This International Women’s Day, we must recognize the outsized impact that the dual COVID-19 and HIV/AIDS pandemics are having on women and girls, particularly in eastern and southern Africa. From school closures to reported increases in gender-based violence (GBV), COVID-19 affects nearly every aspect of life for adolescent girls and young women, and it is further compounded for those who are at risk for HIV.
Today, and every day, we honor the Women of Courage around the world whose determination and resilience inspire us all. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) chooses to challenge the circumstances girls and young women face in the context of HIV and COVID-19. PEPFAR is making every effort to provide critical, life-saving HIV prevention and treatment services while adhering to COVID-19 safety guidelines. The most pressing challenges compel innovation, and, through the DREAMS partnership, PEPFAR is adapting HIV prevention services to continue reaching girls and young women even as COVID-19 persists.
For adolescent girls and women who are living at home with an abuser, COVID-19 lockdowns have presented life-threatening challenges. In environments where girls and young women are already unlikely to seek post violence care, the fear of contracting COVID-19 can discourage visits to clinics. These movement restrictions can also make it even harder to access services. Additionally, efforts to gather international data on the impact of COVID-19 on GBV found significant increases in the number of women using abuse helplines.
DREAMS is focused on delivering violence prevention programming to girls and young women and providing post violence care. In accordance with current PEPFAR COVID-19 guidelines, girls and young women, their community leaders, and their parents/caregivers are learning about the underlying drivers and prevalence of GBV, and strategies to prevent it. DREAMS partners are using mobile technology and home visits to stay in touch with participants and provide referrals to post violence care when needed. Through DREAMS, PEPFAR chooses to challenge the silence around and pervasiveness of sexual violence.
As was evidenced by the increase in adolescent pregnancies during the 2014 Ebola outbreak in Sierra Leone, the DREAMS focus on facilitating access to condoms and other contraceptives for girls and young women in clinical and community settings is even more critical. Studies show that adolescent pregnancies can not only lead to dropping out of school and reducing economic opportunities; pregnancy and breastfeeding can increase the likelihood of HIV transmission. Through PEPFAR, DREAMS participants receive comprehensive HIV prevention education in school and/or in safe spaces to learn about how to use contraceptives effectively to prevent HIV, other sexually transmitted infections, and unintended pregnancies.
DREAMS also supports pre-exposure prophylaxis (PrEP) to girls and young women for HIV prevention. COVID-19 is accelerating creative solutions for PrEP, including multi-month dispensing and demand creation through social media. Through these methods, PEPFAR chooses to challenge the taboos and misinformation around adolescent sexuality to ensure that girls and young women have the information and resources needed to make informed decisions about their sexual and reproductive health.
COVID-19 has forced all countries implementing DREAMS to close schools at some point in the last year. We do not yet know what impact this will have on new HIV infections in girls and young women; however, we do know that each additional year a girl remains in school reduces her likelihood of HIV infection. This means that school closures may be harmful for girls and young women, particularly around learning deficits and the absence of the structure, support, and social protection that school provides. PEPFAR continues to confront the barriers that were already keeping girls out of school and joins with international partners to support girls in returning to school safely.
Although COVID-19 brought with it new challenges, DREAMS reached nearly 1.7 million girls and young women in 2020 with comprehensive HIV prevention services. This is a testament to the dedication and resilience of our staff, our partners, and – most importantly – the remarkable young women with whom we work. As we closely monitor community spread of COVID-19 and adhere to PEPFAR safety requirements, we will continue to challenge for change in order to best support HIV prevention services for women and girls in communities around the world.
About the Author: Dr. Angeli Achrekar is currently serving as the Acting U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy at the U.S. Department of State.