Bernadette Hensen

The session opened with an address from Princess Mabel and a personal account from activist Kanengo Bibusa Zoe Nakamba what (dis)-empowers girls. Speakers presented on social and structural drivers of HIV risk among AGYW and on interventions and programmes to address these factors.

Princess Mabel van Oranje opened the session with an address highlighting the need for more research on the link between child marriage and HIV, and for integrated services, stating that women “…are holistic beings…services should be holistic”. Activist Kanengo Bibusa Zoe Nakamba talked about what (dis)-empowers girls, and stressed that for AGYW to access SRH services they need to be “health-friendly not sex-friendly”. The speakers highlighted the social and structural drivers of HIV risk, and spoke to how these influence multiple health outcomes and undermine retention in the treatment continuum and progress along the prevention cascade. Examples of successful interventions and programmes to address social and structural drivers of risk were presented, including the SASA! intervention, cash transfers and programming to change gender norms. Implementation science research in DREAMS has shown that AGYW who experienced sexual violence “were 2x as likely to report an STI symptom, and anxiety and depression”.

A key message of the session is the need for integrated, multi-sectoral responses that recognise that AGYW are not a homogenous group but dynamic individuals whose lives are influenced by multiple actors and levels. Biomedical interventions alone will not end the HIV epidemic, combination HIV prevention is needed. How highly contextual social and structural factors affect key steps in the prevention cascade, including stigma among healthcare workers, agency and gender norms, need to be considered if we are to reach AGYW with biomedical interventions. To quote Princess Mabel: “we should get much smarter” about integration.