisincreasingwomen’srisksofHIVinfectionandconstrainingtheaccessofwomenlivingwithHIVtolife-savingsservices.Adolescentgirlsandyoungwomen(aged15to24years)arethreetimesmorelikelytoacquireHIVthanadolescentboysandyoungmenofthesameagegroupinsub-SaharanAfrica.OnestudyshowedthatenablinggirlstostayinschooluntiltheycompletesecondaryeducationreducestheirvulnerabilitytoHIVinfectionbyupto50%.Byinterruptingthepowerdynamics,policiescanreducegirls’vulnerabilitytoHIV.Harmfulmasculinitiesarediscouragingmenfromseekingcare.While80%ofwomenwereaccessingtreatmentin2021,only70%ofmenwereontreatment.Meanwhile,weneedtotackleinequalitiesintherealisationofhumanrights.Discriminationagainst,stigmatizationandcriminalizationofgaymenandothermenwhohavesexwithmen,sexworkers,transgenderpeople,peoplewhoinjectdrugsandprisonersarecostinglivesandpreventingtheworldfromachievingagreedAIDStargets.DatainthisreportshowsnosignificantdeclineinnewinfectionsamongmenwhohavesexwithmenineitherwesternandcentralAfricaoreasternorouthernAfrica.Butabetterapproachforkeypopulationsisachievable.Forexample,whilekeypopulationsgenerallyhaveloweraccesstoHIVservices,thisreporthighlightsseveralcountiesinKenyawherefemalesexworkerslivingwithHIVareaccessingHIVtreatmentservicesatequalorbetterratesthanwomenoverall.Thisistheresultofcommunity-ledservices.Meanwhile,wehighlightresearchshowingcountriesthatremoveoravoidcriminalizationhaveseengreaterprogress.4DANGEROUSINEQUALITIESFacinganinfectiousvirus,failuretomakeprogressforkeypopulationsunderminestheentireAIDSresponseandhelpsexplainslowingprogress.Andwheregenderandkeypopulationinequalitiesintersect,theyareamplified.Wealsoneedtotackletheinequalitiesinaccesstotreatmentbetweenadultsandchildren.WhileoverthreequartersofadultslivingwithHIVareonantiretroviraltherapy,justoverhalfofchildrenlivingwithHIVareonthelifesavingmedicine.In2021,childrenaccountedforonly4%ofallpeoplelivingwithHIVbut15%ofallAIDS-relateddeaths.Closingthetreatmentgapforchildrenwillsavelives.Weneedtostrengtheninternationalcooperationandsolidarity,becausewecanonlyendAIDSbyendingAIDSeverywhere.Thisreportshowsthatdonorfundingishelpingcatalyseincreaseddomesticfunding:increasesinexternalHIVfundingforcountriesfromPEPFARandtheGlobalFundduring2018-2021werecorrelatedwithsignificantincreasesindomesticfundingfromnationalgovernments.Bothsourcesbadlyneedtoincrease.In2021,fundingavailableforHIVprogrammesinlow-andmiddle-incomecountrieswasUS$8billionshort.IncreasingdonorsupportisvitaltogettingtheAIDSresponsebackontrack.Thisisamomentforcourage.Toensurethatallofourgirlsareinschool,safeandstrong.Totacklegenderbasedviolence.Topromotehealthymasculinitiestotaketheplaceoftheharmfulbehaviourswhichexacerbaterisksforeveryone.Todecriminalizepeopleinsame-sexrelationships,sexworkers,andpeoplewhousedrugs,andinvestincommunity-ledservicesthatenabletheirinclusion—tohelpbreakdownbarrierstoservicesandcareformillionsofpeople.ToensureservicesforchildrenlivingwithHIVreachthemandmeettheirneeds,closingthetreatmentgapsothatweendAIDSinchildrenforgood.TofullyfundtheAIDSresponsesothatpromisescanbeturnedintoactions.Whatworldleadersneedtodoiscrystalclear.Inoneword:Equalize.Equalizeaccesstorights,equalizeaccesstoservices,equalizeaccesstothebestscience?andmedicine.LeavinginequalitiestofesterisperpetuatingtheAIDSpandemic,endangeringeveryone.Tacklinginequalitieswillnotonlyhelpthemarginalized.Itwillhelpeveryone.5DANGEROUSINEQUALITIESINTRODUCTIONINEQUALITIESARESTOPPINGTHEWORLDFROMENDINGAIDS.Inthe2022editionofourannualGlobalAIDSUpdate,Indanger,wereportedthattheglobalAIDSresponsehasbeenpushedbadlyofftrack.ThedeclinesinnewHIVinfectionsandAIDS-relateddeathshavenotablyslowed,andnewinfectionsarerisinginmanypartsoftheworld.ResourcesfortheresponsehavestagnatedatlevelsthatarewhollyinadequatetoendAIDSasapublichealththreatby2030.Thisreport,whichmarksWorldAIDSDay2022,unpackstheimpactthatgenderinequalities,inequalitiesfacedbykeypopulations,andinequalitiesbetweenchildrenandadultshavehadontheAIDSresponse.Itisnotinevitable,however,thattheseinequalitieswillslowprogresstowardsendingAIDS.Weknowwhatworks—withcourageandcooperation,politicalleaderscantacklethem.GenderinequalitiesareakeydriveroftheAIDSepidemic.Adolescentgirlsandyoungwomeninsub-SaharanAfricaarethreetimesmorelikelytoacquireHIVthantheirmalecounterparts.ArecentstudyalsofoundthatwomenexperiencingintimatepartnerviolenceinthepastyearweremorethanthreetimesmorelikelytohaverecentlyacquiredHIV(1).UnequalpowerdynamicsbetweenmenandwomenandharmfulgendernormsincreasetheHIVvulnerabilityofwomenandgirlsinalltheirdiversity,deprivethemoftheirvoiceandtheabilitytomakedecisionsregardingtheirownlives,reducetheirabilitytoaccessservicesthatmeettheirneeds,increasetheirrisksofexperiencingviolenceorotherharms,andhampertheirabilitytomitigatetheimpactofAIDS.WhiletransformingharmfulgenderandmasculinitynormsamongmenandboyswillhelpreducetheirHIVrisks,itwillalsoreducerisksandvulnerabilitiestoHIVamongwomenandadolescentgirls,includingbyrespectingtheirsexualandreproductivehealthandrightsandupholdingzerotoleranceforanyviolenceagainstthem.6DANGEROUSINEQUALITIESDiscriminationagainst—andstigmatizationandcriminalizationof—keypopulationsarecostinglivesandpreventingtheworldfromachievingtheagreedAIDStargets.Thisistrueinbothconcentratedandgeneralizedepidemics.Forexample,whileHIVincidencehasdeclinedsince2010by58%amongadults(aged15to49years)inwesternandcentralAfricaand62%ineasternandsouthernAfrica,asystematicreviewofdatafoundthattherewasnoconclusivedeclineamonggaymenandothermenwhohavesexwithmeninthoseregionsoverthesameperiod(2).Similarly,programmeandsurveydataincountriesacrossdifferentregionsandtypesofepidemics—suchasIndia,Kenya,Myanmar,NigeriaandVietNam—showthatdifferentkeypopulationshavelowerHIVservicecoveragecomparedtothegeneralpopulation.KeypopulationsarealsoleastlikelytobeprioritizedinthenationalAIDSresponsesofsomecountries.Urgenteffortsareneededtoeliminatetheseinequalities,includingthroughcommunity-ledresponses,acceleratedscale-upofpre-exposureprophylaxis(PrEP)andimmediateactiontocloseaccessgapsforharmreductionservices.TheworldcontinuestofailchildrenintheAIDSresponse.In2021,800000childrenlivingwithHIVwerestillnotonlife-savingtreatment.WeknowwhatneedstobedonetoeliminatetheverticaltransmissionofHIVandmeetthetreatmentneedsofchildren,butafailureofleadershiphaspreventedusfromdoingso,andthewideningdisparityintreatmentcoveragebetweenchildrenandadultsisincreasingratherthandeclining.Manychildrenarealsobeingdiagnosedlate,with60%ofchildrenaged5to14yearslivingwithHIVnotcurrentlyreceivingtreatment.Closingthetreatmentgapforchildrenwillsavelives.InworkingtoimprovetreatmentoutcomesforchildrenlivingwithHIV,wewouldalsocontinue—andevenaccelerate—recentincreasesinratesofviralsuppressionassociatedwithimprovementsinpaediatricHIVtreatmentregimens.Theseinequalitiesaren’tmerelyharmfultoindividuals:theyareimpedingprogressagainstAIDS,reducingthereturnsonHIVinvestmentsandputtingmillionsofpeopleindanger.WhileHIVinfectionandAIDSarebothentirelypreventable,theratesofbotharenotdecliningquicklyenoughtoputusoncoursetoendAIDSby2030.7DANGEROUSINEQUALITIESEverytwominutes,anadolescentgirloryoungwoman(aged15to24years)acquiredHIVin2021.AlthoughtransmissionofHIVamongthisgroupisthedrivingforceofmanynationalepidemicsinsub-SaharanAfrica,in19highHIVburdencountriesinAfrica,dedicatedcombinationpreventionprogrammesforadolescentgirlsandyoungwomenareoperatinginonly40%ofhighHIVincidencelocations.Alackofpolicyreformandinvestmentwithinandbeyondthehealthsectorismakingitdifficult,ifnotimpossible,foradolescentgirlsandyoungwomentoaccessessentialHIVservices.PreventingHIVamongmenandensuringthatmenlivingwithHIVachieveviralsuppressionarealsocriticaltoreducingtheepidemic’stollonwomenandgirlsinseveralpartsoftheworld.Keypopulationsaccountforlessthan5%oftheglobalpopulation,buttheyandtheirsexualpartnerscomprised70%ofnewHIVinfectionsin2021.NeglectoftheHIV-relatedneedsofkeypopulationsnotonlycontributestoneedlesssufferinganddeathamongthosegroups,butitalsoexposestheirsexualpartnerstoconsiderablerisks.Failuretouseavailable,simplestrategiesforpreventingHIVacquisitionamongchildrenisnotonlyatragedyforeachchildlivingwithHIV,butalsofortheirfamiliesandcommunities.Societybearsthelong-termcostsoflifelongantiretroviraltherapyforchildrenwhodidn’tneedtoacquireHIVinthefirstplace.MorethantwodecadesofsustainedinvestmentsintheAIDSresponsehaveachievedhistoricresults.ButallofthesegainsarenowjeopardizedbyinsufficientprogresstoendHIV-relatedinequalities.Thisisnotthefirsttimethatfollowingthroughhasprovedachallengeforglobalhealthefforts.BeforeAIDSwasrecognizedintheearly1980s,globalprogressinreducingtheburdenassociatedwithtuberculosisandmalariastagnatedandcontroleffortsweakened.Theworld’sfailuretofollowthroughtoendthesediseasesallowedthemtoresurge,vastlyincreasingthehumanandeconomiccostsassociatedwiththeseepidemics.WesimplycannotallowthesamethingtooccurinthecaseofAIDS.Thestaggeringlong-termcostsoffailurearejusttoogreat.TheworldmustactnowtogettheAIDSresponsebackontrack.TheGlobalAIDSStrategy2021–2026:EndInequalities,EndAIDSprovidesaclear,achievableblueprintforendingHIV-relatedinequalitiesandgettingusontracktoendAIDSby2030.Merelydoingabitmoreofthesameisarecipeforfailure:inordertotackletheinequalitiesthatareslowingprogress,wemustapplyaninequalitieslensacrossthebreadthofourefforts,leveraginggranulardatatoidentifycriticalinequalitiesandguideoureffortstoaddressthem.8DANGEROUSINEQUALITIESInshort,afailuretoequalizetheAIDSresponsewillresultinafailureoftheresponseitself.Toavoidthisfate,wemustensure:Equalaccesstorights.Equalaccesstoservices.Equalaccesstoscience.Equalaccesstoresources.EndingHIV-relatedinequalities—reachingthosewhohavebeenleftbehindandaddressingtherootcausesofvulnerabilityandexclusion—willrequireadditionalresourcesandchangingthewaywedobusiness.OnlyifwesummonthewilltomobilizetheseresourceswillwebeabletoendAIDS.OurabilitytotackletheinequalitiesthatslowprogressisdiminishedbyadireshortageoffundingfortheAIDSresponse.In2021,fundingavailableforHIVprogrammesinlow-andmiddle-incomecountries(US$21billion)wasUS$8billionshortofamountsneededin2025.MobilizingtheresourcesweneedtocloseHIV-relatedinequalitygapsdemandsthatweconfrontmultiplechallenges.Low-andmiddle-incomecountriesnowpaythemajorityofthecostsoftheirAIDSresponses,althoughthedegreeofdomesticHIVinvestmentvariesconsiderablyamongcountries.Manylow-andmiddle-incomecountries,however,haveyettorecoverfromtheimpactoftheCOVID-19pandemiconnationaleconomiesandcommunityandhealthsystems.ThewarinUkrainehasalsoincreasedthecostoffuel,foodandothercommodities,andsomelong-standinginternationaldonorsarereallocatingdevelopmentfundstoaddresshumanitarianissues.Furthermore,adebtcrisisindevelopingcountriesisunderminingtheirabilitytoprotectthehealthandwell-beingoftheirpopulations:increasesindomestichealthinvestmentshavesharplyslowedinthepastdecadeasdebtburdenhasincreased(Figure0.1).FIGURE0.1Percentageincreaseindomesticpublicexpenditureonhealthinlow-andmiddle-incomecountriesbyfive-yearperiods,2000–2019ONHEALTH(%)PUBLICEXPENDITUREINCREASEINDOMESTIC

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49361392001–2005 2006–2010 2011–2015 2016–2019Source:UNAIDSfinancialestimates,2022;WHOHealthExpenditureDatabase.Note:Latestdataavailableisfor2019expenditures.9DANGEROUSINEQUALITIESWhiletheyaredaunting,thesechallengesdohavesolutions.InnovationsbycountriesandcommunitieshaveidentifiedprogrammaticandpolicystrategiesforclosingHIV-relatedinequalitygapsandaddressingtheneedsofthepopulationsbeingleftbehind.TheworldhassufficientresourcestofundtheAIDSresponse,astheamountsneededtofullyfundimplementationoftheGlobalAIDSStrategy2021–2026aremodestinthecontextoftheglobaleconomy.WealsoknowthatincreasesinbilateralfundingfromtheGovernmentoftheUnitedStatesofAmericaandmultilateralfundingfromtheGlobalFundtoFightAIDS,TuberculosisandMalaria(theGlobalFund)didnotexacerbatelow-andmiddle-incomecountries’dependenceonexternalsources:instead,theyweremetbyincreasesindomesticfinancialcontributionstoHIV.Moreover,thereareclearpathwaysforgeneratingtheneededresources,includingreallocatingresourcesfromdebtpaymentstohealth.TheingredientthatiscurrentlymissingisthepoliticalwilltomakethetoughchoicesrequiredtoinvestinpeopleandendAIDS.ByidentifyingopportunitiestoaddresstheinequalitiesthatareslowingprogressintheAIDSresponse,thisreportaimstohelpmovetheglobalresponsefromstagnationtoaction.Whetherweactnowtogettheresponsebackontrackorwatchthehumanandfinancialcostsriseunnecessarilyandcontinuefordecadestocomeisourchoice.WestillhavetheopportunitytoendAIDSby2030—butonlyifweseizeittoday.ChoosingtodosowillhelpnotonlythemillionsofpeoplewhoareatriskofacquiringHIV,butitwillalsohelpallofus:nooneissafeinapandemicuntilallhaveequitableaccesstopreventionandtreatmentservices.?UNAIDS10DANGEROUSINEQUALITIESReferencesKuchukhidzeS,PanagiotoglouD,BoilyMC,DiabatéS,EatonJW,MbofanaFetal.Theeffectofintimatepartnerviolenceonwomen’sriskofHIVacquisitionandengagementintheHIVtreatmentandcarecascade:anindividual-participantdatameta-analysisofnationallyrepresentativesurveysinsub-SaharanAfrica.Preprint.doi:/10.1101/2022.08.04.22278331.StannahJ,SoniN,LamJ,GiguèreK,LarmarangeJ,Maheu-GirouxMetal.TrendsinHIVtesting,thetreatmentcascade,andHIVincidenceamongmenwhohavesexwithmeninAfrica:asystematicreviewandmeta-regressionanalysis.Preprint(https://www./content/10.1101/202282329v1).11DANGEROUSINEQUALITIESGENDERINEQUALITIESHOLDBACKTHEENDOFAIDSGenderinequalitiesareakeydriveroftheAIDSepidemic.UnequalpowerdynamicsbetweenmenandwomenandharmfulgendernormsincreasetheHIVvulnerabilityofwomenandgirlsinalltheirdiversity,deprivethemoftheirvoiceandtheabilitytomakedecisionsregardingtheirownlives,reducetheirabilitytoaccessservicesthatmeettheirneeds,increasetheirrisksofexperiencingviolenceorotherharms,andhampertheirabilitytomitigatetheimpactofAIDS.Womenandgirlsaccountedfor49%ofnewHIVinfectionsworldwidein2021.Everytwominutes,anadolescentgirloryoungwoman(aged15to24years)acquiredHIVin2021.AIDS-relatedcausesremainthethird-leadingcauseofdeathgloballyforwomenaged15to49yearsandthefourth-leadingcauseofdeathamongyoungerwomen(aged15to29years).Theeffectsofgenderinequalitiesonwomen’sHIVvulnerabilityareespeciallypronouncedinsub-SaharanAfrica,wherewomenaccountedfor63%ofnewHIVinfectionsin2021,andthiswascompoundedbyasignificantlyslowerdeclineinnewinfectionsamongwomencomparedtomenandboys.Overall,AIDS-relatedcausesaretheleadingcauseofdeathamongwomeninAfricaandthesecond-leadingcauseofdeath(aftermaternalmortality)amongyoungerwomen(aged15to29)inAfrica.12AyounggirlattendingthelaunchoftheEducationPlusInitiativeintheGambia,7July2022. ?EDUCATIONPLUSINITIATIVEDANGEROUSINEQUALITIESPracticesthatreinforcepatriarchalsocietalnormscanalsodiscouragemenfromseekingtheservicesthattheyneed.Transgenderandgender-diversepeopleinmanycountriesalsoexperiencesignificantlevelsofstigmaanddiscriminationandviolence—andloweraccesstoHIVservices—thantherestofthepopulation(seesection‘Decriminalization,destigmatizationandinclusionofkeypopulations’)(1).TransformingharmfulgenderandmasculinitynormsamongmenandboyswillhelpreducetheirHIVrisks,butitwillalsoreducerisksandvulnerabilitiestoHIVamongwomenandadolescentgirls,includingbyrespectingtheirsexualandreproductivehealthandrightsandupholdingzerotoleranceforanyviolenceagainstthem.Anestimated250000[150000–360000]adolescentgirlsandyoungwomenacquiredHIVin2021–82%ofthemlivinginsub-SaharanAfrica.?UNAIDSFirstLadyoftheRepublicofTheGambia,H.EFatoumattaBahBarrowwithagroupofstudentsatthelaunchof#EducationPlusinTheGambia,July2022.14DANGEROUSINEQUALITIESTHEVULNERABILITYOFADOLESCENTGIRLSANDYOUNGWOMENOneofthemostseriousofallHIV-relatedinequalitiesisthedisproportionateeffectofHIVamongadolescentgirlsandyoungwomen(aged15to24years).Especiallyinsub-SaharanAfrica―hometo57%ofallpeoplewhoacquiredHIVin2021―transmissionamongadolescentgirlsandyoungwomenispreventingcountriesfrommakingswifterprogresstowardsendingAIDSasapublichealththreat.Anestimated250000[150000–360000]adolescentgirlsandyoungwomenacquiredHIVin2021―82%ofthemlivinginsub-SaharanAfrica.Thistranslatesinto4900newHIVinfectionsamongadolescentgirlsandyoungwomeneveryweek.TheworldisfarofftrackfromachievingthegoalofreducingthenumberofnewHIVinfectionsamongadolescentgirlsandyoungwomenbelow50000by2025.NewHIVinfectionsamongadolescentgirlsandyoungwomenaredecliningslowerthanamongmalesofthesameageinsub-SaharanAfricaAdolescentgirlsandyoungwomeninsub-SaharanAfricaarethreetimesmorelikelytoacquireHIVthantheirmalecounterparts.Moreover,insub-SaharanAfrica,newinfectionsamongadolescentgirlsandyoungwomendeclinedby42%between2010and2021,whileamongmalesofthesameage,thedeclineinnewinfectionswas56%.(Figure1.1).FIGURE1.1TrendsinnewHIVinfectionsamongyoungpeople(15–24years)bysex,easternandsouthernAfrica,2010-2021AMONGYOUNGPEOPLE(15–24YEARS)NUMBEROFNEWHIVINFECTIONS

00000000000000002010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021ADOLESCENTBOYSANDYOUNGMEN(15–24YEARS)ADOLESCENTGIRLSANDYOUNGWOMEN(15–24YEARS)Source:UNAIDSepidemiologicalestimates,2022(/)15DANGEROUSINEQUALITIESGlobally,adolescentgirlsandyoungwomenarenotablymorelikelytoacquire