AROUND PSI
making it difficult to negotiate condom use. As noted, AGYW are experiencing startling levels of sexual violence. Frequently, AGYW’s relationship with sex becomes intertwined with violence and/or financial need. To address these issues, we are implementing comprehensive curricula that teach girls about their bodies, build decision making and assertiveness skills to delay sexual debut, and provide information on methods of protection from HIV and early pregnancy. We are complementing this information with access to clinical services, such as contraceptives, HIV testing, and pre-exposure prophylaxis (PrEP). We are also offering socioeconomic strengthening programs, such as savings groups, to increase AGYW’s economic independence. Finally, we are helping communities and families to surround these youth with support and education.
KH: Can we use new technologies or more flexible approaches—like HIV selftesting—to leapfrog over problems in health systems? DB: PEPFAR is always looking for new technologies and approaches that are data-
driven and can be taken to scale. This year, our policy guidance emphasized the scale up of HIV self-testing (HIVST), PrEP, and a transition to dolutegravir-based treatment regimens. We are scaling up HIVST to reach young people who are healthy and would not typically seek care at health facilities. When appropriate, we are also offering HIVST kits to people living with HIV that they can offer, in turn to their partners who cannot make it to a facility setting. We are also working with private sector colleagues to explore new approaches to find and reach missing populations with healthcare services. Health systems also need innovations in the supply chain and we are exploring the use of digital health technology to address challenges and improve understanding of how HIV commodities are used.
KH: You’ve been especially outspoken about how sexual violence creates risk for AGYW. What are you hearing from AGYW about the role of sexual violence in their lives, and what can we do to address this pervasive problem?
ABOVE Ambassador Birx with DREAMS Ambassador from South Africa Nontokozo at World AIDS Day 2017. (Photo credit: Neshan H. Naltchayan/BCIU)
DB: Sexual violence is pervasive with as many as one third of AGYW reporting forced or coerced sex as their first sexual experience. These unacceptable levels of violence are also apparent in the stories we hear as we visit
DREAMS HAS REACHED MORE THAN 2.5 MILLION ADOLESCENT GIRLS AND YOUNG WOMEN WITH SERVICES AND SUPPORT
(Photo credit: DREAMS) 11