Evidence-Based Approaches to Protecting Adolescent Girls at Risk of HIV

Abstract

Despite decades of investment in HIV prevention, a large and vulnerable population—that of adolescent girls—remains invisible, underserved, and at disproportionate risk of HIV. When the HIV epidemic was first recognized in the early 1980s, prevention messages reflected the context of the same-sex male relations in which the epidemic was first identified. As it became clear that the epidemic also included a large heterosexual component, messages expanded to promote negotiation and responsibility within presumptively voluntary partnerships. However, recommended protection measures assumed relative equality between girls and women and their sexual partners: presuming, for example, that girls and women possessed the ability to avoid pregnancy or choose abstinence, the agency to select a safe partner, and the power to use condoms consistently. In fact, these protection strategies were not feasible and some, such as avoiding pregnancy in child marriage, were virtually unachievable for the vast majority of sexually active adolescent girls. Given the changing shape of the epidemic and the leveling off or shrinking of resources, there is an urgent