Information by Topic and Country

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.

This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.

Click here to link to the full report.

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Click here to link to the article.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

IIn this episode of AIDS 2021, we discuss pre-exposure prophylaxis — PrEP — a critical HIV prevention tool for adolescent girls and young women (AGYW) in countries with high HIV burdens. Janet Fleischman speaks with Mitchell Warren, the executive director of AVAC, and two women working with Wits Reproductive Health and HIV Institute in South Africa – Khanyi Kwatsha, a 26-year-old PrEP ambassador, and Elmari Briedenhann, a senior project manager. They discuss the importance of PrEP for AGYW and highlight innovative approaches to better reach this group and to address the inherent challenges of meeting the needs of this population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with Dr. Linda-Gail Bekker, the deputy director of the Desmond Tutu HIV Center at the University of Cape Town, CEO of the Desmond Tutu HIV Foundation, and former president of the International AIDS Society. They discuss the effects of the Covid-19 pandemic on the lives of adolescent girls and young women and the potential impact on the momentum of HIV prevention programs designed for this vulnerable population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

Covid-19 is taking a heavy toll on adolescent girls and young women in sub-Saharan Africa, exacerbating their risks of HIV, gender-based violence, and unintended pregnancy. To understand these intersecting crises, we spoke to women working with and benefiting from the U.S.-led DREAMS initiative in Lusaka, Zambia: Batuke Walusiku-Mwewa is the Zambia

Country Director for Catholic Medical Mission Board (CMMB); Grace Njobvu and Grace Nachila are DREAMS participants. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) is a public-private partnership that aims to reduce new HIV infections among adolescent girls and young women in 15 countries through a multisectoral package of services.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

This episode of the Global Health Policy Center's Take as Directed podcast examines the changing nature of war and conflict and why gender-based violence (GBV) has become a central feature in crises around the world. GHPC Senior Associate Janet Fleischman sits down with Melissa Dalton, senior fellow and deputy director of the CSIS International Security Program and Director of the Cooperative Defense Project (CDP); and Fatima Imam, executive director of Rehabilitation, Empowerment, and Better Health Initiative and Network of Civil Society Organizations in Nigeria.

Janet and the guests discuss how GBV impacts women and girls in crises, focused especially on the Middle East and northern Nigeria, and how these ubiquitous and traumatizing realities undermine global health security and community resilience. This conversation is linked to a new CSIS report, How Can We Better Reach Women and Girls in Crises? and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

Click here to link to the podcast.

In this episode of Take as Directed, host Janet Fleischman sits down with Geeta Rao Gupta, executive director of the 3D Program for Girls and Women, former president of the International Center for Research on Women (ICRW), and former Deputy Executive Director of UNICEF. They discuss the new series of The Lancet, of which Geeta was a principal author, that outlines the impact of gender norms and inequalities on health, describes persistent barriers to progress, and provides an agenda for action. They also discuss the recent Women Deliver conference in Vancouver and how to maintain optimism for the future.

Click here to listen to the podcast.

February 6th marks the International Day of Zero Tolerance of Female Genital Mutilation (FGM), a United Nations-sponsored awareness day meant to highlight efforts to eradicate FGM. An estimated 200 million women and girls today have undergone some form of FGM, a practice that can cause irreversible physical and mental health challenges. In this episode of Take as Directed, CSIS Global Health Policy Center Senior Associate Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator, activist, and founder of “Kakenya’s Dream”, a leading nongovernmental organization for girls’ education, health, and empowerment, which also works to end FGM and child marriage. Dr. Ntaiya discusses the personal journey that led her to form “Kakenya’s Dream”, and how her work is helping to develop the next generation of women leaders in her community.

Click here to listen to the podcast.

Violence against children (VAC) and violence against women (VAW) are public health and human rights crises of global proportions, with damaging consequences to the health and well-being of individuals and their communities. Fueled by gender inequality, social norms condoning violence and harmful traditional practices,1 and exacerbated by lack of commitment to take preventive and protective action and weak protection systems, violence against women and children (VAWC) as well as the magnitude, human toll and societal cost of this violence is increasingly acknowledged by the global community.

Together for Girls (TfG) is a partnership among national governments, UN entities and private sector organizations working at the intersection of VAW and VAC, with special attention to ending sexual violence against girls. Now being implemented in more than 22 countries, the TfG model supports governments to conduct a national household Violence Against Children Survey (VACS) and to use the data to mobilize action through policies and programs that embed violence prevention and response across multiple sectors.

In 2009, the Government of Tanzania, with support from TfG partners, most notably UNICEF, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), undertook the VACS. Tanzania was the first country to implement a full VACS, surveying both girls and boys (ages 13-24) nationally to assess the prevalence of emotional, physical and sexual violence. It was also the first country to introduce a government-led, multi-sector task force to oversee the implementation of the survey and the ensuing violence prevention and response work catalyzed by the data, which led to the establishment of a multi-sectoral, costed National Plan of Action. Ten years after Tanzania’s landmark research, this case study seeks to consolidate learnings from the national experience of implementing the TfG model.

Janet joins host Beverly Kirk or a conversation about Janet's latest report, which examines why women and girls’ health and protection should be a top priority in emergency and humanitarian crisis situations. It also looks at U.S. policy on global health security. This conversation is linked to the report and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

The Smart Women, Smart Power (SWSP) Initiative convenes top-level women leaders in foreign policy, national security, international business, and international development to amplify their voices, spotlight their expertise, and discuss critical and timely issues. The Smart Women, Smart Power biweekly podcast features powerful, in-depth conversations with women leaders from around the globe who are experts in foreign policy, national security, international business, and international development. SWSP Director Beverly Kirk moderates the podcast series.

Click here to listen to the podcast.

Professor Quarraisha Abdool Karim is one of the world’s leading AIDS researchers and has made pioneering contributions to understanding the HIV epidemic in young people, especially among young women. She joined us for a two-part series to explain her latest research into epidemic hot spots in KwaZulu-Natal in South Africa, focusing on both the structural and biological risk factors that facilitate the spread of HIV in young women. In Part 1, she discusses the social and economic factors that contribute to the dramatic differences in HIV rates in women and men at different ages.In Part 2, she describes her recent findings about biological factors that can simultaneously increase a woman’s risk of HIV acquisition and decrease the efficacy of HIV prevention tools.

Click here to link to Part 1 and here to link to Part 2.

In many ways, Malawi exemplifies the success of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Over the last 14 years, new HIV infections have declined by 34 percent. Despite being among the poorest countries in the world, Malawi is approaching its HIV treatment targets. The possibility of controlling the epidemic is within reach.

But Malawi also lays bare major challenges and gaps facing the HIV response, notably how to prevent HIV and address HIV risk for adolescent girls and young women (AGYW) in low-resource settings.

Malawi is 1 of 10 focus countries in east and southern Africa under DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), a public-private partnership led by the President’s Emergency Plan for AIDS Relief (PEPFAR) that aims to reduce the number of new HIV infections among 15- to 24-year-old women by 40 percent in geographic “hot spots.” As a prevention program, it is attempting to reach young women and their male partners, populations that have proven very difficult to reach thus far.

This is a moment of heightened focus on the urgency of addressing HIV in adolescent girls and young women by the United States, other international partners, and the government of Malawi. To learn more about the status of DREAMS implementation and lessons for other country programs, CSIS conducted a research trip to Malawi in April 2017.

Amb. Virginia Palmer, U.S. Ambassador to Malawi, is a powerful champion for addressing the needs of adolescent girls and young women as the fulcrum for all development goals. We asked her to reflect on efforts in Malawi to control the AIDS epidemic through DREAMS, a public-private partnership designed to prevent new infections in this population. She emphasized the importance of empowering them with education, health and community interventions. Such an approach is necessary to curb the HIV crisis in Malawi, which in turn impacts all other U.S. development programs, and ultimately global health security.

Click here to link to the podcast on SoundCloud.

U.S. leadership through the President’s Emergency Plan for AIDS1 Relief (PEPFAR) has driven remarkable progress in curbing the global AIDS epidemic, raising the possibility of epidemic control in 10 African countries by 2020. But this success masks areas of urgent unfinished business that could derail this momentum, notably preventing HIV infections in adolescent girls and young women ages 15-24 in East and Southern Africa. Addressing the acute risks that these young women face presents unique challenges, especially in the current U.S. budgetary environment, but continued progress against HIV requires that this be a consistent and sustained U.S. priority. The benefits are clear and compelling: empowering these young women and providing access to services to protect themselves from HIV enables them to be healthy and to thrive, which contributes to healthier, more stable and prosperous families, communities, and societies.

Adolescent girls and young women face significantly higher HIV risk than males their age. That, combined with a youth population that has doubled since the start of the epidemic, leads to an inescapable conclusion: if new HIV infections among girls and young women are not greatly reduced, PEPFAR’s enormous investments to achieve an AIDS-free generation are at risk, as is the global response. Focusing on adolescent girls and young women, while also systematically engaging their male partners, provides a critical opportunity to interrupt the cycle of HIV transmission.

In response to these stark realities, in late 2014 PEPFAR launched DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe), a public-private partnership to reduce HIV in adolescent girls and young women in 10 countries. DREAMS holds notable promise in confronting this critical next frontier in fighting HIV, but faces challenges in demonstrating short-term impact on social and economic realities that directly or indirectly contribute to HIV risk for these young women.

The CSIS Global Health Policy Center produced this video during a visit to Zambia in April 2016. It profiles four young Zambian women who describe the stark realities for adolescent girls and young women that fuel the AIDS epidemic – sexual violence, barriers to education and family planning, and gender inequality. Through their stories and insights, the video illustrates that in order to address the AIDS crisis in Southern Africa, we must understand the risks that young women face and work to engage and empower them.

Click here to watch the video. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Zambia is a lower-middle-income country struggling with critical health challenges, including high rates of maternal and neonatal mortality, malnutrition, cervical cancer, and a severe HIV/AIDS epidemic that disproportionately affects adolescent girls and young women. The United States is the largest donor to the health sector in Zambia, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Over the past five years, the U.S. has also helped establish several public-private partnerships (PPPs) aimed at advancing the health of women and families. These PPPs provide lessons about the potential impact of these approaches, the challenges inherent in such partnerships, and the importance of PEPFAR support. With future U.S. global health funding likely to be flat-lined, this is an important moment to assess how partnerships with the private sector can amplify the impact of U.S. investments in women’s and family health.

A delegation from the CSIS Task Force on Women’s and Family Health visited Zambia in April 2016 to examine U.S. investments through three partnerships: Saving Mothers Giving Life (SMGL), Pink Ribbon Red Ribbon (PRRR), and DREAMS. The delegation sought to understand these partnerships in Zambia within the context of U.S. support for women’s and family health, which represent the core of functional health systems.

Click here to read the report. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

The data are stark and incontrovertible: In eastern and southern Africa, 7,000 girls and young women aged 15–24 are infected with HIV every week. A global convergence is finally emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for this population. Unprecedented high-level attention is highlighting this crisis – in July 2015 in Addis Ababa, President Obama emphasized the need “to keep teenage girls safe and AIDS free,” and in September the U.S. announced significant additional resources for this effort. Yet addressing HIV risk in adolescent girls and young women remains a fundamental challenge for controlling the AIDS epidemic.

On World AIDS Day 2014, a new initiative was launched by the President’s Emergency Plan for AIDS Relief (PEPFAR), in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation (now spun off to Girl Effect). With an accumulated $500 million in resources and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries in southern and eastern Africa.

Topics: Adolescent girls and young women, DREAMS, HIV/AIDS

“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”

At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector.  These different funders can leverage each other’s investments.

Click here to read the full blog post.

The data are stark and incontrovertible: In eastern and southern Africa, girls account for 80 percent of all new HIV infections among adolescents, and HIV/AIDS is the leading cause of death for girls aged 15-19. With 7,000 girls and young women aged 15-24 infected every week, the goal of an AIDS-free generation cannot be achieved without a dramatic new approach to this population. After years of neglect, a global convergence is emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for adolescent girls and young women. Whether this new attention can catalyze reductions in new HIV infections represents a fundamental challenge for controlling the AIDS epidemic.

In a major shift, the President's Emergency Plan for AIDS Relief (PEPFAR) launched a new initiative on World AIDS Day in December 2014, in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden "hot spots" in 10 countries in eastern and southern Africa by identifying where these young women are being infected, what is putting them at risk, and how to target programs accordingly. The partnership's goal is to reduce incidence in high-burden areas by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

DREAMS and other international partnerships focused on HIV in adolescent girls and young women represent an ambitious effort to go beyond biomedical interventions to address the social and economic factors that put this population at risk of infection. It remains to be seen, however, if these initiatives can demonstrate impact in a short timeframe, and build toward sustainable programs. This is a critical moment to transform a growing global interest in women and girls in a range of sectors into effective HIV programing, and to highlight the results at the July 2016 International AIDS Conference in Durban, South Africa.

Download the report here.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

Celina Schocken is CEO of Pink Ribbon Red Ribbon, an independent affiliate of the George W. Bush Institute that focuses on cervical and breast cancer prevention and treatment. We asked her to speak about the organization’s work, including why cervical cancer screening should be part of HIV and reproductive health, new innovative technologies, and an April delegation led by President George W. Bush and Mrs. Laura Bush to Botswana and Namibia.

Click here to link to the podcast on SoundCloud.

Zambia is a lower-middle-income country struggling with critical health challenges, including high rates of maternal and neonatal mortality, malnutrition, cervical cancer, and a severe HIV/AIDS epidemic that disproportionately affects adolescent girls and young women. The United States is the largest donor to the health sector in Zambia, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Over the past five years, the U.S. has also helped establish several public-private partnerships (PPPs) aimed at advancing the health of women and families. These PPPs provide lessons about the potential impact of these approaches, the challenges inherent in such partnerships, and the importance of PEPFAR support. With future U.S. global health funding likely to be flat-lined, this is an important moment to assess how partnerships with the private sector can amplify the impact of U.S. investments in women’s and family health.

A delegation from the CSIS Task Force on Women’s and Family Health visited Zambia in April 2016 to examine U.S. investments through three partnerships: Saving Mothers Giving Life (SMGL), Pink Ribbon Red Ribbon (PRRR), and DREAMS. The delegation sought to understand these partnerships in Zambia within the context of U.S. support for women’s and family health, which represent the core of functional health systems.

Click here to read the report. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Cervical cancer kills an estimated 275,000 women every year, 85 percent of whom are in developing countries. The link between HIV and cervical cancer is direct and deadly; HIV-infected women who are also infected with

specific types of human papilloma virus (HPV) are 4-5 times more susceptible to cervical cancer than HIV-negative women. This has important implications for HIV programs, especially in countries with significant HIV epidemics.

Cervical cancer kills an estimated 275,000 women every year, 85 percent of whom are in developing countries. The link between HIV and cervical cancer is direct and deadly; HIV-infected women who are also infected with specific types of human papilloma virus (HPV) are 4-5 times more susceptible to cervical cancer than HIV-negative women. This has

important implications for HIV programs, especially in countries with significant HIV epidemics. To understand the opportunities and challenges of integrating cervical cancer screening and treatment into HIV services for women, the Center for Strategic and International Studies traveled to Zambia, which has been at the forefront of integrating these services.

Global climate progress sits at the center of an acute crisis, as the multilateral order that structured international climate cooperation for three decades frays at the seams.

The Trump administration's withdrawal from 66 United Nations and international organizations in early 2026, compounded by its exit from the Paris Agreement and the UN Framework Convention on Climate Change itself, has launched a rupture in the governance architecture and the geopolitical consensus that made multilateral climate action conceivable.

Institutions have been stripped of authority, voluntary commitments left contingent on political will.

At this precarious moment, what can and should climate funders be doing?

We recently examined the state of environmental multilateralism through an extensive literature review and interviews with climate leaders from around the world - policymakers, UN officials, regional actors, philanthropic leaders and advocates.

Their perspectives reinforced a sobering finding: more consequential than any single country's efforts to undermine the multilateral system is the deeper question of whether that system is still fit for purpose.

Climate philanthropy must do more than fill gaps left by retreating governments; it must ask harder questions about whether gap-filling is the right role at all - and prepare to catalyse the emergence of something new.

This is a pivotal moment for the U.S. Agency for International Development’s vision of global health and development, with the USAID Administrator, Samantha Power, championing locally led and inclusive development, referred to as localization. This approach focuses on making U.S. foreign assistance more accessible, equitable, and responsive by shifting leadership, decision making, and funding to local actors—government, civil society, and the private sector. While previous U.S. administrations promoted greater country ownership, the current discussion has taken on far greater urgency; it is happening amidst a global reckoning around structural racism and social determinants of health, decolonization of global aid, and the power imbalances inherent in donor-driven development. These debates have been accentuated by the COVID-19 pandemic, which has exacerbated inequities while shifting more responsibilities to local actors. Despite challenges ahead in operationalizing localization in compliance with USAID requirements, this vision holds the promise of advancing partner countries’ needs and priorities and transforming the global health landscape through a more inclusive, equitable, collaborative, and sustainable approach.

Most discussion around localization has centered on transitioning health service delivery and procurement to local partners, which is generally standardized and thus easier to measure than localization in the area of health policy. A gap exists in translating the localization agenda to the policy, advocacy, financing, and governance (PAFG) sphere of USAID’s global health programs. This foundational dimension cannot be overlooked: to strengthen health systems, to address health challenges at scale, and to sustain an equitable and inclusive response depends on a strong enabling environment, which reflects the interrelated social, economic, policy, and governance factors that influence the health system. PAFG activities aim to improve the enabling environment for health by strengthening the capacity of governmental bodies (parliaments, ministries, and regulatory agencies), as well as civil society advocacy organizations and the private sector in their stewardship of the health sector (Hardee et al., 2012). Taken together, these components form the foundation for health policy development, advocacy, decision making, civil society engagement, and domestic financing. Indeed, progress in localization will be demonstrated by the extent to which PAFG capacities, skills, and decision making are strengthened and transitioned to local actors. Strong and effective leadership by local actors in health is essential for USAID’s partner countries and local communities to steer toward a healthier future.

As USAID and its partners move forward in implementing localization, the Health Policy Plus (HP+) project seeks to support these efforts by building on its extensive global experience. Specifically, HP+ has partnered with local actors to plan, fund, and implement policy, advocacy, financing, and governance solutions to health challenges aimed at improving health outcomes. These programs have shown the importance of elevating local voices for policy and advocacy, including for marginalized groups and those focused on improving gender equity. HP+ has also shown the value of embedding aspects of localization into the development and implementation of government policies. Informed by HP+ lessons learned at the country level, this brief provides a set of recommendations and illustrative program examples for USAID, its implementing partners, and the global health community to collaborate, implement, and innovate in new ways with local partners to advance localization in the PAFG realm.

By promoting a vision for the way forward, HP+ seeks to further catalyze localization in PAFG and support local partners to achieve sustainable success, aligned with USAID’s commitments and goals. Ambassador Donald Steinberg, expert advisor on localization to Administrator Power, reiterated a guiding principle, often used by HIV advocates, for shifting responsibility to local actors: “Nothing about us without us.”

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

IIn this episode of AIDS 2021, we discuss pre-exposure prophylaxis — PrEP — a critical HIV prevention tool for adolescent girls and young women (AGYW) in countries with high HIV burdens. Janet Fleischman speaks with Mitchell Warren, the executive director of AVAC, and two women working with Wits Reproductive Health and HIV Institute in South Africa – Khanyi Kwatsha, a 26-year-old PrEP ambassador, and Elmari Briedenhann, a senior project manager. They discuss the importance of PrEP for AGYW and highlight innovative approaches to better reach this group and to address the inherent challenges of meeting the needs of this population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with Dr. Linda-Gail Bekker, the deputy director of the Desmond Tutu HIV Center at the University of Cape Town, CEO of the Desmond Tutu HIV Foundation, and former president of the International AIDS Society. They discuss the effects of the Covid-19 pandemic on the lives of adolescent girls and young women and the potential impact on the momentum of HIV prevention programs designed for this vulnerable population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

Covid-19 is taking a heavy toll on adolescent girls and young women in sub-Saharan Africa, exacerbating their risks of HIV, gender-based violence, and unintended pregnancy. To understand these intersecting crises, we spoke to women working with and benefiting from the U.S.-led DREAMS initiative in Lusaka, Zambia: Batuke Walusiku-Mwewa is the Zambia

Country Director for Catholic Medical Mission Board (CMMB); Grace Njobvu and Grace Nachila are DREAMS participants. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) is a public-private partnership that aims to reduce new HIV infections among adolescent girls and young women in 15 countries through a multisectoral package of services.

South Africa, which has the largest HIV epidemic in the world and one of the highest rates of gender-based violence, is now experiencing a worsening COVID-19 epidemic. Professor Quarraisha Abdool Karim, Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and a leading global expert on HIV/AIDS, spoke to CSIS about the particularly negative impact of Covid-19 on adolescent girls and young women, and how it is fueling a parallel epidemic of gender-based violence. At a time when even the President of South Africa has condemned the violence against women during the COVID-19 crisis, Professor Abdool Karim calls for a proactive response to these twin crises.

Click here to link to see the video.

The population of Africa is expected to double over the next 20 years, which means that many countries are facing either a demographic dividend or potentially a disaster, with critical implications for global health and development. In this episode of Take as Directed, Janet Fleischman sits down with Amb. Mark Dybul, Director of the Center for Global Health and Quality, and Professor in the Department of Medicine at Georgetown University Medical Center, and formerly head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. They discuss why these demographic trends matter and how U.S. programs can better engage young people, especially adolescent girls and young women, to address their needs and support local innovation.

Click here to link to the podcast on SoundCloud.

Many of the fastest growing populations are in the world’s poorest countries, putting them at a critical threshold: either they will accelerate economic growth and innovation by investing in their burgeoning youth population or the rapid population growth coupled with a shortage of opportunities for young people will undermine advances in health, development, and ultimately security. These demographic trends, most notable in sub-Saharan Africa, are often referred to as a “youth boom” or a “youth bulge.” Given the enormous implications of these demographic shifts, U.S. assistance should promote young people’s health and development, with particular emphasis on empowering young women. Investments in human capital and gender equality would yield enormous benefits in improving health, reducing poverty, and increasing economic and political stability. Given that these goals align so strongly with U.S. national interests, they benefit from strong bipartisan support.

This agenda constitutes an urgent priority. The magnitude of this demographic transition is evident in sub-Saharan Africa; sixty percent of the population is under the age of 25 and is projected to dramatically increase in the coming years due to decreased under-five child mortality and to continued high fertility, which is often driven by early and closely spaced childbearing. In many of these countries, notably in the Sahel region of West Africa, the population may double as soon as 2030—the year the world community pledged to achieve the Sustainable Development Goals—and possibly quadruple by the end of the century. Overall, the population in sub-Saharan Africa could increase from 1 billion to 4 billion before the end of the century.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

Covid-19 is taking a heavy toll on adolescent girls and young women in sub-Saharan Africa, exacerbating their risks of HIV, gender-based violence, and unintended pregnancy. To understand these intersecting crises, we spoke to women working with and benefiting from the U.S.-led DREAMS initiative in Lusaka, Zambia: Batuke Walusiku-Mwewa is the Zambia

Country Director for Catholic Medical Mission Board (CMMB); Grace Njobvu and Grace Nachila are DREAMS participants. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) is a public-private partnership that aims to reduce new HIV infections among adolescent girls and young women in 15 countries through a multisectoral package of services.

In many ways, Malawi exemplifies the success of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Over the last 14 years, new HIV infections have declined by 34 percent. Despite being among the poorest countries in the world, Malawi is approaching its HIV treatment targets. The possibility of controlling the epidemic is within reach.

But Malawi also lays bare major challenges and gaps facing the HIV response, notably how to prevent HIV and address HIV risk for adolescent girls and young women (AGYW) in low-resource settings.

Malawi is 1 of 10 focus countries in east and southern Africa under DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), a public-private partnership led by the President’s Emergency Plan for AIDS Relief (PEPFAR) that aims to reduce the number of new HIV infections among 15- to 24-year-old women by 40 percent in geographic “hot spots.” As a prevention program, it is attempting to reach young women and their male partners, populations that have proven very difficult to reach thus far.

This is a moment of heightened focus on the urgency of addressing HIV in adolescent girls and young women by the United States, other international partners, and the government of Malawi. To learn more about the status of DREAMS implementation and lessons for other country programs, CSIS conducted a research trip to Malawi in April 2017.

Amb. Virginia Palmer, U.S. Ambassador to Malawi, is a powerful champion for addressing the needs of adolescent girls and young women as the fulcrum for all development goals. We asked her to reflect on efforts in Malawi to control the AIDS epidemic through DREAMS, a public-private partnership designed to prevent new infections in this population. She emphasized the importance of empowering them with education, health and community interventions. Such an approach is necessary to curb the HIV crisis in Malawi, which in turn impacts all other U.S. development programs, and ultimately global health security.

Click here to link to the podcast on SoundCloud.

U.S. leadership through the President’s Emergency Plan for AIDS1 Relief (PEPFAR) has driven remarkable progress in curbing the global AIDS epidemic, raising the possibility of epidemic control in 10 African countries by 2020. But this success masks areas of urgent unfinished business that could derail this momentum, notably preventing HIV infections in adolescent girls and young women ages 15-24 in East and Southern Africa. Addressing the acute risks that these young women face presents unique challenges, especially in the current U.S. budgetary environment, but continued progress against HIV requires that this be a consistent and sustained U.S. priority. The benefits are clear and compelling: empowering these young women and providing access to services to protect themselves from HIV enables them to be healthy and to thrive, which contributes to healthier, more stable and prosperous families, communities, and societies.

Adolescent girls and young women face significantly higher HIV risk than males their age. That, combined with a youth population that has doubled since the start of the epidemic, leads to an inescapable conclusion: if new HIV infections among girls and young women are not greatly reduced, PEPFAR’s enormous investments to achieve an AIDS-free generation are at risk, as is the global response. Focusing on adolescent girls and young women, while also systematically engaging their male partners, provides a critical opportunity to interrupt the cycle of HIV transmission.

In response to these stark realities, in late 2014 PEPFAR launched DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe), a public-private partnership to reduce HIV in adolescent girls and young women in 10 countries. DREAMS holds notable promise in confronting this critical next frontier in fighting HIV, but faces challenges in demonstrating short-term impact on social and economic realities that directly or indirectly contribute to HIV risk for these young women.

Zambia is a lower-middle-income country struggling with critical health challenges, including high rates of maternal and neonatal mortality, malnutrition, cervical cancer, and a severe HIV/AIDS epidemic that disproportionately affects adolescent girls and young women. The United States is the largest donor to the health sector in Zambia, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Over the past five years, the U.S. has also helped establish several public-private partnerships (PPPs) aimed at advancing the health of women and families. These PPPs provide lessons about the potential impact of these approaches, the challenges inherent in such partnerships, and the importance of PEPFAR support. With future U.S. global health funding likely to be flat-lined, this is an important moment to assess how partnerships with the private sector can amplify the impact of U.S. investments in women’s and family health.

A delegation from the CSIS Task Force on Women’s and Family Health visited Zambia in April 2016 to examine U.S. investments through three partnerships: Saving Mothers Giving Life (SMGL), Pink Ribbon Red Ribbon (PRRR), and DREAMS. The delegation sought to understand these partnerships in Zambia within the context of U.S. support for women’s and family health, which represent the core of functional health systems.

Click here to read the report. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

The data are stark and incontrovertible: In eastern and southern Africa, 7,000 girls and young women aged 15–24 are infected with HIV every week. A global convergence is finally emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for this population. Unprecedented high-level attention is highlighting this crisis – in July 2015 in Addis Ababa, President Obama emphasized the need “to keep teenage girls safe and AIDS free,” and in September the U.S. announced significant additional resources for this effort. Yet addressing HIV risk in adolescent girls and young women remains a fundamental challenge for controlling the AIDS epidemic.

On World AIDS Day 2014, a new initiative was launched by the President’s Emergency Plan for AIDS Relief (PEPFAR), in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation (now spun off to Girl Effect). With an accumulated $500 million in resources and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries in southern and eastern Africa.

Topics: Adolescent girls and young women, DREAMS, HIV/AIDS

“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”

At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector.  These different funders can leverage each other’s investments.

Click here to read the full blog post.

The data are stark and incontrovertible: In eastern and southern Africa, girls account for 80 percent of all new HIV infections among adolescents, and HIV/AIDS is the leading cause of death for girls aged 15-19. With 7,000 girls and young women aged 15-24 infected every week, the goal of an AIDS-free generation cannot be achieved without a dramatic new approach to this population. After years of neglect, a global convergence is emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for adolescent girls and young women. Whether this new attention can catalyze reductions in new HIV infections represents a fundamental challenge for controlling the AIDS epidemic.

In a major shift, the President's Emergency Plan for AIDS Relief (PEPFAR) launched a new initiative on World AIDS Day in December 2014, in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden "hot spots" in 10 countries in eastern and southern Africa by identifying where these young women are being infected, what is putting them at risk, and how to target programs accordingly. The partnership's goal is to reduce incidence in high-burden areas by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

DREAMS and other international partnerships focused on HIV in adolescent girls and young women represent an ambitious effort to go beyond biomedical interventions to address the social and economic factors that put this population at risk of infection. It remains to be seen, however, if these initiatives can demonstrate impact in a short timeframe, and build toward sustainable programs. This is a critical moment to transform a growing global interest in women and girls in a range of sectors into effective HIV programing, and to highlight the results at the July 2016 International AIDS Conference in Durban, South Africa.

Download the report here.

Many of us remember the HIV/AIDS prevention mantra “ABC” – Abstinence, Be faithful, use Condoms – but I recently heard a new “ABC” message emanating from the Ebola crisis: Avoid Body Contact, a chilling message for the epidemic ravaging West Africa.

While prevention messages are critical, a lesson from the struggle against HIV/AIDS is that women’s and girls’ risk of infection is compounded by gender disparities and inequalities, and many U.S. programs lost precious time before realizing that A, B, and C were often not within a woman’s or girl’s power to control. Similar concerns might apply to the Ebola crisis. As the United States mounts its emergency assistance to combat Ebola, these lessons should be applied from the start; targeted strategies to address the realities and vulnerabilities that women and girls face are key to an effective and sustainable response.

To read the full blog post, click here.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

For decades, the United States has been the global leader in supporting voluntary family planning services around the world. The benefits of family planning are numerous, not only for women's health, but also for increasing child survival, nutrition, education, and economic development, as well as preventing mother-to-child transmission of HIV.

This chapter, published in The Mother & Child Project, was adapted from Family Planning and Linkages with U.S. Health and Development Goals, written by Janet and Alisha Kramer.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

You can order the book from Amazon.com here. Or, download the paper from which the chapter was adapted here.

The international outrage over Boko Haram’s abduction of Nigerian schoolgirls has escalated since the story first hit the news; mothers in Nigeria took action and celebrities from Angelina Jolie all the way to First Lady Michelle Obama have made their voices heard.

With mainstream attention finally focused on why the education, health, and empowerment of women and girls matters to Americans, it is time for the Obama administration to re-enforce its commitment to these issues and elevate them as central to U.S. foreign policy.

“Investing in family planning is investing in the future.” These words from Ethiopian health official, Dr. Tewodros Bekele, summarize key findings of a new CSIS video and report about family planning in Ethiopia.

The CSIS video is designed to bring the voices of Ethiopian women and girls as well as champions of family planning into the U.S. policy discussion. Through the voices of rural women, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia’s development.

Topics: Economic development, Ethiopia, family planning, reproductive health, U.S. policy

In 2014, the CSIS Global Health Policy Center led a delegation to Ethiopia to examine the progress made and remaining challenges for expanding access to and demand for family planning services. Congressional staff from the offices of Senator Mark Kirk (R-IL), Representative Charlie Dent (R-PA), and Representative Karen Bass (D-CA) participated. Jennifer Dyer, executive director of Hope Through Healing Hands, and Tom Walsh, senior program officer for the Bill & Melinda Gates Foundation, also participated.

Based on the trip, this report outlines Ethiopia’s health extension program and how health extension workers are providing family planning education and services. The report also gives policy recommendations for future U.S. engagement on issues of family planning in Ethiopia, as well as lessons learned that can be applied in other countries.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

Billboards in Ethiopia’s capital announce the 2013 International Conference on Family Planning from November 12-15, under the theme “Full Access, Full Choice.” The conference participants from around the world should draw lessons from Ethiopia’s own experience that family planning is central to broader women’s health and development,

contributing to the empowerment of women and girls and more stable and prosperous families. Secretary of State John Kerry’s video message to the conference offers a unique opportunity for the United States to strategically reposition family planning as key to sustainable development, and to re-double U.S. commitment to national family planning programs.

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference, entitled "Linkages between Gender, AIDS, and Development: Implications for U.S. Policy" on June 11, 2010.

This report provides background on the programs represented at the conference, summaries of the speakers' presentations, and U.S. policy options that emerged from the conference. It is intended to help inform the discussion surrounding the implementation of GHI and PEPFAR II and to emphasize the importance of fully utilizing the opportunities to reach women and girls by addressing the health and development challenges that contribute to their risk of HIV.

I’m heading to South Africa and Zambia to look at innovative programs that link gender, AIDS, and development. While PEPFAR is not designed to fund development programs, there is a growing recognition that U.S. HIV/AIDS funding must link with the broader development agenda. Given the high HIV infection rates among women and girls in southern Africa, I am going to investigate how HIV/AIDS funding can be

linked to aspects of the development agenda to address the structural, societal factors that shape women and girls’ risk of HIV infection and complicate their situations once infected. Key linkages with the development arena include family planning and reproductive health as an essential component of HIV/AIDS services, and education for girls and economic empowerment for women as HIV prevention strategies.

The XVII International AIDS Conference in Mexico City sheds a global spotlight on both the progress in combating HIV and AIDS and the failure of our current prevention efforts to stem the epidemic. Despite increased funding for and access to HIV and AIDS treatment around the world, the imperative to vastly increase HIV prevention remains urgent: for every two people put on treatment, five more are newly infected. In the absence of a medical vaccine, the course of the epidemic will depend on how the global community rises to the challenge of prevention.

CARE’s global work on HIV and AIDS in over 40 countries demonstrates that making a real difference in the AIDS epidemic requires more comprehensive, multisectoral approaches to prevention that address the broader context and the factors that are fueling the epidemic. We need strategies that link HIV prevention with development approaches that attack the underlying causes of vulnerability to HIV – such as economic and food security, community empowerment, reproductive health and education – that can build economic and social “vaccines.” A comprehensive approach of this nature means going beyond traditional prevention programming focusing on individual behavior change to also address the social, economic and cultural factors that shape people’s risk of contracting HIV and impede their access to prevention programs.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

Debate about President Obama’s legacy will shift to Africa in late July, when he travels to Kenya on his fourth and likely final presidential trip to the continent. The trip is expected to focus on supporting economic entrepreneurship and combatting terrorism, which, along with increasing Africa’s energy capacity and food security, have been central to his Africa policy. In my latest blog, I write that this agenda misses a necessary component for progress on the continent; the President could cement a lasting legacy by explicitly linking U.S. Africa policy to the health and empowerment of women and girls, arguably the continent’s most dynamic and underdeveloped resource and an indispensable component of any successful economic and security program.

This piece is based on Janet's recent trip to Malawi and Kenya as part of a CARE learning tour that focused on the importance of U.S. investments in women and girls. The delegation included five members of Congress and senior administration officials.

The international outrage over Boko Haram’s abduction of Nigerian schoolgirls has escalated since the story first hit the news; mothers in Nigeria took action and celebrities from Angelina Jolie all the way to First Lady Michelle Obama have made their voices heard.

With mainstream attention finally focused on why the education, health, and empowerment of women and girls matters to Americans, it is time for the Obama administration to re-enforce its commitment to these issues and elevate them as central to U.S. foreign policy.

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference, entitled "Linkages between Gender, AIDS, and Development: Implications for U.S. Policy" on June 11, 2010.

This report provides background on the programs represented at the conference, summaries of the speakers' presentations, and U.S. policy options that emerged from the conference. It is intended to help inform the discussion surrounding the implementation of GHI and PEPFAR II and to emphasize the importance of fully utilizing the opportunities to reach women and girls by addressing the health and development challenges that contribute to their risk of HIV.

Girls’ education has long been recognized as a critical tool in the fight against HIV/AIDS, in the empowerment of women and girls, and in enhancing the health and welfare of families and communities. In a severely AIDS-affected country like Zambia, education and HIV/AIDS are inseparable: the epidemic is causing many girls in poor communities to lose access to education, often

compelling them to withdraw from school to look after sick parents or to care for their siblings, or the absenteeism resulting from their care-giving duties leaves them unable to keep up at school. Even those who stay in school face risks related to sexual abuse by teachers themselves or by older men who offer them money in exchange for sex, sometimes as a way to pay for school fees.

The province of KwaZulu Natal in South Africa is the hardest hit with HIV, with HIV prevalence rates at antenatal clinics estimated to be over 40 percent - about twice as high as the national prevalence. When combined with high rates of teenage pregnancy – about one-third of 18 and 19 year olds have already given birth - it is critical to address the social and economic factors that are contributing to this alarming situation. Data collected by the New York-based Population Council have shown that factors such as poverty, orphanhood, and social isolation can influence sexual behaviors, and therefore HIV risk.

Click here to read the full blog post.

Growing evidence shows that getting and keeping young people in school, particularly girls, dramatically lowers their vulnerability to HIV. By itself, merely attending primary school makes young people significantly less likely to contract HIV. When young people stay in school through the secondary level, education’s protective effect against HIV is even more pronounced. This is especially true for girls who, with each additional year of education, gain greater independence, are better equipped to make decisions affecting their sexual lives, and have higher income earning potential – all of which help them stay safe from HIV. Higher education levels are also clearly correlated with delayed sexual debut, greater HIV awareness and knowledge about HIV testing sites, fewer sexual partners, higher rates of condom use, and greater communication about HIV prevention between partners – all factors that substantially lower HIV risk.

By providing young women with greater economic options and autonomy, education also affords them the knowledge, skills, and opportunities they need to make informed choices about how to delay marriage and childbearing; have healthier babies; avoid commercial sex and other risky behaviors; and gain awareness of their rights.

"Access for All," the theme of next month's International AIDS Conference in Bangkok, sets an appropriately high standard for the world's response to the pandemic. Unfortunately, all too many prevention and treatment programs fail to address the needs of most of those living with the virus, especially in Africa: women and girls. It's time to design programs targeted to the risks that women and girls face in a world of AIDS.

Most prevention messages, and certainly those favored by the Bush administration, focus on the "ABC" approach to fighting HIV-AIDS: abstinence, be faithful, and use condoms. While important messages, these things are often not within women's power to control. It is urgent that we develop a "DEF" approach that responds to needs repeatedly expressed by women living with HIV-AIDS and by AIDS activists in Africa.

A saved copy of this article is also available here.

The catastrophe of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in Africa, which has already claimed over 18 million lives on that continent, has hit girls and women harder than boys and men. In many countries of eastern and southern Africa, HIV prevalence among girls under age eighteen is four to seven times higher than among boys the same age, an unusual disparity that means a lower average age of death from AIDS, as well as more deaths overall, among women than men.

Abuses of the human rights of girls, especially sexual violence and other sexual abuse, contribute directly to this disparity in infection and mortality. In Zambia, as in other countries in the region, tens of thousands of girls—many orphaned by AIDS or otherwise without parental care—suffer in silence as the government fails to provide basic protections from sexual assault that would lessen their vulnerability to HIV/AIDS.

Through girls’ own testimonies, this report shows sexual assault of girls in Zambia in the era of HIV/AIDS to be widespread and complex. It documents several categories of abuse that heighten girls’ risk of HIV infection, including (1) sexual assault of girls by family members, particularly the shocking and all too common practice of abuse of orphan girls by men who are their guardians, or by others who are charged to assist or look after them, including teachers, (2) abuse of girls, again often orphans, who are heads of household or otherwise desperately poor and have few options other than trading sex for their and their siblings’ survival, and (3) abuse of girls who live on the street, of whom many are there because they are without parental care. All of these situations of abuse must be addressed as part of combating the HIV/AIDS epidemic in Zambia.

Tom Malinowski, former assistant secretary of state for democracy, human rights, and labor, discusses the complicated human rights dialogue between the U.S. and Ethiopia, and reflects on his tenure at the State Department. He also provides his thoughts on human rights under the Trump administration.vulnerability to HIV/AIDS.

Click here to link to the podcast on SoundCloud.

With each passing week, the political unrest and repression in Ethiopia is attracting new levels of global attention: from Feyisa Lilesa’s protest sign at the Rio Olympics in August, to recent clashes in Oromia where hundreds of protesters were killed by security forces and hundreds more jailed, and now the government’s declaration of a sweeping state of emergency for the next six months.

There is little doubt that the inherent contradictions of Ethiopian rule—tight restrictions on human rights and governance while pursuing pro-poor policies—now threaten to derail its notable but fragile progress in women’s and children’s health. The current crisis also exposes the shortcomings of U.S. policy in Ethiopia; while providing substantial funding for health and development and maintaining close security ties, U.S. reluctance to hold its longtime ally accountable for its repressive tactics could put these investments at risk.

Click here to read the full article.

For decades, the United States has been the global leader in supporting voluntary family planning services around the world. The benefits of family planning are numerous, not only for women's health, but also for increasing child survival, nutrition, education, and economic development, as well as preventing mother-to-child transmission of HIV.

This chapter, published in The Mother & Child Project, was adapted from Family Planning and Linkages with U.S. Health and Development Goals, written by Janet and Alisha Kramer.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

You can order the book from Amazon.com here. Or, download the paper from which the chapter was adapted here.

“Investing in family planning is investing in the future.” These words from Ethiopian health official, Dr. Tewodros Bekele, summarize key findings of a new CSIS video and report about family planning in Ethiopia.

The CSIS video is designed to bring the voices of Ethiopian women and girls as well as champions of family planning into the U.S. policy discussion. Through the voices of rural women, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia’s development.

Topics: Economic development, Ethiopia, family planning, reproductive health, U.S. policy

In 2014, the CSIS Global Health Policy Center led a delegation to Ethiopia to examine the progress made and remaining challenges for expanding access to and demand for family planning services. Congressional staff from the offices of Senator Mark Kirk (R-IL), Representative Charlie Dent (R-PA), and Representative Karen Bass (D-CA) participated. Jennifer Dyer, executive director of Hope Through Healing Hands, and Tom Walsh, senior program officer for the Bill & Melinda Gates Foundation, also participated.

Based on the trip, this report outlines Ethiopia’s health extension program and how health extension workers are providing family planning education and services. The report also gives policy recommendations for future U.S. engagement on issues of family planning in Ethiopia, as well as lessons learned that can be applied in other countries.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

The CSIS Global Health Policy Center produced this video, following a bipartisan congressional staff delegation to Ethiopia in February 2014. The video is designed to bring the voices of Ethiopian women and girls, as well as champions of family planning, into the U.S. policy

discussion. Through the voices of rural women at health posts, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia's development.

Billboards in Ethiopia’s capital announce the 2013 International Conference on Family Planning from November 12-15, under the theme “Full Access, Full Choice.” The conference participants from around the world should draw lessons from Ethiopia’s own experience that family planning is central to broader women’s health and development,

contributing to the empowerment of women and girls and more stable and prosperous families. Secretary of State John Kerry’s video message to the conference offers a unique opportunity for the United States to strategically reposition family planning as key to sustainable development, and to re-double U.S. commitment to national family planning programs.

Senegal is a key country for U.S. investments in women’s and children’s health, demonstrating the impact of support for strong national leadership and targeted U.S. health resources. The U.S.-Senegal partnership has led to significant health gains, notably rises in immunization and contraceptive prevalence rates. However, that progress is still fragile and significant challenges remain, including high maternal mortality, weak health systems, and reaching young people. This is a critical time for the United States to support Senegal in accelerating its momentum and assuming greater control of its health financing and implementation. Success is not only essential to advance women’s and children’s health in Senegal, but also holds important lessons about how U.S. engagement can have a measurable and sustainable impact on women’s and children’s health in other priority countries.

To understand the lessons from Senegal’s recent experience, a delegation from the CSIS Task Force on Women’s and Family Health visited Senegal in February 2016. The delegation focused on the following overarching questions:

1. How have U.S. investments in women’s and family health—through bilateral health programs and engagement in multilateral health partnerships—supported Senegal’s progress in family planning and maternal and child health?

2. What has been the impact of integrating family planning with other maternal and child health services at the facility and community levels?

3. What has been the role of the private sector and public-private partnerships in developing innovative approaches to address Senegal’s persistent health challenges?

4. What are the prospects for family planning and maternal and child health programs in Senegal to transition to sustainable financing?

The report examines the U.S. partnership with Senegal to advance women’s and family health, and finds that the United States can play an important role in furthering Senegal’s capacity to sustain its health gains, build its investment case for international financing, and navigate the complex challenges ahead. To consolidate gains, the report argues that the United States should elevate attention and resources for integrated services to improve access to family planning and child health services. In addition, the report highlights the ongoing challenge of maternal mortality, which will require U.S. support to go beyond program-specific funding in order to accelerate efforts to strengthen health systems and human resources for health. Finally, the report calls for the United States to assist Senegal as it develops plans for a gradual, phased transition away from external support to more sustainable financing of health programs through the government of Senegal, the private sector, and new international financing mechanisms.

The members of the delegation were Julie Becker, senior vice president, Rabin Martin; Janet Fleischman, senior associate, CSIS Global Health Policy Center; Renee Gamela, senior adviser and communications director, Office of U.S. Representative Richard Hanna; Jennifer Kates, vice president and director of global health & HIV policy, Kaiser Family Foundation; and Cathryn Streifel, program manager and research associate, CSIS Global Health Policy Center.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

The contribution of faith-based organizations (FBOs) to health services and in reaching poor communities around the world has long been the subject of debate among public health experts and policymakers. To explore the nexus between faith and health, the CSIS Global Health Policy Center convened two recent events. The first focused on faith-based organizations and family planning in Kenya, and the second, timed for

the release of the new Lancet series on faith-based health care, examined the contributions of faith organizations to global health efforts, and implications for U.S. policy. Both events identified unique strengths and challenges associated with faith-based health programs, as well as opportunities for greater dialogue and collaboration among governments, donors, and faith-based health providers to reach health goals.

Anta Ba is a 26-year-old woman living in Guédiawaye, a poor urban area of Senegal’s capital, Dakar.  In a new CSIS video, Anta explains why she decided to access family planning, despite her husband’s opposition, and why these services matter for her own life and for women’s health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal—government and NGO health workers, an imam, and the Minister of Health—the video illustrates new approaches to expanding access to family planning as well as the challenges ahead.

The video was released at a vibrant CSIS event on April 27 called “Partnerships to Advance Family Planning in Senegal: Lessons for U.S. Policy,” which featured the minister of health, Dr. Awa Marie Coll Seck. In her keynote address, Dr. Coll Seck passionately articulated her commitment to family planning for the health and development of her country and the Francophone West African subregion: “You can understand my enthusiasm in defending such a cause considering my activism in women’s rights. And my role as a mother, because I am also a mother, and grandmother; and as a medical doctor. But also after listening to people, men and women, in my own country but also in many corners in Africa…. This is not a story of Senegal alone, it’s a story of all Africa but at least let us do something clear for the West African countries.”

Two panels focused on implementation and funding for family planning in Senegal and the subregion. The first panel – with Dr. Bocar Mamadou Daff from Senegal’s Ministry of Health, Pape Gaye from IntraHealth, and Maaike Van Min from Marie Stopes International – delved into the new approaches to advance access to family planning and the importance of the leadership and coordination by the Ministry of Health. Valuable lessons are emerging from Senegal’s experience, including the Informed Push Model to eliminate stock-outs of contraceptives, integration of family planning with immunizations, mobile clinics to reach vulnerable women, and engagement with religious communities and civil society. Yet all the panelists agreed that clear challenges remain for continued progress, such as addressing the reproductive health needs of young people, expanding the engagement of religious leaders, building a multisectoral response, and attracting private sector support for greater sustainability.

The donor perspectives on funding were the subject of the second panel, which included Katie Taylor from USAID, Nomi Fuchs-Montgomery from the Bill & Melinda Gates Foundation, and Fatimata Sy from the Ouagadougou Partnership. They all emphasized the importance of building on public-private partnerships and attracting new donors for family planning in Senegal and for the subregion, as well as the critical role of country-led, costed plans and political will to ensure progress. Taylor noted that since USAID’s primary health goal is to end preventable maternal and child deaths, family planning has to be a critical intervention, and that Senegal’s progress demonstrates why these investments are so effective. Fuchs-Montgomery underscored the foundation’s approach to ensuring that their investments in Senegal and Niger are leveraged by other donors, with the aim of improving women’s health and accelerating a regional demographic transition. To accomplish this, she emphasized, will require leadership, partnerships, and perseverance. Speaking from a regional perspective, Sy noted the importance of donors aligning with countries’ national plans, and expressed her concern that despite costed plans, significant funding gaps remain.  Fragile progress will require continued outside funding, Sy added.

You can read the full blog post here. watch Partnerships for Family Planning: Lessons for U.S. Policy in two parts, here and here.

Anta Ba is a 26-year-old woman living in Guédiawaye, a poor urban area of Senegal’s capital, Dakar. In a new CSIS video, Anta explains why she decided to access family planning, despite her husband’s opposition, and why these services matter for her own life and for women’s health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal—government and NGO health workers, an imam, and the Minister of Health—the video illustrates new approaches to expanding access to family planning as well as the challenges ahead.

The video was released at a vibrant CSIS event on April 27 called Partnerships for Family Planning: Lessons for U.S. Policy which featured the minister of health, Dr. Awa Marie Coll Seck. In her keynote address, Dr. Coll Seck passionately articulated her commitment to family planning for the health and development of her country and the francophone West African subregion. In this post, I provide highlights of the event and Dr. Coll Seck’s remarks.

Click here to see the video about family planning in Senegal. You can watch the CSIS program Partnerships for Family Planning: Lessons for U.S. Policy in two parts, here and here. This blog post provides an overview of both the video and the CSIS program.

In a recent interview with the CSIS Global Health Policy Center in Dakar, the Senegalese Minister of Health, Dr. Awa Marie Coll-Seck, used a familiar term to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of

the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal. Participants at this week’s annual meeting of the Ouagadougou Partnership should examine lessons from Senegal as they work to advance women’s health and family planning in the subregion.

The Senegalese minister of health, Dr. Awa Marie Coll-Seck, used a familiar term with us to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal, and prospects for advancing women’s health and family planning in the subregion may depend on its success.

This country leadership has led to strategic partnerships between Senegal and the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the United Nations Population Fund (UNFPA), and the William and Flora Hewlett Foundation, among others. The goal is to “reposition” family planning in Senegal and in the francophone West African subregion. Senegal is a main focus of these efforts, since it is seen as the regional hub and is one of the most stable democracies in Africa. Given the current attention to family planning in Senegal, we wanted to see for ourselves what opportunities and challenges are presented by these partnerships, especially related to U.S. policy, and what it will take to build the domestic political support and accountability to ensure further progress.

As Senegal has launched a national family planning strategy and doubled its budget for contraceptives, the donors’ support has encouraged innovative approaches. Early results have been promising—Senegal’s contraceptive prevalence rate among married women increased from 12 to 16 percent (2012 to 2013), after years of stagnation, and new data will be available soon that are expected to show a similar increase for 2013–2014.

Click here to download the full report.

The CSIS Global Health Policy Center produced this video, following a bipartisan congressional staff delegation to Ethiopia in February 2014. The video is designed to bring the voices of Ethiopian women and girls, as well as champions of family planning, into the U.S. policy

discussion. Through the voices of rural women at health posts, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia's development.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.

This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.

Click here to link to the full report.

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Click here to link to the article.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

The population of Africa is expected to double over the next 20 years, which means that many countries are facing either a demographic dividend or potentially a disaster, with critical implications for global health and development. In this episode of Take as Directed, Janet Fleischman sits down with Amb. Mark Dybul, Director of the Center for Global Health and Quality, and Professor in the Department of Medicine at Georgetown University Medical Center, and formerly head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. They discuss why these demographic trends matter and how U.S. programs can better engage young people, especially adolescent girls and young women, to address their needs and support local innovation.

Click here to link to the podcast on SoundCloud.

Many of the fastest growing populations are in the world’s poorest countries, putting them at a critical threshold: either they will accelerate economic growth and innovation by investing in their burgeoning youth population or the rapid population growth coupled with a shortage of opportunities for young people will undermine advances in health, development, and ultimately security. These demographic trends, most notable in sub-Saharan Africa, are often referred to as a “youth boom” or a “youth bulge.” Given the enormous implications of these demographic shifts, U.S. assistance should promote young people’s health and development, with particular emphasis on empowering young women. Investments in human capital and gender equality would yield enormous benefits in improving health, reducing poverty, and increasing economic and political stability. Given that these goals align so strongly with U.S. national interests, they benefit from strong bipartisan support.

This agenda constitutes an urgent priority. The magnitude of this demographic transition is evident in sub-Saharan Africa; sixty percent of the population is under the age of 25 and is projected to dramatically increase in the coming years due to decreased under-five child mortality and to continued high fertility, which is often driven by early and closely spaced childbearing. In many of these countries, notably in the Sahel region of West Africa, the population may double as soon as 2030—the year the world community pledged to achieve the Sustainable Development Goals—and possibly quadruple by the end of the century. Overall, the population in sub-Saharan Africa could increase from 1 billion to 4 billion before the end of the century.

In some communities of KwaZulu-Natal Province, South Africa, 60 percent of women have HIV. Nearly 4,500 South Africans are newly infected every week; one-third are adolescent girls/young women (AGYW) ages 15-24. These are staggering figures, by any stretch of the imagination. Yet, the HIV epidemic is not being treated like a crisis. In February, we traveled to South Africa, to understand what is happening in these areas with “hyper-endemic” HIV epidemics, where prevalence rates exceed 15 percent among adults. We were alarmed by the complacency toward the rate of new infections at all levels and the absence of an emergency response, especially for young people.

This is no time for business as usual from South Africa or its partners, including the U.S. government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The epidemic is exacerbated by its concentration in 15-49-year-olds, those of reproductive and working age who are the backbone of South Africa. Without aggressive action to reduce the rate of new infections in young people, HIV will continue to take a tremendous toll on the country for years and generations to come. Collective action is needed to push beyond the complacency and internal barriers to implement policies and interventions that directly target HIV prevention and treatment for young people. PEPFAR should ensure its programs support those efforts.

Click here to read the full commentary.

Violence against children (VAC) and violence against women (VAW) are public health and human rights crises of global proportions, with damaging consequences to the health and well-being of individuals and their communities. Fueled by gender inequality, social norms condoning violence and harmful traditional practices,1 and exacerbated by lack of commitment to take preventive and protective action and weak protection systems, violence against women and children (VAWC) as well as the magnitude, human toll and societal cost of this violence is increasingly acknowledged by the global community.

Together for Girls (TfG) is a partnership among national governments, UN entities and private sector organizations working at the intersection of VAW and VAC, with special attention to ending sexual violence against girls. Now being implemented in more than 22 countries, the TfG model supports governments to conduct a national household Violence Against Children Survey (VACS) and to use the data to mobilize action through policies and programs that embed violence prevention and response across multiple sectors.

In 2009, the Government of Tanzania, with support from TfG partners, most notably UNICEF, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), undertook the VACS. Tanzania was the first country to implement a full VACS, surveying both girls and boys (ages 13-24) nationally to assess the prevalence of emotional, physical and sexual violence. It was also the first country to introduce a government-led, multi-sector task force to oversee the implementation of the survey and the ensuing violence prevention and response work catalyzed by the data, which led to the establishment of a multi-sectoral, costed National Plan of Action. Ten years after Tanzania’s landmark research, this case study seeks to consolidate learnings from the national experience of implementing the TfG model.

Janet Fleischman, host Cathryn Streifel, producer, and Ribka Gemilangsari, editor Global Health Policy Center November 30, 2018

Women’s health services, including maternal health and family planning, are critical to enable women and girls to access economic empowerment opportunities. In this episode of Take as Directed, Janet speaks with Margaret Schuler, Senior Vice President of the International Programs Group at World Vision, and David Ray, Vice President for Policy and Advocacy at CARE. The three discuss how the current bipartisan momentum around economic empowerment for women provides an opportunity to strengthen linkages with U.S. investments in women’s global health, how such an approach fits with USAID’s “Journey to Self-Reliance” framework, and the role of women’s groups and faith-based organizations in promoting access to both economic empowerment programs and women’s health services.

Click here to link to the podcast on SoundCloud.

Beth Schlachter, executive director of FP2020, discussed the London Summit on Family Planning that took place in July 2017, at which approximately $2.5 billion in new money was pledged for international family planning. We asked her to reflect on the unique FP2020 partnership, its achievements as well as the challenges it faces in meeting its goals in the world’s 69 lowest income countries. She stressed the importance of continued U.S. leadership in family planning, both in its bilateral assistance and in technical support at the country level, and her concerns about the global impact that would result if the U.S. abandons this role.

Click here to link to the podcast on SoundCloud.

On his first business day in office, President Trump reinstated and expanded the Mexico City Policy, which denies U.S. funding to any foreign NGOs that perform, counsel, or refer about abortion with non-U.S. funds. In past Republican administrations, this policy applied only to U.S. funding for international family planning, but President Trump has expanded it to apply to all global health funding. We asked Jen Kates, Vice President and Director of Global Health & HIV Policy at the Kaiser Family Foundation, to update us on the new policy and the potential implications for global health programs.

Click here to link to the podcast on SoundCloud.

With each passing week, the political unrest and repression in Ethiopia is attracting new levels of global attention: from Feyisa Lilesa’s protest sign at the Rio Olympics in August, to recent clashes in Oromia where hundreds of protesters were killed by security forces and hundreds more jailed, and now the government’s declaration of a sweeping state of emergency for the next six months.

There is little doubt that the inherent contradictions of Ethiopian rule—tight restrictions on human rights and governance while pursuing pro-poor policies—now threaten to derail its notable but fragile progress in women’s and children’s health. The current crisis also exposes the shortcomings of U.S. policy in Ethiopia; while providing substantial funding for health and development and maintaining close security ties, U.S. reluctance to hold its longtime ally accountable for its repressive tactics could put these investments at risk.

Click here to read the full article.

The CSIS Global Health Policy Center produced this video during a visit to Zambia in April 2016. It profiles four young Zambian women who describe the stark realities for adolescent girls and young women that fuel the AIDS epidemic – sexual violence, barriers to education and family planning, and gender inequality. Through their stories and insights, the video illustrates that in order to address the AIDS crisis in Southern Africa, we must understand the risks that young women face and work to engage and empower them.

Click here to watch the video. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Zambia is a lower-middle-income country struggling with critical health challenges, including high rates of maternal and neonatal mortality, malnutrition, cervical cancer, and a severe HIV/AIDS epidemic that disproportionately affects adolescent girls and young women. The United States is the largest donor to the health sector in Zambia, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Over the past five years, the U.S. has also helped establish several public-private partnerships (PPPs) aimed at advancing the health of women and families. These PPPs provide lessons about the potential impact of these approaches, the challenges inherent in such partnerships, and the importance of PEPFAR support. With future U.S. global health funding likely to be flat-lined, this is an important moment to assess how partnerships with the private sector can amplify the impact of U.S. investments in women’s and family health.

A delegation from the CSIS Task Force on Women’s and Family Health visited Zambia in April 2016 to examine U.S. investments through three partnerships: Saving Mothers Giving Life (SMGL), Pink Ribbon Red Ribbon (PRRR), and DREAMS. The delegation sought to understand these partnerships in Zambia within the context of U.S. support for women’s and family health, which represent the core of functional health systems.

Click here to read the report. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Senegal is a key country for U.S. investments in women’s and children’s health, demonstrating the impact of support for strong national leadership and targeted U.S. health resources. The U.S.-Senegal partnership has led to significant health gains, notably rises in immunization and contraceptive prevalence rates. However, that progress is still fragile and significant challenges remain, including high maternal mortality, weak health systems, and reaching young people. This is a critical time for the United States to support Senegal in accelerating its momentum and assuming greater control of its health financing and implementation. Success is not only essential to advance women’s and children’s health in Senegal, but also holds important lessons about how U.S. engagement can have a measurable and sustainable impact on women’s and children’s health in other priority countries.

To understand the lessons from Senegal’s recent experience, a delegation from the CSIS Task Force on Women’s and Family Health visited Senegal in February 2016. The delegation focused on the following overarching questions:

1. How have U.S. investments in women’s and family health—through bilateral health programs and engagement in multilateral health partnerships—supported Senegal’s progress in family planning and maternal and child health?

2. What has been the impact of integrating family planning with other maternal and child health services at the facility and community levels?

3. What has been the role of the private sector and public-private partnerships in developing innovative approaches to address Senegal’s persistent health challenges?

4. What are the prospects for family planning and maternal and child health programs in Senegal to transition to sustainable financing?

The report examines the U.S. partnership with Senegal to advance women’s and family health, and finds that the United States can play an important role in furthering Senegal’s capacity to sustain its health gains, build its investment case for international financing, and navigate the complex challenges ahead. To consolidate gains, the report argues that the United States should elevate attention and resources for integrated services to improve access to family planning and child health services. In addition, the report highlights the ongoing challenge of maternal mortality, which will require U.S. support to go beyond program-specific funding in order to accelerate efforts to strengthen health systems and human resources for health. Finally, the report calls for the United States to assist Senegal as it develops plans for a gradual, phased transition away from external support to more sustainable financing of health programs through the government of Senegal, the private sector, and new international financing mechanisms.

The members of the delegation were Julie Becker, senior vice president, Rabin Martin; Janet Fleischman, senior associate, CSIS Global Health Policy Center; Renee Gamela, senior adviser and communications director, Office of U.S. Representative Richard Hanna; Jennifer Kates, vice president and director of global health & HIV policy, Kaiser Family Foundation; and Cathryn Streifel, program manager and research associate, CSIS Global Health Policy Center.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

The contribution of faith-based organizations (FBOs) to health services and in reaching poor communities around the world has long been the subject of debate among public health experts and policymakers. To explore the nexus between faith and health, the CSIS Global Health Policy Center convened two recent events. The first focused on faith-based organizations and family planning in Kenya, and the second, timed for

the release of the new Lancet series on faith-based health care, examined the contributions of faith organizations to global health efforts, and implications for U.S. policy. Both events identified unique strengths and challenges associated with faith-based health programs, as well as opportunities for greater dialogue and collaboration among governments, donors, and faith-based health providers to reach health goals.

Debate about President Obama’s legacy will shift to Africa in late July, when he travels to Kenya on his fourth and likely final presidential trip to the continent. The trip is expected to focus on supporting economic entrepreneurship and combatting terrorism, which, along with increasing Africa’s energy capacity and food security, have been central to his Africa policy. In my latest blog, I write that this agenda misses a necessary component for progress on the continent; the President could cement a lasting legacy by explicitly linking U.S. Africa policy to the health and empowerment of women and girls, arguably the continent’s most dynamic and underdeveloped resource and an indispensable component of any successful economic and security program.

This piece is based on Janet's recent trip to Malawi and Kenya as part of a CARE learning tour that focused on the importance of U.S. investments in women and girls. The delegation included five members of Congress and senior administration officials.

Anta Ba is a 26-year-old woman living in Guédiawaye, a poor urban area of Senegal’s capital, Dakar.  In a new CSIS video, Anta explains why she decided to access family planning, despite her husband’s opposition, and why these services matter for her own life and for women’s health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal—government and NGO health workers, an imam, and the Minister of Health—the video illustrates new approaches to expanding access to family planning as well as the challenges ahead.

The video was released at a vibrant CSIS event on April 27 called “Partnerships to Advance Family Planning in Senegal: Lessons for U.S. Policy,” which featured the minister of health, Dr. Awa Marie Coll Seck. In her keynote address, Dr. Coll Seck passionately articulated her commitment to family planning for the health and development of her country and the Francophone West African subregion: “You can understand my enthusiasm in defending such a cause considering my activism in women’s rights. And my role as a mother, because I am also a mother, and grandmother; and as a medical doctor. But also after listening to people, men and women, in my own country but also in many corners in Africa…. This is not a story of Senegal alone, it’s a story of all Africa but at least let us do something clear for the West African countries.”

Two panels focused on implementation and funding for family planning in Senegal and the subregion. The first panel – with Dr. Bocar Mamadou Daff from Senegal’s Ministry of Health, Pape Gaye from IntraHealth, and Maaike Van Min from Marie Stopes International – delved into the new approaches to advance access to family planning and the importance of the leadership and coordination by the Ministry of Health. Valuable lessons are emerging from Senegal’s experience, including the Informed Push Model to eliminate stock-outs of contraceptives, integration of family planning with immunizations, mobile clinics to reach vulnerable women, and engagement with religious communities and civil society. Yet all the panelists agreed that clear challenges remain for continued progress, such as addressing the reproductive health needs of young people, expanding the engagement of religious leaders, building a multisectoral response, and attracting private sector support for greater sustainability.

The donor perspectives on funding were the subject of the second panel, which included Katie Taylor from USAID, Nomi Fuchs-Montgomery from the Bill & Melinda Gates Foundation, and Fatimata Sy from the Ouagadougou Partnership. They all emphasized the importance of building on public-private partnerships and attracting new donors for family planning in Senegal and for the subregion, as well as the critical role of country-led, costed plans and political will to ensure progress. Taylor noted that since USAID’s primary health goal is to end preventable maternal and child deaths, family planning has to be a critical intervention, and that Senegal’s progress demonstrates why these investments are so effective. Fuchs-Montgomery underscored the foundation’s approach to ensuring that their investments in Senegal and Niger are leveraged by other donors, with the aim of improving women’s health and accelerating a regional demographic transition. To accomplish this, she emphasized, will require leadership, partnerships, and perseverance. Speaking from a regional perspective, Sy noted the importance of donors aligning with countries’ national plans, and expressed her concern that despite costed plans, significant funding gaps remain.  Fragile progress will require continued outside funding, Sy added.

You can read the full blog post here. watch Partnerships for Family Planning: Lessons for U.S. Policy in two parts, here and here.

Anta Ba is a 26-year-old woman living in Guédiawaye, a poor urban area of Senegal’s capital, Dakar. In a new CSIS video, Anta explains why she decided to access family planning, despite her husband’s opposition, and why these services matter for her own life and for women’s health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal—government and NGO health workers, an imam, and the Minister of Health—the video illustrates new approaches to expanding access to family planning as well as the challenges ahead.

The video was released at a vibrant CSIS event on April 27 called Partnerships for Family Planning: Lessons for U.S. Policy which featured the minister of health, Dr. Awa Marie Coll Seck. In her keynote address, Dr. Coll Seck passionately articulated her commitment to family planning for the health and development of her country and the francophone West African subregion. In this post, I provide highlights of the event and Dr. Coll Seck’s remarks.

Click here to see the video about family planning in Senegal. You can watch the CSIS program Partnerships for Family Planning: Lessons for U.S. Policy in two parts, here and here. This blog post provides an overview of both the video and the CSIS program.

For decades, the United States has been the global leader in supporting voluntary family planning services around the world. The benefits of family planning are numerous, not only for women's health, but also for increasing child survival, nutrition, education, and economic development, as well as preventing mother-to-child transmission of HIV.

This chapter, published in The Mother & Child Project, was adapted from Family Planning and Linkages with U.S. Health and Development Goals, written by Janet and Alisha Kramer.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

You can order the book from Amazon.com here. Or, download the paper from which the chapter was adapted here.

In a recent interview with the CSIS Global Health Policy Center in Dakar, the Senegalese Minister of Health, Dr. Awa Marie Coll-Seck, used a familiar term to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of

the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal. Participants at this week’s annual meeting of the Ouagadougou Partnership should examine lessons from Senegal as they work to advance women’s health and family planning in the subregion.

The Senegalese minister of health, Dr. Awa Marie Coll-Seck, used a familiar term with us to express her commitment to expanding access to family planning—“yes we can.” That is a bold proposition in such a conservative country, in a region with some of the world’s highest maternal mortality and unmet need for family planning. Her leadership reflects an important moment in Senegal, and prospects for advancing women’s health and family planning in the subregion may depend on its success.

This country leadership has led to strategic partnerships between Senegal and the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the United Nations Population Fund (UNFPA), and the William and Flora Hewlett Foundation, among others. The goal is to “reposition” family planning in Senegal and in the francophone West African subregion. Senegal is a main focus of these efforts, since it is seen as the regional hub and is one of the most stable democracies in Africa. Given the current attention to family planning in Senegal, we wanted to see for ourselves what opportunities and challenges are presented by these partnerships, especially related to U.S. policy, and what it will take to build the domestic political support and accountability to ensure further progress.

As Senegal has launched a national family planning strategy and doubled its budget for contraceptives, the donors’ support has encouraged innovative approaches. Early results have been promising—Senegal’s contraceptive prevalence rate among married women increased from 12 to 16 percent (2012 to 2013), after years of stagnation, and new data will be available soon that are expected to show a similar increase for 2013–2014.

Click here to download the full report.

“Investing in family planning is investing in the future.” These words from Ethiopian health official, Dr. Tewodros Bekele, summarize key findings of a new CSIS video and report about family planning in Ethiopia.

The CSIS video is designed to bring the voices of Ethiopian women and girls as well as champions of family planning into the U.S. policy discussion. Through the voices of rural women, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia’s development.

Topics: Economic development, Ethiopia, family planning, reproductive health, U.S. policy

In 2014, the CSIS Global Health Policy Center led a delegation to Ethiopia to examine the progress made and remaining challenges for expanding access to and demand for family planning services. Congressional staff from the offices of Senator Mark Kirk (R-IL), Representative Charlie Dent (R-PA), and Representative Karen Bass (D-CA) participated. Jennifer Dyer, executive director of Hope Through Healing Hands, and Tom Walsh, senior program officer for the Bill & Melinda Gates Foundation, also participated.

Based on the trip, this report outlines Ethiopia’s health extension program and how health extension workers are providing family planning education and services. The report also gives policy recommendations for future U.S. engagement on issues of family planning in Ethiopia, as well as lessons learned that can be applied in other countries.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

The CSIS Global Health Policy Center produced this video, following a bipartisan congressional staff delegation to Ethiopia in February 2014. The video is designed to bring the voices of Ethiopian women and girls, as well as champions of family planning, into the U.S. policy

discussion. Through the voices of rural women at health posts, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, the video vividly highlights the importance of family planning as a core component of Ethiopia's development.

Billboards in Ethiopia’s capital announce the 2013 International Conference on Family Planning from November 12-15, under the theme “Full Access, Full Choice.” The conference participants from around the world should draw lessons from Ethiopia’s own experience that family planning is central to broader women’s health and development,

contributing to the empowerment of women and girls and more stable and prosperous families. Secretary of State John Kerry’s video message to the conference offers a unique opportunity for the United States to strategically reposition family planning as key to sustainable development, and to re-double U.S. commitment to national family planning programs.

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women’s health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women’s health will require maximizing investments by engaging new partners, identifying program synergies, and aligning with countries’ national priorities to meet women’s needs. Such strategic coordination—involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services—presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges of strengthening U.S. policy approaches to women’s global health issues.

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women's health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women's health will require maximizing investment by engaging new partners., identifying program synergies, and aligning with countries' national priorities to meet women's needs. Such strategic coordination--involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services--presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges related to strengthening U.S. policy approaches to women's global health issues. CSIS chose to visit Zambia because of the new level of political will and leadership on women's health issues in the country; women leaders, in particular, are in an exceptional position to drive forward country ownership, including Zambia's first lady and other high-level government health officials.

The world's HIV/AIDS leaders are gathering in Washington, D.C., this week under the theme "turning the tide together." Yet the hope and optimism around creating an "AIDS-free generation" needs to be channeled into critical strategies that could make an immediate difference for women and girls.

The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. I was recently in Tanzania, where the results of U.S. health investments indicate that this is a feasible and cost effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities.

The President's Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women's health will require integrating HIV/AIDS services with family planning and reproductive health services. The

results from U.S. health investments in Tanzania indicate that this is a feasible and cost-effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities. The lessons being learned in Tanzania should inform the scale-up of strategic integration under PEPFAR for these critical interventions.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in prevalence countries in Africa. Yet despite bipartisan political consensus on the intersection between HIV and GBV, efforts to address this area have not attracted the attention or resources necessary to drive the program innovation that could demonstrate progress. However, new momentum is now being brought to this agenda with the U.S. President's Emergency Plan for AIDS Relief's (PEPFAR) GBV initiative.

This paper examines how the GBV initiative is being introduced in Tanzania, one of the GBV focus countries, based on interviews in Tanzania in April 2012 with U.S. government officials, nongovernmental organizations, and implementing partners, as well as interviews in Washington, D.C. It describes the importance of this initiative for the work of PEPFAR and the Global Health Initiative (GHI), impediments to progress, why this program has the potential to provide valuable and timely lessons for achieving HIV-related goals and for improving health outcomes for women and girls, and priority steps for getting the best results in the future.

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs.

The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

A period of major change is unfolding in health and HIV services in South Africa, carrying opportunities and risks for delivering effective, integrated health services that improve health outcomes and save lives. South Africa is decentralizing HIV services to the primary health are level, paving the way for greater integration to address women's health and to reduce maternal mortality. The United States can find feasible, flexible ways to support this process, even though its health program through the President's

Emergency Plan for AIDS Relief (PEPFAR), is scaling down. As PEPFAR transitions from an emergency to a more sustainable response, this is a crucial moment to demonstrate that it can address HIV-related goals by linking to more comprehensive services for women--notably linking HIV with family planning (FP), reproductive health (RH), and maternal child health (MCH). The stakes are high for PEPFAR and for the Global Health Initiative (GHI) to show results and, most importantly, for the women and children most at risk.

The Obama administration’s Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR (the President’s Emergency Plan for AIDS Relief). As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government’s health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries,the emphasis on program integration in those U.S. government programs is especially relevant.

This paper, which is based on interviews conducted in Kenya in November 2010, as well as with policymakers and implementing partners in Washington, D.C., shows that the APHIA experience illustrates that integration across health sectors is feasible and effective, and that more focused evaluation of the impact of integrated programs would help Kenya and other GHI-Plus country teams and national governments as they develop their strategies. The maternal and child health (MCH) model in Kenya’s Western province is emerging as an innovative example of the benefits of providing women with a comprehensive set of MCH, family planning, reproductive health, and HIV/AIDS services in an integrated setting.

With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction

involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.

The world faces enormous challenges in the global health arena, many of which have a disproportionate impact on women and girls. Many key global health priorities revolve in fundamental ways around the gender-related barriers that women and girls face in accessing health-related information, services, and resources, all of which increase their vulnerability to ill health. For success and sustainability, the United States should anchor its global health strategy in a firm commitment to address the gender disparities that affect global health outcomes.

This report proposes that a gender-focused approach to global health build on four cornerstones:

These areas are clearly linked and underscore the importance of an integrated, comprehensive global health policy.

The election of President Barack Obama has fundamentally changed the landscape for the debates around U.S. support for international family planning (FP) programs. The personal engagement of top leadership, notably the president himself and Secretary of State Hillary Clinton, combined with policy and budgetary announcements that make averting unintended pregnancies a priority issue, clearly signal the administration’s intention to promote family planning as part of a comprehensive approach to global health.

Despite the polarization that often surrounds the debates on these issues in the United States, largely over their perceived linkage to the highly charged issue of abortion, an unprecedented opportunity now exists to significantly expand international FP programs based on a common-ground approach.

The core element of this approach is the need to move toward universal access to FP services—defined throughout this paper as education, counseling, and contraceptive commodities—provided on a voluntary basis to females and couples.

This report was written by Janet Fleischman, senior associate of the CSIS HIV/AIDS Task Force and chair of the gender committee. It is based on the presentations and discussions at the CSIS conference held on October 30, 2007, “Integrating Reproductive Health and HIV/AIDS Services: Lessons from the Field for PEPFAR Reauthorization,” as well as Fleischman’s visits to Kenya, South Africa, and India in 2007 and her interviews with U.S. administration officials, congressional staff, HIV/AIDS organizations and service providers, reproductive health organizations, and women living with HIV/AIDS.

In the context of reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR), and looking ahead to the strategy that will be developed by the next U.S. administration, the conference sought to focus high-level attention on the opportunities and challenges of integrating reproductive health (RH) and HIV/AIDS programs. The proceedings demonstrated that substantial ingenuity and innovation is under way in integrating these services, and highlighted the importance of ensuring that the emerging lessons from the field inform decisions about the next phase of U.S. AIDS policy.

Asunta Wagura'shealthy baby boy has sparked considerable controversy in Kenya. As an HIV-infected woman and AIDS activist, Asunta's decision to conceive a child exposes an emerging feature of the global HIV/AIDS pandemic: increased access to life-prolonging treatment is affecting women's reproductive choices, and challenging ideas about the kind of services and policies required.

If we are to keep pace with the evolving pandemic, concerns about women's reproductive health must become an integral part of HIV/AIDS services and policies.

February 6th marks the International Day of Zero Tolerance of Female Genital Mutilation (FGM), a United Nations-sponsored awareness day meant to highlight efforts to eradicate FGM. An estimated 200 million women and girls today have undergone some form of FGM, a practice that can cause irreversible physical and mental health challenges. In this episode of Take as Directed, CSIS Global Health Policy Center Senior Associate Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator, activist, and founder of “Kakenya’s Dream”, a leading nongovernmental organization for girls’ education, health, and empowerment, which also works to end FGM and child marriage. Dr. Ntaiya discusses the personal journey that led her to form “Kakenya’s Dream”, and how her work is helping to develop the next generation of women leaders in her community.

Click here to listen to the podcast.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.

This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.

Click here to link to the full report.

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Click here to link to the article.

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

For decades, the United States has been the global leader in supporting voluntary family planning services around the world. The benefits of family planning are numerous, not only for women's health, but also for increasing child survival, nutrition, education, and economic development, as well as preventing mother-to-child transmission of HIV.

This chapter, published in The Mother & Child Project, was adapted from Family Planning and Linkages with U.S. Health and Development Goals, written by Janet and Alisha Kramer.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

You can order the book from Amazon.com here. Or, download the paper from which the chapter was adapted here.

In 2014, the CSIS Global Health Policy Center led a delegation to Ethiopia to examine the progress made and remaining challenges for expanding access to and demand for family planning services. Congressional staff from the offices of Senator Mark Kirk (R-IL), Representative Charlie Dent (R-PA), and Representative Karen Bass (D-CA) participated. Jennifer Dyer, executive director of Hope Through Healing Hands, and Tom Walsh, senior program officer for the Bill & Melinda Gates Foundation, also participated.

Based on the trip, this report outlines Ethiopia’s health extension program and how health extension workers are providing family planning education and services. The report also gives policy recommendations for future U.S. engagement on issues of family planning in Ethiopia, as well as lessons learned that can be applied in other countries.

Topics: Economic development, Ethiopia, family planning, FP-HIV integration, reproductive health, U.S. policy

Billboards in Ethiopia’s capital announce the 2013 International Conference on Family Planning from November 12-15, under the theme “Full Access, Full Choice.” The conference participants from around the world should draw lessons from Ethiopia’s own experience that family planning is central to broader women’s health and development,

contributing to the empowerment of women and girls and more stable and prosperous families. Secretary of State John Kerry’s video message to the conference offers a unique opportunity for the United States to strategically reposition family planning as key to sustainable development, and to re-double U.S. commitment to national family planning programs.

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women’s health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women’s health will require maximizing investments by engaging new partners, identifying program synergies, and aligning with countries’ national priorities to meet women’s needs. Such strategic coordination—involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services—presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges of strengthening U.S. policy approaches to women’s global health issues.

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women's health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women's health will require maximizing investment by engaging new partners., identifying program synergies, and aligning with countries' national priorities to meet women's needs. Such strategic coordination--involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services--presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges related to strengthening U.S. policy approaches to women's global health issues. CSIS chose to visit Zambia because of the new level of political will and leadership on women's health issues in the country; women leaders, in particular, are in an exceptional position to drive forward country ownership, including Zambia's first lady and other high-level government health officials.

The world's HIV/AIDS leaders are gathering in Washington, D.C., this week under the theme "turning the tide together." Yet the hope and optimism around creating an "AIDS-free generation" needs to be channeled into critical strategies that could make an immediate difference for women and girls.

The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. I was recently in Tanzania, where the results of U.S. health investments indicate that this is a feasible and cost effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities.

The President's Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women's health will require integrating HIV/AIDS services with family planning and reproductive health services. The

results from U.S. health investments in Tanzania indicate that this is a feasible and cost-effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities. The lessons being learned in Tanzania should inform the scale-up of strategic integration under PEPFAR for these critical interventions.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in prevalence countries in Africa. Yet despite bipartisan political consensus on the intersection between HIV and GBV, efforts to address this area have not attracted the attention or resources necessary to drive the program innovation that could demonstrate progress. However, new momentum is now being brought to this agenda with the U.S. President's Emergency Plan for AIDS Relief's (PEPFAR) GBV initiative.

This paper examines how the GBV initiative is being introduced in Tanzania, one of the GBV focus countries, based on interviews in Tanzania in April 2012 with U.S. government officials, nongovernmental organizations, and implementing partners, as well as interviews in Washington, D.C. It describes the importance of this initiative for the work of PEPFAR and the Global Health Initiative (GHI), impediments to progress, why this program has the potential to provide valuable and timely lessons for achieving HIV-related goals and for improving health outcomes for women and girls, and priority steps for getting the best results in the future.

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs.

The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

A period of major change is unfolding in health and HIV services in South Africa, carrying opportunities and risks for delivering effective, integrated health services that improve health outcomes and save lives. South Africa is decentralizing HIV services to the primary health are level, paving the way for greater integration to address women's health and to reduce maternal mortality. The United States can find feasible, flexible ways to support this process, even though its health program through the President's

Emergency Plan for AIDS Relief (PEPFAR), is scaling down. As PEPFAR transitions from an emergency to a more sustainable response, this is a crucial moment to demonstrate that it can address HIV-related goals by linking to more comprehensive services for women--notably linking HIV with family planning (FP), reproductive health (RH), and maternal child health (MCH). The stakes are high for PEPFAR and for the Global Health Initiative (GHI) to show results and, most importantly, for the women and children most at risk.

The Obama administration’s Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR (the President’s Emergency Plan for AIDS Relief). As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government’s health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries,the emphasis on program integration in those U.S. government programs is especially relevant.

This paper, which is based on interviews conducted in Kenya in November 2010, as well as with policymakers and implementing partners in Washington, D.C., shows that the APHIA experience illustrates that integration across health sectors is feasible and effective, and that more focused evaluation of the impact of integrated programs would help Kenya and other GHI-Plus country teams and national governments as they develop their strategies. The maternal and child health (MCH) model in Kenya’s Western province is emerging as an innovative example of the benefits of providing women with a comprehensive set of MCH, family planning, reproductive health, and HIV/AIDS services in an integrated setting.

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference, entitled "Linkages between Gender, AIDS, and Development: Implications for U.S. Policy" on June 11, 2010.

This report provides background on the programs represented at the conference, summaries of the speakers' presentations, and U.S. policy options that emerged from the conference. It is intended to help inform the discussion surrounding the implementation of GHI and PEPFAR II and to emphasize the importance of fully utilizing the opportunities to reach women and girls by addressing the health and development challenges that contribute to their risk of HIV.

With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction

involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.

The election of President Barack Obama has fundamentally changed the landscape for the debates around U.S. support for international family planning (FP) programs. The personal engagement of top leadership, notably the president himself and Secretary of State Hillary Clinton, combined with policy and budgetary announcements that make averting unintended pregnancies a priority issue, clearly signal the administration’s intention to promote family planning as part of a comprehensive approach to global health.

Despite the polarization that often surrounds the debates on these issues in the United States, largely over their perceived linkage to the highly charged issue of abortion, an unprecedented opportunity now exists to significantly expand international FP programs based on a common-ground approach.

The core element of this approach is the need to move toward universal access to FP services—defined throughout this paper as education, counseling, and contraceptive commodities—provided on a voluntary basis to females and couples.

This report was written by Janet Fleischman, senior associate of the CSIS HIV/AIDS Task Force and chair of the gender committee. It is based on the presentations and discussions at the CSIS conference held on October 30, 2007, “Integrating Reproductive Health and HIV/AIDS Services: Lessons from the Field for PEPFAR Reauthorization,” as well as Fleischman’s visits to Kenya, South Africa, and India in 2007 and her interviews with U.S. administration officials, congressional staff, HIV/AIDS organizations and service providers, reproductive health organizations, and women living with HIV/AIDS.

In the context of reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR), and looking ahead to the strategy that will be developed by the next U.S. administration, the conference sought to focus high-level attention on the opportunities and challenges of integrating reproductive health (RH) and HIV/AIDS programs. The proceedings demonstrated that substantial ingenuity and innovation is under way in integrating these services, and highlighted the importance of ensuring that the emerging lessons from the field inform decisions about the next phase of U.S. AIDS policy.

Asunta Wagura'shealthy baby boy has sparked considerable controversy in Kenya. As an HIV-infected woman and AIDS activist, Asunta's decision to conceive a child exposes an emerging feature of the global HIV/AIDS pandemic: increased access to life-prolonging treatment is affecting women's reproductive choices, and challenging ideas about the kind of services and policies required.

If we are to keep pace with the evolving pandemic, concerns about women's reproductive health must become an integral part of HIV/AIDS services and policies.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

Sometimes innovation to spur social change arises in unexpected places. At a time of increased extremism and insecurity in West Africa, the remarkable story of a partnership to advance women’s health and empowerment through family planning is worthy of global attention. By tackling such challenges, the partnership provides hope for women, girls, and their communities in a troubled region, with lessons for other parts of the world.

The story began in 2011, in Ouagadougou, the capital of landlocked Burkina Faso, when representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was unimaginable at its outset almost a decade ago, when even discussing family planning in such conservative societies was still perceived to be taboo. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners, with a special emphasis on engaging young people.

Click here to read the full article.

Sometimes innovation to spur social change arises in unexpected places. In 2011, in Ouagadougou, the capital of Burkina Faso, representatives from nine Francophone West African countries joined with international donors to launch a simple but radical plan. The idea was to expand access to contraception in a region that was dramatically lagging behind the rest of the continent in maternal and child health. What became known as the Ouagadougou Partnership achieved a level of success that was virtually unimaginable at the outset, when even discussing family planning in such conservative societies was perceived to be taboo. Now, almost a decade later, the partnership’s impact and lessons for other regions warrant both celebration and reflection.

The nine Francophone countries of the subregion (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo) united around an ambitious regional goal—to reach one million additional voluntary users of modern family planning methods by 2015, and 2.2 million more by 2020. The results have been impressive, especially given the low starting point of approximately 2.7 million users: by 2019, over 3.1 million additional voluntary users have been reached, Francophone West Africa has one of the fastest increases in modern contraceptive rates among developing regions, and family planning funding from the core donors has more than doubled. Even more important for future prospects, the partnership has evolved into a dynamic and influential regional platform involving governments, donors, civil society, and implementing partners.

The story of this partnership reflects a unique historical convergence: a group of bilateral and philanthropic donors willing to commit to the subregion, country-level champions from government and civil society, supported by implementing partners, prepared to advance family planning for health and development reasons, and a shared interest in doing business differently to address egregious gaps in women’s health and stalled indicators on family planning. By banding together, fueled by a shared commitment to achieving a regional goal, “friendly” competition among the countries, and grounded in data and evidence, the nine relatively small countries capitalized on their commonalities and made the region a more important geographic space and population size.

Janet was commissioned in 2019 by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation to write this report documenting the history of the Ouagadougou Partnership. She completed her research in January 2020, before the first cases of COVID-19 were confirmed in Francophone West Africa (in Senegal and Burkina Faso) in March 2020. Accordingly, this report does not address the impact of COVID-19 in Francophone West Africa or the challenges it presents to the Ouagadougou Partnership’s activities.

“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”

At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector.  These different funders can leverage each other’s investments.

Click here to read the full blog post.

The data are stark and incontrovertible: In eastern and southern Africa, girls account for 80 percent of all new HIV infections among adolescents, and HIV/AIDS is the leading cause of death for girls aged 15-19. With 7,000 girls and young women aged 15-24 infected every week, the goal of an AIDS-free generation cannot be achieved without a dramatic new approach to this population. After years of neglect, a global convergence is emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for adolescent girls and young women. Whether this new attention can catalyze reductions in new HIV infections represents a fundamental challenge for controlling the AIDS epidemic.

In a major shift, the President's Emergency Plan for AIDS Relief (PEPFAR) launched a new initiative on World AIDS Day in December 2014, in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden "hot spots" in 10 countries in eastern and southern Africa by identifying where these young women are being infected, what is putting them at risk, and how to target programs accordingly. The partnership's goal is to reduce incidence in high-burden areas by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

DREAMS and other international partnerships focused on HIV in adolescent girls and young women represent an ambitious effort to go beyond biomedical interventions to address the social and economic factors that put this population at risk of infection. It remains to be seen, however, if these initiatives can demonstrate impact in a short timeframe, and build toward sustainable programs. This is a critical moment to transform a growing global interest in women and girls in a range of sectors into effective HIV programing, and to highlight the results at the July 2016 International AIDS Conference in Durban, South Africa.

Download the report here.

Former President Bill Clinton delivered an energizing “call to action” at the closing session of AIDS 2012, encapsulating the high hopes and the sobering challenges facing the fight against global HIV/AIDS. Calling for renewed commitment despite the difficult economic environment, he told the

packed conference hall: “If you scale it up and it works, the money will be there to fund it.” For the nearly 24,000 participants, the two Clinton speeches – by the Secretary of State and the former President – served as notable bookends to the conference’s long-awaited return to the United States.

Funding for the response to the global AIDS crisis has increased exponentially in recent years, from US$ 260 million in 1996 to almost US$ 10 billion in 2007, nearly a forty-fold increase. While this figure still falls short of anticipated global need in the coming years, it is nonetheless a marked shift in the global response to the AIDS epidemic. At the same time, the new level of resources confers even greater responsibilities on the funding institutions to ensure that the key drivers of the epidemic are being addressed effectively.

This is particularly true in the area of gender and AIDS. While there is now broad international consensus that the gender dimension of the epidemic must be addressed, the three major AIDS financing institutions—the World Bank, the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)—have not historically focused on ensuring that funding and programs adequately target gender issues. However, recent initiatives in each of the three institutions hold promise for new momentum in this area.

All three major AIDS funding institutions have recently acknowledged the importance of gender and the need to prioritize the gender issues, and each is looking at different approaches toward defining and expanding gender strategies and programs.

The urgency and the challenges of advancing gender equity and equality are glaringly evident around the world. While the impacts of Covid-19 are reversing decades of health and development gains for women and girls, conflicts from Afghanistan to Ethiopia and, increasingly, Ukraine expose how failure to address gender dynamics significantly worsens those crises and further undermines global peace, prosperity, and security. This is an inflection point for U.S. policymakers—a year into a Biden administration that has made bold pronouncements on gender, with a world celebrating Women’s History Month—to assess the road ahead for the global dimensions of the new National Strategy on Gender Equity and Equality. Amid so many competing priorities, the question is, what will it take to propel this significant gender initiative to the next stage and establish the credibility and attention to deliver concrete results, not simply aspirational words?

On March 8, 2022, International Women’s Day, President Biden reaffirmed his commitment to advance gender equity and equality domestically and globally. Framed by the launch of the first-ever national gender strategy and supported by a $2.6 billion budget request for gender programs in foreign assistance, the administration is seeking to reinvigorate U.S. leadership with an ambitious vision for a whole-of-government approach. The administration has put in place exceptional leadership and capacity to deliver at high political levels, including at the White House, the State Department and the U.S. Mission to the United Nations, the U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Yet the time window for action and impact is narrowing, and next steps for implementation involve protracted, inside government processes. At the same time, the path ahead is increasingly complicated, with multiple world crises, a global pandemic, toxic partisanship, and institutional resistance all threatening to derail the agenda. After the sustained attacks on gender-related issues under the Trump administration, especially around sexual and reproductive health and LGBTQI+ rights, the Biden administration is faced with the strategic imperative of advancing gender equity and equality as essential to achieving U.S. goals on global health and development, economic prosperity, and national security, and proving that this can be accomplished.

To demonstrate the necessity of prioritizing global gender issues, the strategy will have to be executed effectively and deliver results. This will require the administration to expedite the timeline, identify a limited number of top-line priorities, widen the circle of committed champions, and garner operational and political support from key external, global partners.

Click here to link to the full commentary.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

In this episode of Take as Directed, host Janet Fleischman sits down with Geeta Rao Gupta, executive director of the 3D Program for Girls and Women, former president of the International Center for Research on Women (ICRW), and former Deputy Executive Director of UNICEF. They discuss the new series of The Lancet, of which Geeta was a principal author, that outlines the impact of gender norms and inequalities on health, describes persistent barriers to progress, and provides an agenda for action. They also discuss the recent Women Deliver conference in Vancouver and how to maintain optimism for the future.

Click here to listen to the podcast.

The urgency and the challenges of advancing gender equity and equality are glaringly evident around the world. While the impacts of Covid-19 are reversing decades of health and development gains for women and girls, conflicts from Afghanistan to Ethiopia and, increasingly, Ukraine expose how failure to address gender dynamics significantly worsens those crises and further undermines global peace, prosperity, and security. This is an inflection point for U.S. policymakers—a year into a Biden administration that has made bold pronouncements on gender, with a world celebrating Women’s History Month—to assess the road ahead for the global dimensions of the new National Strategy on Gender Equity and Equality. Amid so many competing priorities, the question is, what will it take to propel this significant gender initiative to the next stage and establish the credibility and attention to deliver concrete results, not simply aspirational words?

On March 8, 2022, International Women’s Day, President Biden reaffirmed his commitment to advance gender equity and equality domestically and globally. Framed by the launch of the first-ever national gender strategy and supported by a $2.6 billion budget request for gender programs in foreign assistance, the administration is seeking to reinvigorate U.S. leadership with an ambitious vision for a whole-of-government approach. The administration has put in place exceptional leadership and capacity to deliver at high political levels, including at the White House, the State Department and the U.S. Mission to the United Nations, the U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Yet the time window for action and impact is narrowing, and next steps for implementation involve protracted, inside government processes. At the same time, the path ahead is increasingly complicated, with multiple world crises, a global pandemic, toxic partisanship, and institutional resistance all threatening to derail the agenda. After the sustained attacks on gender-related issues under the Trump administration, especially around sexual and reproductive health and LGBTQI+ rights, the Biden administration is faced with the strategic imperative of advancing gender equity and equality as essential to achieving U.S. goals on global health and development, economic prosperity, and national security, and proving that this can be accomplished.

To demonstrate the necessity of prioritizing global gender issues, the strategy will have to be executed effectively and deliver results. This will require the administration to expedite the timeline, identify a limited number of top-line priorities, widen the circle of committed champions, and garner operational and political support from key external, global partners.

Click here to link to the full commentary.

On April 28, the U.S. Global Health Initiative (GHI) issued guidance on the women, girls, and gender equality principle – the first guidance to be issued about the GHI principles. The purpose of the guidance is to provide clarification on the goals and programming options for GHI country teams and partner countries. By explicitly recognizing that gender-related

inequalities “disproportionately compromise the health of women and girls and, in turn, affect families and communities,” the GHI is moving forward in putting women and girls at the center of its response. Importantly, the guidance seeks to go beyond looking at women and girls just as beneficiaries of health services and extends into empowering women as key actors and decision makers.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

South Africa, which has the largest HIV epidemic in the world and one of the highest rates of gender-based violence, is now experiencing a worsening COVID-19 epidemic. Professor Quarraisha Abdool Karim, Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and a leading global expert on HIV/AIDS, spoke to CSIS about the particularly negative impact of Covid-19 on adolescent girls and young women, and how it is fueling a parallel epidemic of gender-based violence. At a time when even the President of South Africa has condemned the violence against women during the COVID-19 crisis, Professor Abdool Karim calls for a proactive response to these twin crises.

Click here to link to see the video.

This episode of the Global Health Policy Center's Take as Directed podcast examines the changing nature of war and conflict and why gender-based violence (GBV) has become a central feature in crises around the world. GHPC Senior Associate Janet Fleischman sits down with Melissa Dalton, senior fellow and deputy director of the CSIS International Security Program and Director of the Cooperative Defense Project (CDP); and Fatima Imam, executive director of Rehabilitation, Empowerment, and Better Health Initiative and Network of Civil Society Organizations in Nigeria.

Janet and the guests discuss how GBV impacts women and girls in crises, focused especially on the Middle East and northern Nigeria, and how these ubiquitous and traumatizing realities undermine global health security and community resilience. This conversation is linked to a new CSIS report, How Can We Better Reach Women and Girls in Crises? and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

Click here to link to the podcast.

Violence against children (VAC) and violence against women (VAW) are public health and human rights crises of global proportions, with damaging consequences to the health and well-being of individuals and their communities. Fueled by gender inequality, social norms condoning violence and harmful traditional practices,1 and exacerbated by lack of commitment to take preventive and protective action and weak protection systems, violence against women and children (VAWC) as well as the magnitude, human toll and societal cost of this violence is increasingly acknowledged by the global community.

Together for Girls (TfG) is a partnership among national governments, UN entities and private sector organizations working at the intersection of VAW and VAC, with special attention to ending sexual violence against girls. Now being implemented in more than 22 countries, the TfG model supports governments to conduct a national household Violence Against Children Survey (VACS) and to use the data to mobilize action through policies and programs that embed violence prevention and response across multiple sectors.

In 2009, the Government of Tanzania, with support from TfG partners, most notably UNICEF, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), undertook the VACS. Tanzania was the first country to implement a full VACS, surveying both girls and boys (ages 13-24) nationally to assess the prevalence of emotional, physical and sexual violence. It was also the first country to introduce a government-led, multi-sector task force to oversee the implementation of the survey and the ensuing violence prevention and response work catalyzed by the data, which led to the establishment of a multi-sectoral, costed National Plan of Action. Ten years after Tanzania’s landmark research, this case study seeks to consolidate learnings from the national experience of implementing the TfG model.

Janet joins host Beverly Kirk or a conversation about Janet's latest report, which examines why women and girls’ health and protection should be a top priority in emergency and humanitarian crisis situations. It also looks at U.S. policy on global health security. This conversation is linked to the report and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

The Smart Women, Smart Power (SWSP) Initiative convenes top-level women leaders in foreign policy, national security, international business, and international development to amplify their voices, spotlight their expertise, and discuss critical and timely issues. The Smart Women, Smart Power biweekly podcast features powerful, in-depth conversations with women leaders from around the globe who are experts in foreign policy, national security, international business, and international development. SWSP Director Beverly Kirk moderates the podcast series.

Click here to listen to the podcast.

Debate about President Obama’s legacy will shift to Africa in late July, when he travels to Kenya on his fourth and likely final presidential trip to the continent. The trip is expected to focus on supporting economic entrepreneurship and combatting terrorism, which, along with increasing Africa’s energy capacity and food security, have been central to his Africa policy. In my latest blog, I write that this agenda misses a necessary component for progress on the continent; the President could cement a lasting legacy by explicitly linking U.S. Africa policy to the health and empowerment of women and girls, arguably the continent’s most dynamic and underdeveloped resource and an indispensable component of any successful economic and security program.

This piece is based on Janet's recent trip to Malawi and Kenya as part of a CARE learning tour that focused on the importance of U.S. investments in women and girls. The delegation included five members of Congress and senior administration officials.

The international outrage over Boko Haram’s abduction of Nigerian schoolgirls has escalated since the story first hit the news; mothers in Nigeria took action and celebrities from Angelina Jolie all the way to First Lady Michelle Obama have made their voices heard.

With mainstream attention finally focused on why the education, health, and empowerment of women and girls matters to Americans, it is time for the Obama administration to re-enforce its commitment to these issues and elevate them as central to U.S. foreign policy.

To mark International Women’s Day, First Lady Michelle Obama participated in the 2014 International Women of Courage awards ceremony at the State Department on March 4. The honorees, representing ten countries, were recognized for their extraordinary work on behalf of women and girls -- from combatting

gender-based violence and acid attacks, to advancing reproductive health and human rights. The First Lady spoke passionately about the need to confront the challenges that women and girls face at home and around the world, and about how the women being honored “are creating ripples that stretch across the globe.”

The health and empowerment of women and girls around the world has been elevated as a priority on the U.S. diplomacy and development agendas. This has been evidenced by a number of actions taken by the Obama Administration, most notably the focus on women, girls, and gender equality (WGGE) as one of seven core principles of the Administration’s Global Health Initiative (GHI). The GHI, announced in May 2009, was intended to promote a more comprehensive approach to U.S. government (USG) global health programs. As part of the GHI process, teams in countries receiving U.S. health assistance prepared GHI strategies, aligning their programs with the GHI’s principles, including WGGE, and have begun to implement those strategies.

To begin to understand how the principle is being applied to programs on the ground, the Kaiser Family Foundation conducted key informant interviews with 15 GHI country teams as well as USG staff in Washington, DC. The findings from the interviews yielded nine central themes and trends related to the response to and implementation of WGGE.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in high HIV prevalence countries in Africa. Despite bipartisan political consensus on the intersection of HIV and GBV, efforts to address

this area have not attracted the necessary attention and resources to drive the program innovation that could demonstrate progress. That may now be beginning to change, with new momentum being brought to this agenda by the President’s Emergency Plan for AIDS Reliefs (PEPFAR) GBV initiative.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in prevalence countries in Africa. Yet despite bipartisan political consensus on the intersection between HIV and GBV, efforts to address this area have not attracted the attention or resources necessary to drive the program innovation that could demonstrate progress. However, new momentum is now being brought to this agenda with the U.S. President's Emergency Plan for AIDS Relief's (PEPFAR) GBV initiative.

This paper examines how the GBV initiative is being introduced in Tanzania, one of the GBV focus countries, based on interviews in Tanzania in April 2012 with U.S. government officials, nongovernmental organizations, and implementing partners, as well as interviews in Washington, D.C. It describes the importance of this initiative for the work of PEPFAR and the Global Health Initiative (GHI), impediments to progress, why this program has the potential to provide valuable and timely lessons for achieving HIV-related goals and for improving health outcomes for women and girls, and priority steps for getting the best results in the future.

With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction

involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.

Violence against women is a global health crisis of epidemic proportions and often a cause and consequence of HIV. Violence and the threat of violence dramatically increase the vulnerability of women and girls to HIV by making it difficult or impossible for women to abstain from sex, to get their partners to be faithful, or to use a condom.

Violence is also a barrier for women in accessing HIV prevention, care, and treatment services. That is why the UNAIDS-led Global Coalition on Women and AIDS has made stopping violence against women a top priority. High rates of violence make women more vulnerable Growing evidence from around the world shows that a large proportion of women and girls are subjected to violence by family members, acquaintances, and strangers.

The catastrophe of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in Africa, which has already claimed over 18 million lives on that continent, has hit girls and women harder than boys and men. In many countries of eastern and southern Africa, HIV prevalence among girls under age eighteen is four to seven times higher than among boys the same age, an unusual disparity that means a lower average age of death from AIDS, as well as more deaths overall, among women than men.

Abuses of the human rights of girls, especially sexual violence and other sexual abuse, contribute directly to this disparity in infection and mortality. In Zambia, as in other countries in the region, tens of thousands of girls—many orphaned by AIDS or otherwise without parental care—suffer in silence as the government fails to provide basic protections from sexual assault that would lessen their vulnerability to HIV/AIDS.

Through girls’ own testimonies, this report shows sexual assault of girls in Zambia in the era of HIV/AIDS to be widespread and complex. It documents several categories of abuse that heighten girls’ risk of HIV infection, including (1) sexual assault of girls by family members, particularly the shocking and all too common practice of abuse of orphan girls by men who are their guardians, or by others who are charged to assist or look after them, including teachers, (2) abuse of girls, again often orphans, who are heads of household or otherwise desperately poor and have few options other than trading sex for their and their siblings’ survival, and (3) abuse of girls who live on the street, of whom many are there because they are without parental care. All of these situations of abuse must be addressed as part of combating the HIV/AIDS epidemic in Zambia.

During the 1994 genocide, Rwandan women were subjected to sexual violence on a massive scale, perpetrated by members of the infamous Hutu militia groups known as the Interahamwe, by other civilians, and by soldiers of the Rwandan Armed Forces (Forces Armées Rwandaises, FAR), including the Presidential Guard. Administrative, military and political leaders at the national and local levels, as well as heads of militia, directed or encouraged both the killings and sexual violence to further their political goal: the destruction of the Tutsi as a group. They therefore bear responsibility for these abuses.

Although the exact number of women raped will never be known, testimonies from survivors confirm that rape was extremely widespread and that thousands of women were individually raped, gang-raped, raped with objects such as sharpened sticks or gun barrels, held in sexual slavery (either collectively or through forced "marriage") or sexually mutilated. These crimes were frequently part of a pattern in which Tutsi women were raped after they had witnessed the torture and killings of their relatives and the destruction and looting of their homes. According to witnesses, many women were killed immediately after being raped.

In the genocide two years ago, many of Rwanda's women were brutally raped — in front of their relatives, sometimes with gun barrels or pieces of wood — and were then forced to watch as their assailants murdered their loved ones.

Thousands of women were raped, gang-raped, mutilated, held in sexual slavery or forcibly taken as "wives" by their persecutors. Not one of those indicted so far by the International Criminal Tribunal on Rwanda, however, has been charged with rape. This aspect of the genocide must not be neglected, and right now the tribunal has a perfect opportunity to include rape in its prosecution.

You can find the article here.

Former President Bill Clinton delivered an energizing “call to action” at the closing session of AIDS 2012, encapsulating the high hopes and the sobering challenges facing the fight against global HIV/AIDS. Calling for renewed commitment despite the difficult economic environment, he told the

packed conference hall: “If you scale it up and it works, the money will be there to fund it.” For the nearly 24,000 participants, the two Clinton speeches – by the Secretary of State and the former President – served as notable bookends to the conference’s long-awaited return to the United States.

Funding for the response to the global AIDS crisis has increased exponentially in recent years, from US$ 260 million in 1996 to almost US$ 10 billion in 2007, nearly a forty-fold increase. While this figure still falls short of anticipated global need in the coming years, it is nonetheless a marked shift in the global response to the AIDS epidemic. At the same time, the new level of resources confers even greater responsibilities on the funding institutions to ensure that the key drivers of the epidemic are being addressed effectively.

This is particularly true in the area of gender and AIDS. While there is now broad international consensus that the gender dimension of the epidemic must be addressed, the three major AIDS financing institutions—the World Bank, the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)—have not historically focused on ensuring that funding and programs adequately target gender issues. However, recent initiatives in each of the three institutions hold promise for new momentum in this area.

All three major AIDS funding institutions have recently acknowledged the importance of gender and the need to prioritize the gender issues, and each is looking at different approaches toward defining and expanding gender strategies and programs.

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

The health and empowerment of women and girls around the world has been elevated as a priority on the U.S. diplomacy and development agendas. This has been evidenced by a number of actions taken by the Obama Administration, most notably the focus on women, girls, and gender equality (WGGE) as one of seven core principles of the Administration’s Global Health Initiative (GHI). The GHI, announced in May 2009, was intended to promote a more comprehensive approach to U.S. government (USG) global health programs. As part of the GHI process, teams in countries receiving U.S. health assistance prepared GHI strategies, aligning their programs with the GHI’s principles, including WGGE, and have begun to implement those strategies.

To begin to understand how the principle is being applied to programs on the ground, the Kaiser Family Foundation conducted key informant interviews with 15 GHI country teams as well as USG staff in Washington, DC. The findings from the interviews yielded nine central themes and trends related to the response to and implementation of WGGE.

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs.

The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs. The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success.

Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

A period of major change is unfolding in health and HIV services in South Africa, carrying opportunities and risks for delivering effective, integrated health services that improve health outcomes and save lives. South Africa is decentralizing HIV services to the primary health are level, paving the way for greater integration to address women's health and to reduce maternal mortality. The United States can find feasible, flexible ways to support this process, even though its health program through the President's

Emergency Plan for AIDS Relief (PEPFAR), is scaling down. As PEPFAR transitions from an emergency to a more sustainable response, this is a crucial moment to demonstrate that it can address HIV-related goals by linking to more comprehensive services for women--notably linking HIV with family planning (FP), reproductive health (RH), and maternal child health (MCH). The stakes are high for PEPFAR and for the Global Health Initiative (GHI) to show results and, most importantly, for the women and children most at risk.

In May 2009, President Obama announced a new U.S. Global Health Initiative (GHI), proposed as a six-year, $63 billion effort to develop a comprehensive U.S. government strategy for global health, acting as an umbrella over most U.S. global health programs. The GHI is guided by seven core principles, the first of which is a “focus on women, girls, and gender equality.” The prominent attention given to this principle,

particularly as the first of the seven core principles, was seen as an indication of the importance placed on the health of women and girls as well as gender equality on the U.S. global health agenda. It is not yet known, however, how this principle will be implemented at the country level, and how its inclusion in the GHI will impact the health outcomes of those women, girls, families, and communities whom the GHI is intended to reach.

On April 28, the U.S. Global Health Initiative (GHI) issued guidance on the women, girls, and gender equality principle – the first guidance to be issued about the GHI principles. The purpose of the guidance is to provide clarification on the goals and programming options for GHI country teams and partner countries. By explicitly recognizing that gender-related

inequalities “disproportionately compromise the health of women and girls and, in turn, affect families and communities,” the GHI is moving forward in putting women and girls at the center of its response. Importantly, the guidance seeks to go beyond looking at women and girls just as beneficiaries of health services and extends into empowering women as key actors and decision makers.

The Obama administration’s Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR (the President’s Emergency Plan for AIDS Relief). As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government’s health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries,the emphasis on program integration in those U.S. government programs is especially relevant.

This paper, which is based on interviews conducted in Kenya in November 2010, as well as with policymakers and implementing partners in Washington, D.C., shows that the APHIA experience illustrates that integration across health sectors is feasible and effective, and that more focused evaluation of the impact of integrated programs would help Kenya and other GHI-Plus country teams and national governments as they develop their strategies. The maternal and child health (MCH) model in Kenya’s Western province is emerging as an innovative example of the benefits of providing women with a comprehensive set of MCH, family planning, reproductive health, and HIV/AIDS services in an integrated setting.

The opportunities to integrate health services to better address the client’s needs – especially women – is a key piece of the Obama administration’s Global Health Initiative (GHI). I went to Kenya in November to look for lessons for GHI from another US program -- the PEPFAR-USAID program called the AIDS, Population, Health and Integrated Assistance

Project (known as APHIA II; the next phase, APHIA Plus, will begin in 2011). APHIA II has shown that integration of HIV/AIDS and family planning can be an important component of HIV services for women, and that PEPFAR funds can be used effectively in an integrated setting to promote access to HIV services as well as broader health outcomes for women and children.

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference, entitled "Linkages between Gender, AIDS, and Development: Implications for U.S. Policy" on June 11, 2010.

This report provides background on the programs represented at the conference, summaries of the speakers' presentations, and U.S. policy options that emerged from the conference. It is intended to help inform the discussion surrounding the implementation of GHI and PEPFAR II and to emphasize the importance of fully utilizing the opportunities to reach women and girls by addressing the health and development challenges that contribute to their risk of HIV.

The imperative to devote specific focus to the multifaceted issues faced by women and girls as a pillar of both global health and HIV strategies has gained increasing prominence in international policy discourse in recent years. Yet the global-level policy changes necessary to operationalize these strategies too rarely filter down to the range of actors at the country level, including to AIDS professionals within national governments, the United Nations and other development partner organizations, and to members of civil society.

This brief describes the new directions in U.S. policy, notably in the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Health Initiative (GHI), and how these new goals might relate to strengthening national AIDS responses and programs focusing on women and girls.

The urgency and the challenges of advancing gender equity and equality are glaringly evident around the world. While the impacts of Covid-19 are reversing decades of health and development gains for women and girls, conflicts from Afghanistan to Ethiopia and, increasingly, Ukraine expose how failure to address gender dynamics significantly worsens those crises and further undermines global peace, prosperity, and security. This is an inflection point for U.S. policymakers—a year into a Biden administration that has made bold pronouncements on gender, with a world celebrating Women’s History Month—to assess the road ahead for the global dimensions of the new National Strategy on Gender Equity and Equality. Amid so many competing priorities, the question is, what will it take to propel this significant gender initiative to the next stage and establish the credibility and attention to deliver concrete results, not simply aspirational words?

On March 8, 2022, International Women’s Day, President Biden reaffirmed his commitment to advance gender equity and equality domestically and globally. Framed by the launch of the first-ever national gender strategy and supported by a $2.6 billion budget request for gender programs in foreign assistance, the administration is seeking to reinvigorate U.S. leadership with an ambitious vision for a whole-of-government approach. The administration has put in place exceptional leadership and capacity to deliver at high political levels, including at the White House, the State Department and the U.S. Mission to the United Nations, the U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Yet the time window for action and impact is narrowing, and next steps for implementation involve protracted, inside government processes. At the same time, the path ahead is increasingly complicated, with multiple world crises, a global pandemic, toxic partisanship, and institutional resistance all threatening to derail the agenda. After the sustained attacks on gender-related issues under the Trump administration, especially around sexual and reproductive health and LGBTQI+ rights, the Biden administration is faced with the strategic imperative of advancing gender equity and equality as essential to achieving U.S. goals on global health and development, economic prosperity, and national security, and proving that this can be accomplished.

To demonstrate the necessity of prioritizing global gender issues, the strategy will have to be executed effectively and deliver results. This will require the administration to expedite the timeline, identify a limited number of top-line priorities, widen the circle of committed champions, and garner operational and political support from key external, global partners.

Click here to link to the full commentary.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

IIn this episode of AIDS 2021, we discuss pre-exposure prophylaxis — PrEP — a critical HIV prevention tool for adolescent girls and young women (AGYW) in countries with high HIV burdens. Janet Fleischman speaks with Mitchell Warren, the executive director of AVAC, and two women working with Wits Reproductive Health and HIV Institute in South Africa – Khanyi Kwatsha, a 26-year-old PrEP ambassador, and Elmari Briedenhann, a senior project manager. They discuss the importance of PrEP for AGYW and highlight innovative approaches to better reach this group and to address the inherent challenges of meeting the needs of this population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with Dr. Linda-Gail Bekker, the deputy director of the Desmond Tutu HIV Center at the University of Cape Town, CEO of the Desmond Tutu HIV Foundation, and former president of the International AIDS Society. They discuss the effects of the Covid-19 pandemic on the lives of adolescent girls and young women and the potential impact on the momentum of HIV prevention programs designed for this vulnerable population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

Covid-19 is taking a heavy toll on adolescent girls and young women in sub-Saharan Africa, exacerbating their risks of HIV, gender-based violence, and unintended pregnancy. To understand these intersecting crises, we spoke to women working with and benefiting from the U.S.-led DREAMS initiative in Lusaka, Zambia: Batuke Walusiku-Mwewa is the Zambia

Country Director for Catholic Medical Mission Board (CMMB); Grace Njobvu and Grace Nachila are DREAMS participants. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) is a public-private partnership that aims to reduce new HIV infections among adolescent girls and young women in 15 countries through a multisectoral package of services.

South Africa, which has the largest HIV epidemic in the world and one of the highest rates of gender-based violence, is now experiencing a worsening COVID-19 epidemic. Professor Quarraisha Abdool Karim, Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and a leading global expert on HIV/AIDS, spoke to CSIS about the particularly negative impact of Covid-19 on adolescent girls and young women, and how it is fueling a parallel epidemic of gender-based violence. At a time when even the President of South Africa has condemned the violence against women during the COVID-19 crisis, Professor Abdool Karim calls for a proactive response to these twin crises.

Click here to link to see the video.

This is a pivotal moment for the U.S. Agency for International Development’s vision of global health and development, with the USAID Administrator, Samantha Power, championing locally led and inclusive development, referred to as localization. This approach focuses on making U.S. foreign assistance more accessible, equitable, and responsive by shifting leadership, decision making, and funding to local actors—government, civil society, and the private sector. While previous U.S. administrations promoted greater country ownership, the current discussion has taken on far greater urgency; it is happening amidst a global reckoning around structural racism and social determinants of health, decolonization of global aid, and the power imbalances inherent in donor-driven development. These debates have been accentuated by the COVID-19 pandemic, which has exacerbated inequities while shifting more responsibilities to local actors. Despite challenges ahead in operationalizing localization in compliance with USAID requirements, this vision holds the promise of advancing partner countries’ needs and priorities and transforming the global health landscape through a more inclusive, equitable, collaborative, and sustainable approach.

Most discussion around localization has centered on transitioning health service delivery and procurement to local partners, which is generally standardized and thus easier to measure than localization in the area of health policy. A gap exists in translating the localization agenda to the policy, advocacy, financing, and governance (PAFG) sphere of USAID’s global health programs. This foundational dimension cannot be overlooked: to strengthen health systems, to address health challenges at scale, and to sustain an equitable and inclusive response depends on a strong enabling environment, which reflects the interrelated social, economic, policy, and governance factors that influence the health system. PAFG activities aim to improve the enabling environment for health by strengthening the capacity of governmental bodies (parliaments, ministries, and regulatory agencies), as well as civil society advocacy organizations and the private sector in their stewardship of the health sector (Hardee et al., 2012). Taken together, these components form the foundation for health policy development, advocacy, decision making, civil society engagement, and domestic financing. Indeed, progress in localization will be demonstrated by the extent to which PAFG capacities, skills, and decision making are strengthened and transitioned to local actors. Strong and effective leadership by local actors in health is essential for USAID’s partner countries and local communities to steer toward a healthier future.

As USAID and its partners move forward in implementing localization, the Health Policy Plus (HP+) project seeks to support these efforts by building on its extensive global experience. Specifically, HP+ has partnered with local actors to plan, fund, and implement policy, advocacy, financing, and governance solutions to health challenges aimed at improving health outcomes. These programs have shown the importance of elevating local voices for policy and advocacy, including for marginalized groups and those focused on improving gender equity. HP+ has also shown the value of embedding aspects of localization into the development and implementation of government policies. Informed by HP+ lessons learned at the country level, this brief provides a set of recommendations and illustrative program examples for USAID, its implementing partners, and the global health community to collaborate, implement, and innovate in new ways with local partners to advance localization in the PAFG realm.

By promoting a vision for the way forward, HP+ seeks to further catalyze localization in PAFG and support local partners to achieve sustainable success, aligned with USAID’s commitments and goals. Ambassador Donald Steinberg, expert advisor on localization to Administrator Power, reiterated a guiding principle, often used by HIV advocates, for shifting responsibility to local actors: “Nothing about us without us.”

Pregnant women are known to be especially vulnerable to infection with influenza, including with the H1N1 virus, and to have an elevated risk of serious health complications, including disproportionately high fatality rates and spontaneous miscarriages. This increase in risk is due to the fact that a woman’s immune system is compromised during pregnancy, and because she faces a greater risk of respiratory complications in the later stages

of pregnancy as the enlarging uterus compresses her diaphragm and chest. While the number of H1N1-associated deaths in pregnant women has not been huge, the Centers for Disease Control and Prevention (CDC) has reported that 13% of all H1N1-related deaths between April and June were among otherwise healthy pregnant women. In addition, pregnant women infected with H1N1 face a 4x greater risk of hospitalization than non-pregnant H1N1 patients.

This is a pivotal moment for the Biden administration and the U.S. Agency for International Development (USAID) as they formulate a new vision for sustainable global health and development. The chief proponent is USAID Administrator Samantha Power, who is championing locally led and inclusive development, known as localisation.

The aspiration is to make U.S. foreign assistance more accessible, equitable, and responsive by shifting leadership, decision-making, and funding to local actors – government, civil society, and private sector.

While previous U.S. administrations promoted country ownership, the current discussion has taken on far greater urgency; it is happening amidst a pandemic and a global reckoning around structural racism and social determinants of health, decolonisation of global aid, and the power imbalances inherent in donor-driven development. Despite many challenges ahead, this vision holds the promise of advancing partner countries’ needs and priorities and transforming the global health landscape through a more equitable, collaborative, and sustainable approach.

As USAID moves forward with localisation, lessons learned from the Health Policy Plus Project (HP+) experience in partnering with local actors in 49 countries to design and apply policy, advocacy, financing and governance solutions to health challenges can help inform the way forward.

Click here to link to the full commentary.

This is a pivotal moment for the U.S. Agency for International Development’s vision of global health and development, with the USAID Administrator, Samantha Power, championing locally led and inclusive development, referred to as localization. This approach focuses on making U.S. foreign assistance more accessible, equitable, and responsive by shifting leadership, decision making, and funding to local actors—government, civil society, and the private sector. While previous U.S. administrations promoted greater country ownership, the current discussion has taken on far greater urgency; it is happening amidst a global reckoning around structural racism and social determinants of health, decolonization of global aid, and the power imbalances inherent in donor-driven development. These debates have been accentuated by the COVID-19 pandemic, which has exacerbated inequities while shifting more responsibilities to local actors. Despite challenges ahead in operationalizing localization in compliance with USAID requirements, this vision holds the promise of advancing partner countries’ needs and priorities and transforming the global health landscape through a more inclusive, equitable, collaborative, and sustainable approach.

Most discussion around localization has centered on transitioning health service delivery and procurement to local partners, which is generally standardized and thus easier to measure than localization in the area of health policy. A gap exists in translating the localization agenda to the policy, advocacy, financing, and governance (PAFG) sphere of USAID’s global health programs. This foundational dimension cannot be overlooked: to strengthen health systems, to address health challenges at scale, and to sustain an equitable and inclusive response depends on a strong enabling environment, which reflects the interrelated social, economic, policy, and governance factors that influence the health system. PAFG activities aim to improve the enabling environment for health by strengthening the capacity of governmental bodies (parliaments, ministries, and regulatory agencies), as well as civil society advocacy organizations and the private sector in their stewardship of the health sector (Hardee et al., 2012). Taken together, these components form the foundation for health policy development, advocacy, decision making, civil society engagement, and domestic financing. Indeed, progress in localization will be demonstrated by the extent to which PAFG capacities, skills, and decision making are strengthened and transitioned to local actors. Strong and effective leadership by local actors in health is essential for USAID’s partner countries and local communities to steer toward a healthier future.

As USAID and its partners move forward in implementing localization, the Health Policy Plus (HP+) project seeks to support these efforts by building on its extensive global experience. Specifically, HP+ has partnered with local actors to plan, fund, and implement policy, advocacy, financing, and governance solutions to health challenges aimed at improving health outcomes. These programs have shown the importance of elevating local voices for policy and advocacy, including for marginalized groups and those focused on improving gender equity. HP+ has also shown the value of embedding aspects of localization into the development and implementation of government policies. Informed by HP+ lessons learned at the country level, this brief provides a set of recommendations and illustrative program examples for USAID, its implementing partners, and the global health community to collaborate, implement, and innovate in new ways with local partners to advance localization in the PAFG realm.

By promoting a vision for the way forward, HP+ seeks to further catalyze localization in PAFG and support local partners to achieve sustainable success, aligned with USAID’s commitments and goals. Ambassador Donald Steinberg, expert advisor on localization to Administrator Power, reiterated a guiding principle, often used by HIV advocates, for shifting responsibility to local actors: “Nothing about us without us.”

Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

Click here to link to the commentary.

Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.

This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.

Click here to link to the full report.

The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

Click here to link to the article.

Now is the time for global and national leaders to step up and prioritize the health and development needs of adolescent girls and young women in policy and funding. In sub-Saharan Africa, the devastating impact of the Covid-19 crisis has heightened the risks that adolescent girls and young women face of HIV and gender-based violence, and has undermined their access to education, sexual and reproductive health, and economic empowerment. This crisis demands that we follow the lead of women and girls on the ground, share global resources with them, and allow adolescent girls and young women to take the microphone and further this agenda. This video highlights the urgency of stepping up for women and girls to address these challenges through three powerful voices: Mrs. Monica Geingos, the First Lady of the Republic of Namibia; Dr. Natalia Kanem, executive director of UNFPA; and Vilepi Banda, a 17-year-old DREAMS ambassador in Lusaka, Zambia.

Click here to link to the video.

On December 1, 2014—World AIDS Day—PEPFAR launched a bold initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. The goal was to significantly reduce new HIV incidence among adolescent girls and young women in the highest-burden countries in sub-Saharan Africa and in Haiti, where they face a far higher risk for new HIV infection—2 to 14 times higher—than their male peers. Despite the urgency of reducing HIV in this population to reach global goals for epidemic control, Covid-19 and new global efforts around health security threaten to divert the focus on this critical population. DREAMS is now at an inflection point, facing the risk that its progress on girls and young women will be reversed, along with decades of health and development gains for women and girls.

A major new report for the CSIS Global Health Policy Center examines what lessons have been learned in the first five years of DREAMS and what the next five-year approach might be, including redressing the disruptions and costly damage imposed by Covid-19. The report analyzes how DREAMS has evolved and what its impacts have been, including what factors contributed to success or constituted barriers. It also discusses implications for U.S. policy, focused on what is needed going forward if DREAMS is to further drive down HIV infections and increase the health and agency of girls and young women more broadly, with recommendations for the new Biden-Harris administration and Congress. The report argues that DREAMS has been successful in reaching millions of girls and young women with a multisectoral package of services and has catalyzed a global focus on young women and HIV. Although directly attributing the DREAMS impact is complicated, DREAMS has contributed to a decline in HIV incidence among AGYW in all the DREAMS districts. Yet DREAMS represents an expensive model that would be difficult for countries to replicate and sustain and has sparked criticism for operating in parallel to national and local mechanisms. Despite its challenges and critics, DREAMS has proven to be a promising model that is uniquely suited to an adapted and reimagined U.S. strategy that moves toward more integrated approaches and away from siloed, vertical programs.

Click here to download the report.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Click here to link to the podcast.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy.

In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Click here to link to the podcast.

Covid-19 is threatening education for girls and could reverse decades of health and development progress for girls and young women in sub-Saharan Africa. Education for girls, especially secondary education, is critical to prevent HIV, as well as early marriage, unintended pregnancy, and gender-based violence, while promoting empowerment and economic independence. To understand the impact of Covid-19 on education for girls, and the serious challenges girls are facing in returning to school after the Covid-19 lockdowns, we bring you three critical perspectives: Dr. Shannon Hader, UNAIDS deputy director of programme; Dr. Kakenya Ntaiya, founder and president of Kakenya’s Dream, which runs schools for girls in rural Kenya; and Chipego Kalumbi, a 17-year-old student and participant in PEPFAR’s DREAMS’s program in Lusaka, Zambia.

Click here to link to the video.

The Covid-19 pandemic has glaringly illuminated and exacerbated gender inequalities in health and development around the world. These mutually reinforcing crises, further compounded in countries with high HIV burdens, demonstrate that strengthening global health security requires a concerted focus on the health, development, and leadership of women and girls. Given the Biden-Harris administration’s new commitments to global health and gender, this is a propitious moment for the United States to catalyze programs, policies, and resources focused on women and girls to advance global health security strategy. “No country can recover from this pandemic,” President Biden said on March 8, International Women’s Day, “if it leaves half of its population behind.”

Requiring a gender lens for global health security is consistent with U.S. national interests in advancing women’s and girls’ access to healthcare, promoting social and economic development, providing humanitarian assistance, and increasing the odds of success for preparedness, response, and recovery activities. Such an approach calls for concerted action on four key fronts, and the administration will be judged on the progress it makes in these areas:

Click here to read the full commentary.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population.

You can see a photo of Valary with her daughter and her chickens here.

Thirty experts in global health, foreign policy, economic development, and national security signed "A Call to Action: Women’s Health and Gender Equality." The group represents a range of political views, but agrees that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests.

The results of the 2020 elections have brought the United States to a pivotal juncture. The Biden-Harris administration should capitalize on the window of opportunity of its first months in office to establish key pillars that will guide its tenure; a priority should be to reimagine U.S. global leadership on women’s health and gender equality. This will require Americans from diverse political persuasions to come together to promote a new vision and proactive strategy for the reinvention of the U.S. international agenda on these issues. With unprecedented domestic and global mobilization around women’s health and gender, this moment calls for decisive and inclusive action.

We represent a range of political views, but our engagement on women’s health and gender equality draws from a series of high-level activities organized by the CSIS Global Health Policy Center: the CSIS Commission on Strengthening America’s Global Health Security (2018–2022), the CSIS Women’s Health Policy Forum (2017–2020), and the CSIS Task Force on Women’s and Family Health (2015–2017). All these endeavors have shown that advancing women’s health and gender equality as fundamental rights is not only critical for global health and development, but also serves U.S. national security interests; in particular, this includes reaching long-standing U.S. goals on global health, poverty reduction, economic development, conflict prevention, and humanitarian response. Our purpose is to cut through the divisive partisanship and congressional deadlock to promote the renewal of a common sense, bipartisan approach to women’s and girls’ health, empowerment, and gender equality, building on points of continuity from prior Republican and Democratic administrations. Now is the time to bring people together, to look forward, and to rebuild consensus.

To meet this challenge, the new administration should adopt a signature focus on women’s health and gender equality as a fundamental pillar of U.S. foreign and development policies and programs. The time has come to restore U.S. leadership and capacity, repair frayed alliances around the world, and renew U.S. commitments to support a robust strategy to promote women’s health, development, and gender equality. This means adopting a new style of U.S. leadership, characterized by greater multilateralism and humility, learning from others and joining them as a supportive partner, and using U.S. power and influence to lift up and amplify voices from the Global South and women’s movements. To accomplish this, the new administration should adopt a bold approach to elevate this agenda and galvanize bipartisan support, while simultaneously reaching beyond Congress to forge a coalition that heightens the visibility of the private sector, health care providers, and the faith community to join with nongovernmental organizations and advocates for women’s and girls’ health and rights and gender equality. Such an approach would advance U.S. interests in saving lives while promoting prosperity and stability, and could help overcome the reluctance among more moderate voices in Congress.

Click here to read the full document and to see the signatories.

On World AIDS day in 2014, the U.S. Global AIDS coordinator, Ambassador Deborah Birx, sounded the alarm on HIV infections in adolescent girls and young women (AGYW) and launched an ambitious initiative called DREAMS—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—to significantly reduce new HIV cases in the highest-burden countries. After five years and over $900 million invested, DREAMS is now at an inflection point, with Covid-19 threatening to reverse its impact, along with decades of health and development gains for women and girls.

Faced with the intersecting crises of HIV, Covid-19, and gender inequality, the Biden-Harris administration should advance a strategic vision around securing a healthy future for this growing population of young women as key to the Covid-19 response and to the prosperity and stability of their countries—all central to U.S. national interests. While Covid-19 and vaccine distribution will dominate U.S. global health policy in the near term, these issues do not exist in a vacuum: in countries battling HIV epidemics, efforts to tackle the health and economic impacts of Covid-19 will not succeed without also addressing the fundamental challenges of HIV and gender inequality, which increase risk and vulnerability, especially for AGYW. To launch such a timely and targeted response, the incoming administration should build on the existing platform of DREAMS, adapting and amplifying its focus on AGYW as a priority health and development initiative.

You can read the full Commentary here.

IIn this episode of AIDS 2021, we discuss pre-exposure prophylaxis — PrEP — a critical HIV prevention tool for adolescent girls and young women (AGYW) in countries with high HIV burdens. Janet Fleischman speaks with Mitchell Warren, the executive director of AVAC, and two women working with Wits Reproductive Health and HIV Institute in South Africa – Khanyi Kwatsha, a 26-year-old PrEP ambassador, and Elmari Briedenhann, a senior project manager. They discuss the importance of PrEP for AGYW and highlight innovative approaches to better reach this group and to address the inherent challenges of meeting the needs of this population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with Dr. Linda-Gail Bekker, the deputy director of the Desmond Tutu HIV Center at the University of Cape Town, CEO of the Desmond Tutu HIV Foundation, and former president of the International AIDS Society. They discuss the effects of the Covid-19 pandemic on the lives of adolescent girls and young women and the potential impact on the momentum of HIV prevention programs designed for this vulnerable population.

Click here to link to the podcast.

In this episode of AIDS 2020, Janet Fleischman speaks with two women in Kenya about the impact of Covid-19: Maurine Murenga, who is executive director of Lean On Me Foundation, which supports adolescent mothers living with HIV, as well as a Global Fund board member; and Brenda Ochieng, a peer mentor for Pathfinder’s DREAMS project in Mombasa, Kenya. They discuss the progress in and challenges to HIV prevention among adolescent girls and young women in Kenya, and the worsening impact of the Covid-19 pandemic on this population.

Click here to link to the podcast.

South Africa, which has the largest HIV epidemic in the world and one of the highest rates of gender-based violence, is now experiencing a worsening COVID-19 epidemic. Professor Quarraisha Abdool Karim, Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and a leading global expert on HIV/AIDS, spoke to CSIS about the particularly negative impact of Covid-19 on adolescent girls and young women, and how it is fueling a parallel epidemic of gender-based violence. At a time when even the President of South Africa has condemned the violence against women during the COVID-19 crisis, Professor Abdool Karim calls for a proactive response to these twin crises.

Click here to link to see the video.

The population of Africa is expected to double over the next 20 years, which means that many countries are facing either a demographic dividend or potentially a disaster, with critical implications for global health and development. In this episode of Take as Directed, Janet Fleischman sits down with Amb. Mark Dybul, Director of the Center for Global Health and Quality, and Professor in the Department of Medicine at Georgetown University Medical Center, and formerly head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. They discuss why these demographic trends matter and how U.S. programs can better engage young people, especially adolescent girls and young women, to address their needs and support local innovation.

Click here to link to the podcast on SoundCloud.

Many of the fastest growing populations are in the world’s poorest countries, putting them at a critical threshold: either they will accelerate economic growth and innovation by investing in their burgeoning youth population or the rapid population growth coupled with a shortage of opportunities for young people will undermine advances in health, development, and ultimately security. These demographic trends, most notable in sub-Saharan Africa, are often referred to as a “youth boom” or a “youth bulge.” Given the enormous implications of these demographic shifts, U.S. assistance should promote young people’s health and development, with particular emphasis on empowering young women. Investments in human capital and gender equality would yield enormous benefits in improving health, reducing poverty, and increasing economic and political stability. Given that these goals align so strongly with U.S. national interests, they benefit from strong bipartisan support.

This agenda constitutes an urgent priority. The magnitude of this demographic transition is evident in sub-Saharan Africa; sixty percent of the population is under the age of 25 and is projected to dramatically increase in the coming years due to decreased under-five child mortality and to continued high fertility, which is often driven by early and closely spaced childbearing. In many of these countries, notably in the Sahel region of West Africa, the population may double as soon as 2030—the year the world community pledged to achieve the Sustainable Development Goals—and possibly quadruple by the end of the century. Overall, the population in sub-Saharan Africa could increase from 1 billion to 4 billion before the end of the century.

In some communities of KwaZulu-Natal Province, South Africa, 60 percent of women have HIV. Nearly 4,500 South Africans are newly infected every week; one-third are adolescent girls/young women (AGYW) ages 15-24. These are staggering figures, by any stretch of the imagination. Yet, the HIV epidemic is not being treated like a crisis. In February, we traveled to South Africa, to understand what is happening in these areas with “hyper-endemic” HIV epidemics, where prevalence rates exceed 15 percent among adults. We were alarmed by the complacency toward the rate of new infections at all levels and the absence of an emergency response, especially for young people.

This is no time for business as usual from South Africa or its partners, including the U.S. government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The epidemic is exacerbated by its concentration in 15-49-year-olds, those of reproductive and working age who are the backbone of South Africa. Without aggressive action to reduce the rate of new infections in young people, HIV will continue to take a tremendous toll on the country for years and generations to come. Collective action is needed to push beyond the complacency and internal barriers to implement policies and interventions that directly target HIV prevention and treatment for young people. PEPFAR should ensure its programs support those efforts.

Click here to read the full commentary.

Professor Quarraisha Abdool Karim is one of the world’s leading AIDS researchers and has made pioneering contributions to understanding the HIV epidemic in young people, especially among young women. She joined us for a two-part series to explain her latest research into epidemic hot spots in KwaZulu-Natal in South Africa, focusing on both the structural and biological risk factors that facilitate the spread of HIV in young women. In Part 1, she discusses the social and economic factors that contribute to the dramatic differences in HIV rates in women and men at different ages.In Part 2, she describes her recent findings about biological factors that can simultaneously increase a woman’s risk of HIV acquisition and decrease the efficacy of HIV prevention tools.

Click here to link to Part 1 and here to link to Part 2.

In many ways, Malawi exemplifies the success of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Over the last 14 years, new HIV infections have declined by 34 percent. Despite being among the poorest countries in the world, Malawi is approaching its HIV treatment targets. The possibility of controlling the epidemic is within reach.

But Malawi also lays bare major challenges and gaps facing the HIV response, notably how to prevent HIV and address HIV risk for adolescent girls and young women (AGYW) in low-resource settings.

Malawi is 1 of 10 focus countries in east and southern Africa under DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), a public-private partnership led by the President’s Emergency Plan for AIDS Relief (PEPFAR) that aims to reduce the number of new HIV infections among 15- to 24-year-old women by 40 percent in geographic “hot spots.” As a prevention program, it is attempting to reach young women and their male partners, populations that have proven very difficult to reach thus far.

This is a moment of heightened focus on the urgency of addressing HIV in adolescent girls and young women by the United States, other international partners, and the government of Malawi. To learn more about the status of DREAMS implementation and lessons for other country programs, CSIS conducted a research trip to Malawi in April 2017.

Amb. Virginia Palmer, U.S. Ambassador to Malawi, is a powerful champion for addressing the needs of adolescent girls and young women as the fulcrum for all development goals. We asked her to reflect on efforts in Malawi to control the AIDS epidemic through DREAMS, a public-private partnership designed to prevent new infections in this population. She emphasized the importance of empowering them with education, health and community interventions. Such an approach is necessary to curb the HIV crisis in Malawi, which in turn impacts all other U.S. development programs, and ultimately global health security.

Click here to link to the podcast on SoundCloud.

U.S. leadership through the President’s Emergency Plan for AIDS1 Relief (PEPFAR) has driven remarkable progress in curbing the global AIDS epidemic, raising the possibility of epidemic control in 10 African countries by 2020. But this success masks areas of urgent unfinished business that could derail this momentum, notably preventing HIV infections in adolescent girls and young women ages 15-24 in East and Southern Africa. Addressing the acute risks that these young women face presents unique challenges, especially in the current U.S. budgetary environment, but continued progress against HIV requires that this be a consistent and sustained U.S. priority. The benefits are clear and compelling: empowering these young women and providing access to services to protect themselves from HIV enables them to be healthy and to thrive, which contributes to healthier, more stable and prosperous families, communities, and societies.

Adolescent girls and young women face significantly higher HIV risk than males their age. That, combined with a youth population that has doubled since the start of the epidemic, leads to an inescapable conclusion: if new HIV infections among girls and young women are not greatly reduced, PEPFAR’s enormous investments to achieve an AIDS-free generation are at risk, as is the global response. Focusing on adolescent girls and young women, while also systematically engaging their male partners, provides a critical opportunity to interrupt the cycle of HIV transmission.

In response to these stark realities, in late 2014 PEPFAR launched DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe), a public-private partnership to reduce HIV in adolescent girls and young women in 10 countries. DREAMS holds notable promise in confronting this critical next frontier in fighting HIV, but faces challenges in demonstrating short-term impact on social and economic realities that directly or indirectly contribute to HIV risk for these young women.

Celina Schocken is CEO of Pink Ribbon Red Ribbon, an independent affiliate of the George W. Bush Institute that focuses on cervical and breast cancer prevention and treatment. We asked her to speak about the organization’s work, including why cervical cancer screening should be part of HIV and reproductive health, new innovative technologies, and an April delegation led by President George W. Bush and Mrs. Laura Bush to Botswana and Namibia.

Click here to link to the podcast on SoundCloud.

The CSIS Global Health Policy Center produced this video during a visit to Zambia in April 2016. It profiles four young Zambian women who describe the stark realities for adolescent girls and young women that fuel the AIDS epidemic – sexual violence, barriers to education and family planning, and gender inequality. Through their stories and insights, the video illustrates that in order to address the AIDS crisis in Southern Africa, we must understand the risks that young women face and work to engage and empower them.

Click here to watch the video. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Zambia is a lower-middle-income country struggling with critical health challenges, including high rates of maternal and neonatal mortality, malnutrition, cervical cancer, and a severe HIV/AIDS epidemic that disproportionately affects adolescent girls and young women. The United States is the largest donor to the health sector in Zambia, largely through the President’s Emergency Plan for AIDS Relief (PEPFAR).

Over the past five years, the U.S. has also helped establish several public-private partnerships (PPPs) aimed at advancing the health of women and families. These PPPs provide lessons about the potential impact of these approaches, the challenges inherent in such partnerships, and the importance of PEPFAR support. With future U.S. global health funding likely to be flat-lined, this is an important moment to assess how partnerships with the private sector can amplify the impact of U.S. investments in women’s and family health.

A delegation from the CSIS Task Force on Women’s and Family Health visited Zambia in April 2016 to examine U.S. investments through three partnerships: Saving Mothers Giving Life (SMGL), Pink Ribbon Red Ribbon (PRRR), and DREAMS. The delegation sought to understand these partnerships in Zambia within the context of U.S. support for women’s and family health, which represent the core of functional health systems.

Click here to read the report. You can link to the Zambia page of the CSIS Task Force on Women's & Family Health here.

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

You can find the full report here, and you can link to the CSIS Task Force on Women's & Family Health here.

“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”

At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector.  These different funders can leverage each other’s investments.

Click here to read the full blog post.

The data are stark and incontrovertible: In eastern and southern Africa, girls account for 80 percent of all new HIV infections among adolescents, and HIV/AIDS is the leading cause of death for girls aged 15-19. With 7,000 girls and young women aged 15-24 infected every week, the goal of an AIDS-free generation cannot be achieved without a dramatic new approach to this population. After years of neglect, a global convergence is emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for adolescent girls and young women. Whether this new attention can catalyze reductions in new HIV infections represents a fundamental challenge for controlling the AIDS epidemic.

In a major shift, the President's Emergency Plan for AIDS Relief (PEPFAR) launched a new initiative on World AIDS Day in December 2014, in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden "hot spots" in 10 countries in eastern and southern Africa by identifying where these young women are being infected, what is putting them at risk, and how to target programs accordingly. The partnership's goal is to reduce incidence in high-burden areas by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

DREAMS and other international partnerships focused on HIV in adolescent girls and young women represent an ambitious effort to go beyond biomedical interventions to address the social and economic factors that put this population at risk of infection. It remains to be seen, however, if these initiatives can demonstrate impact in a short timeframe, and build toward sustainable programs. This is a critical moment to transform a growing global interest in women and girls in a range of sectors into effective HIV programing, and to highlight the results at the July 2016 International AIDS Conference in Durban, South Africa.

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U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women’s health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women’s health will require maximizing investments by engaging new partners, identifying program synergies, and aligning with countries’ national priorities to meet women’s needs. Such strategic coordination—involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services—presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges of strengthening U.S. policy approaches to women’s global health issues.

U.S. policymakers and private-sector partners increasingly appreciate the importance of targeted U.S. investments in women's health to achieve global health outcomes, especially in sub-Saharan Africa. With budgetary constraints worsening, progress in women's health will require maximizing investment by engaging new partners., identifying program synergies, and aligning with countries' national priorities to meet women's needs. Such strategic coordination--involving maternal newborn and child health, voluntary family planning, and HIV and AIDS services--presents new opportunities to expand the impact of U.S. investments.

In March 2013, the CSIS Global Health Policy Center led a delegation to Zambia to examine the opportunities and challenges related to strengthening U.S. policy approaches to women's global health issues. CSIS chose to visit Zambia because of the new level of political will and leadership on women's health issues in the country; women leaders, in particular, are in an exceptional position to drive forward country ownership, including Zambia's first lady and other high-level government health officials.

Cervical cancer kills an estimated 275,000 women every year, 85 percent of whom are in developing countries. The link between HIV and cervical cancer is direct and deadly; HIV-infected women who are also infected with

specific types of human papilloma virus (HPV) are 4-5 times more susceptible to cervical cancer than HIV-negative women. This has important implications for HIV programs, especially in countries with significant HIV epidemics.

When Joyce Banda unexpectedly ascended to the presidency of Malawi last April, after the death of President Mutharika, many in her country and around the world wondered what her impact would be as Malawi’s first female president. Among the many challenges, her government faces high rates of maternal mortality, high total fertility rates, and high HIV prevalence among women and girls, combined with low levels of women’s economic empowerment and widespread violence against women.

A short video interview with President Banda explores how women leaders in Africa are bringing new attention to women’s health and empowerment in their own countries, and how they're bringing those voices into the discussion about U.S. policy priorities for women’s global health.

Cervical cancer kills an estimated 275,000 women every year, 85 percent of whom are in developing countries. The link between HIV and cervical cancer is direct and deadly; HIV-infected women who are also infected with specific types of human papilloma virus (HPV) are 4-5 times more susceptible to cervical cancer than HIV-negative women. This has

important implications for HIV programs, especially in countries with significant HIV epidemics. To understand the opportunities and challenges of integrating cervical cancer screening and treatment into HIV services for women, the Center for Strategic and International Studies traveled to Zambia, which has been at the forefront of integrating these services.

The health and empowerment of women and girls around the world has been elevated as a priority on the U.S. diplomacy and development agendas. This has been evidenced by a number of actions taken by the Obama Administration, most notably the focus on women, girls, and gender equality (WGGE) as one of seven core principles of the Administration’s Global Health Initiative (GHI). The GHI, announced in May 2009, was intended to promote a more comprehensive approach to U.S. government (USG) global health programs. As part of the GHI process, teams in countries receiving U.S. health assistance prepared GHI strategies, aligning their programs with the GHI’s principles, including WGGE, and have begun to implement those strategies.

To begin to understand how the principle is being applied to programs on the ground, the Kaiser Family Foundation conducted key informant interviews with 15 GHI country teams as well as USG staff in Washington, DC. The findings from the interviews yielded nine central themes and trends related to the response to and implementation of WGGE.

Former President Bill Clinton delivered an energizing “call to action” at the closing session of AIDS 2012, encapsulating the high hopes and the sobering challenges facing the fight against global HIV/AIDS. Calling for renewed commitment despite the difficult economic environment, he told the

packed conference hall: “If you scale it up and it works, the money will be there to fund it.” For the nearly 24,000 participants, the two Clinton speeches – by the Secretary of State and the former President – served as notable bookends to the conference’s long-awaited return to the United States.

This is an exciting and promising moment in the global effort to eliminate new HIV infections among children; we can finally see the possibility of eliminating mother-to-child transmission of HIV. To address the current status of these efforts and the way forward, the heads of WHO, UNICEF, and PEPFAR joined with ministers of health from Africa, representatives from the Global Fund, UNAIDS, UNITAID, the private sector, and women living with HIV at CSIS on July 22. You can find full video of the event here.

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The world's HIV/AIDS leaders are gathering in Washington, D.C., this week under the theme "turning the tide together." Yet the hope and optimism around creating an "AIDS-free generation" needs to be channeled into critical strategies that could make an immediate difference for women and girls.

The President’s Emergency Plan for AIDS Relief (PEPFAR) is well positioned to serve as a foundation for other global health programs, building on its health infrastructure, training, and systems. To fulfill that potential in the vital area of women’s health will require integrating HIV/AIDS services with family planning and reproductive health services. I was recently in Tanzania, where the results of U.S. health investments indicate that this is a feasible and cost effective strategy to combat the AIDS epidemic and promote the health of women and girls, and through them their families and communities.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in high HIV prevalence countries in Africa. Despite bipartisan political consensus on the intersection of HIV and GBV, efforts to address

this area have not attracted the necessary attention and resources to drive the program innovation that could demonstrate progress. That may now be beginning to change, with new momentum being brought to this agenda by the President’s Emergency Plan for AIDS Reliefs (PEPFAR) GBV initiative.

The dual global epidemics of HIV/AIDS and gender-based violence (GBV) exert a destructive and disproportionate impact on women and girls, especially in prevalence countries in Africa. Yet despite bipartisan political consensus on the intersection between HIV and GBV, efforts to address this area have not attracted the attention or resources necessary to drive the program innovation that could demonstrate progress. However, new momentum is now being brought to this agenda with the U.S. President's Emergency Plan for AIDS Relief's (PEPFAR) GBV initiative.

This paper examines how the GBV initiative is being introduced in Tanzania, one of the GBV focus countries, based on interviews in Tanzania in April 2012 with U.S. government officials, nongovernmental organizations, and implementing partners, as well as interviews in Washington, D.C. It describes the importance of this initiative for the work of PEPFAR and the Global Health Initiative (GHI), impediments to progress, why this program has the potential to provide valuable and timely lessons for achieving HIV-related goals and for improving health outcomes for women and girls, and priority steps for getting the best results in the future.

The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs.

The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results.

In May 2009, President Obama announced a new U.S. Global Health Initiative (GHI), proposed as a six-year, $63 billion effort to develop a comprehensive U.S. government strategy for global health, acting as an umbrella over most U.S. global health programs. The GHI is guided by seven core principles, the first of which is a “focus on women, girls, and gender equality.” The prominent attention given to this principle,

particularly as the first of the seven core principles, was seen as an indication of the importance placed on the health of women and girls as well as gender equality on the U.S. global health agenda. It is not yet known, however, how this principle will be implemented at the country level, and how its inclusion in the GHI will impact the health outcomes of those women, girls, families, and communities whom the GHI is intended to reach.

The Obama administration’s Global Health Initiative (GHI), announced in May 2009 as a six-year, $63-billion program, has put a strong emphasis on integration of health services, building largely on the work of PEPFAR (the President’s Emergency Plan for AIDS Relief). As implementation of GHI is moving ahead and country strategies are being developed, this is an important moment to bring forward lessons learned from the experience of integration in the U.S. government’s health and development programs. A key example involves U.S. health programs in Kenya over the past five years, notably the APHIA program (the AIDS, Population and Health Integrated Assistance program), which developed an integrated program based on the PEPFAR platform. This paper finds that the APHIA programs in Kenya hold some important lessons that should help inform GHI implementation. Since Kenya has been designated one of eight GHI-Plus countries,the emphasis on program integration in those U.S. government programs is especially relevant.

This paper, which is based on interviews conducted in Kenya in November 2010, as well as with policymakers and implementing partners in Washington, D.C., shows that the APHIA experience illustrates that integration across health sectors is feasible and effective, and that more focused evaluation of the impact of integrated programs would help Kenya and other GHI-Plus country teams and national governments as they develop their strategies. The maternal and child health (MCH) model in Kenya’s Western province is emerging as an innovative example of the benefits of providing women with a comprehensive set of MCH, family planning, reproductive health, and HIV/AIDS services in an integrated setting.

The opportunities to integrate health services to better address the client’s needs – especially women – is a key piece of the Obama administration’s Global Health Initiative (GHI). I went to Kenya in November to look for lessons for GHI from another US program -- the PEPFAR-USAID program called the AIDS, Population, Health and Integrated Assistance

Project (known as APHIA II; the next phase, APHIA Plus, will begin in 2011). APHIA II has shown that integration of HIV/AIDS and family planning can be an important component of HIV services for women, and that PEPFAR funds can be used effectively in an integrated setting to promote access to HIV services as well as broader health outcomes for women and children.

Global health, development, and gender are now understood to be dynamic and interlinked components of U.S. foreign policy. Given the emerging policy and programmatic debates on how these three domains are to be integrated to bring the greatest returns, especially in improving the health and welfare of women and girls, the CSIS Global Health Policy Center hosted a conference, entitled "Linkages between Gender, AIDS, and Development: Implications for U.S. Policy" on June 11, 2010.

This report provides background on the programs represented at the conference, summaries of the speakers' presentations, and U.S. policy options that emerged from the conference. It is intended to help inform the discussion surrounding the implementation of GHI and PEPFAR II and to emphasize the importance of fully utilizing the opportunities to reach women and girls by addressing the health and development challenges that contribute to their risk of HIV.

The imperative to devote specific focus to the multifaceted issues faced by women and girls as a pillar of both global health and HIV strategies has gained increasing prominence in international policy discourse in recent years. Yet the global-level policy changes necessary to operationalize these strategies too rarely filter down to the range of actors at the country level, including to AIDS professionals within national governments, the United Nations and other development partner organizations, and to members of civil society.

This brief describes the new directions in U.S. policy, notably in the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Health Initiative (GHI), and how these new goals might relate to strengthening national AIDS responses and programs focusing on women and girls.

The interlinked tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics are taking a dramatic toll on women’s lives, notably in countries with high HIV prevalence. While TB is now the third leading cause of death among women aged 15-44, killing some 700,000 women every year and causing illness in millions more, it is particularly lethal for women living with HIV. Yet the burden of the dual TB/HIV epidemic on women, and the

gender-related barriers to detection and treatment, are not being addressed explicitly by global donors, national health systems, or community groups. The urgency of this situation demands that TB be elevated as a key women’s health issue, and that TB screening, prevention and treatment be made a routine part of HIV, reproductive health and maternal and child health services. The lives of millions of women depend on our ability to move this agenda forward.

With all the troubling political news coming out of Kenya these days, it’s important to highlight some promising initiatives that are under way in the arena of women’s health, often driven by civil society groups or international NGOs in collaboration with the government. One area where such initiatives are getting some traction

involves the bi-directional integration of family planning/reproductive health with HIV/AIDS services. Indeed, the new approaches toward broader integration hold the promise of helping to address both the country’s HIV/AIDS crisis and women’s reproductive health needs, including addressing the huge unmet need for family planning.

Girls’ education has long been recognized as a critical tool in the fight against HIV/AIDS, in the empowerment of women and girls, and in enhancing the health and welfare of families and communities. In a severely AIDS-affected country like Zambia, education and HIV/AIDS are inseparable: the epidemic is causing many girls in poor communities to lose access to education, often

compelling them to withdraw from school to look after sick parents or to care for their siblings, or the absenteeism resulting from their care-giving duties leaves them unable to keep up at school. Even those who stay in school face risks related to sexual abuse by teachers themselves or by older men who offer them money in exchange for sex, sometimes as a way to pay for school fees.

The province of KwaZulu Natal in South Africa is the hardest hit with HIV, with HIV prevalence rates at antenatal clinics estimated to be over 40 percent - about twice as high as the national prevalence. When combined with high rates of teenage pregnancy – about one-third of 18 and 19 year olds have already given birth - it is critical to address the social and economic factors that are contributing to this alarming situation. Data collected by the New York-based Population Council have shown that factors such as poverty, orphanhood, and social isolation can influence sexual behaviors, and therefore HIV risk.

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I’m heading to South Africa and Zambia to look at innovative programs that link gender, AIDS, and development. While PEPFAR is not designed to fund development programs, there is a growing recognition that U.S. HIV/AIDS funding must link with the broader development agenda. Given the high HIV infection rates among women and girls in southern Africa, I am going to investigate how HIV/AIDS funding can be

linked to aspects of the development agenda to address the structural, societal factors that shape women and girls’ risk of HIV infection and complicate their situations once infected. Key linkages with the development arena include family planning and reproductive health as an essential component of HIV/AIDS services, and education for girls and economic empowerment for women as HIV prevention strategies.

When Michelle Obama, the first lady of the United States, visits Ghana with President Barack Obama in July, the powerful voice she has used to empower disadvantaged girls at home can be extended to Africa. By spotlighting the disproportionate impact of Aids on women and girls, she can help strengthen the Aids response - at home and abroad.

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The XVII International AIDS Conference in Mexico City sheds a global spotlight on both the progress in combating HIV and AIDS and the failure of our current prevention efforts to stem the epidemic. Despite increased funding for and access to HIV and AIDS treatment around the world, the imperative to vastly increase HIV prevention remains urgent: for every two people put on treatment, five more are newly infected. In the absence of a medical vaccine, the course of the epidemic will depend on how the global community rises to the challenge of prevention.

CARE’s global work on HIV and AIDS in over 40 countries demonstrates that making a real difference in the AIDS epidemic requires more comprehensive, multisectoral approaches to prevention that address the broader context and the factors that are fueling the epidemic. We need strategies that link HIV prevention with development approaches that attack the underlying causes of vulnerability to HIV – such as economic and food security, community empowerment, reproductive health and education – that can build economic and social “vaccines.” A comprehensive approach of this nature means going beyond traditional prevention programming focusing on individual behavior change to also address the social, economic and cultural factors that shape people’s risk of contracting HIV and impede their access to prevention programs.

The AIDS crisis not only represents a threat to the lives of millions of people, particularly in sub-Saharan Africa, but it also undermines hard-won gains throughout the developing world. Through our global field experience, CARE has seen how the AIDS pandemic is linked to deepening poverty, gender inequality and social marginalization. To make a real difference in the fight against HIV and AIDS, our responses must be as interconnected and multidimensional as the AIDS pandemic itself.

This report describes how a comprehensive approach to HIV and AIDS, addressing both the underlying drivers of vulnerability to HIV and AIDS and the broader arenas in which these vulnerabilities play out, is the best use of U.S. HIV funding. Unless the global response to HIV and AIDS addresses these factors, particularly for women and girls, even the best-funded efforts will not achieve lasting impact. Accordingly, this report builds the case for such a comprehensive and sustainable approach by drawing upon CARE’s field experience, focusing on program examples in three key arenas: addressing gender inequality and vulnerability, integrating HIV with economic and food security and supporting community mobilization and engagement.

This report was written by Janet Fleischman, senior associate of the CSIS HIV/AIDS Task Force and chair of the gender committee. It is based on the presentations and discussions at the CSIS conference held on October 30, 2007, “Integrating Reproductive Health and HIV/AIDS Services: Lessons from the Field for PEPFAR Reauthorization,” as well as Fleischman’s visits to Kenya, South Africa, and India in 2007 and her interviews with U.S. administration officials, congressional staff, HIV/AIDS organizations and service providers, reproductive health organizations, and women living with HIV/AIDS.

In the context of reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR), and looking ahead to the strategy that will be developed by the next U.S. administration, the conference sought to focus high-level attention on the opportunities and challenges of integrating reproductive health (RH) and HIV/AIDS programs. The proceedings demonstrated that substantial ingenuity and innovation is under way in integrating these services, and highlighted the importance of ensuring that the emerging lessons from the field inform decisions about the next phase of U.S. AIDS policy.

This is a defining moment for U.S. AIDS policy, as Congress and the Bush administration prepare for the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR), which expires in September 2008. The reauthorization process offers U.S. policymakers the chance to reflect on the evolution oft he epidemic, to analyze the data collected, and to apply the lessons learned during PEPFAR's first phase, in order to strengthen U.S. AIDS strategy going forward.

Policymakers recognize that gender is an essential component in the fight against the global AIDS epidemic, and PEPFAR has made progress in implementing gender strategies. But the time has come to move beyond consensus statements on the importance of gender and limited programs to develop a stronger, elevated, and comprehensive approach that has real impact on the lives of women and girls in a world of AIDS.

Asunta Wagura'shealthy baby boy has sparked considerable controversy in Kenya. As an HIV-infected woman and AIDS activist, Asunta's decision to conceive a child exposes an emerging feature of the global HIV/AIDS pandemic: increased access to life-prolonging treatment is affecting women's reproductive choices, and challenging ideas about the kind of services and policies required.

If we are to keep pace with the evolving pandemic, concerns about women's reproductive health must become an integral part of HIV/AIDS services and policies.

Women account for nearly half of HIV infections worldwide and almost two-thirds of those among young people, with female infections rising in almost every region. Yet twenty-five years into the global AIDS epidemic, there is still no widely available technology that women can both initiate and control to protect themselves from HIV. Due to gender norms and inequalities, many women and girls lack the social and economic power to control key aspects of their lives, particularly sexual matters. As a result, women are in a difficult, and often impossible, situation when it comes to negotiating with their partners over abstinence, fidelity, or condom use.

Given the AIDS epidemic’s disproportionate impact on women, there is a critical need to develop prevention options that women can use with, or when necessary without, their partner's knowledge. Unless women gain greater access to effective prevention tools that they can control, global and national efforts to halt the spread of AIDS cannot succeed. Improving prevention options for women requires both broadening current prevention strategies and developing new technologies that enhance women’s ability to protect themselves.

AIDS, like poverty, has a disproportionate impact on women and girls. Worldwide, of the 1.2 billion people living on less than $1 a day, 70 percent are women. Women own a minority of the world’s land, and yet produce two-thirds of the food in the developing world, are the primary caretakers for children, orphans, and the sick, and represent almost half of those living with HIV globally—nearly 60 percent in sub-Saharan Africa.

In many societies, women are economically and financially dependent on male partners and family members. This dependence can dramatically increase their chances of becoming infected with HIV. Moreover, many women have little control over sexual matters in their relationships, which they often fear might be jeopardized by discussions about sexual issues.

Violence against women is a global health crisis of epidemic proportions and often a cause and consequence of HIV. Violence and the threat of violence dramatically increase the vulnerability of women and girls to HIV by making it difficult or impossible for women to abstain from sex, to get their partners to be faithful, or to use a condom.

Violence is also a barrier for women in accessing HIV prevention, care, and treatment services. That is why the UNAIDS-led Global Coalition on Women and AIDS has made stopping violence against women a top priority. High rates of violence make women more vulnerable Growing evidence from around the world shows that a large proportion of women and girls are subjected to violence by family members, acquaintances, and strangers.

Growing evidence shows that getting and keeping young people in school, particularly girls, dramatically lowers their vulnerability to HIV. By itself, merely attending primary school makes young people significantly less likely to contract HIV. When young people stay in school through the secondary level, education’s protective effect against HIV is even more pronounced. This is especially true for girls who, with each additional year of education, gain greater independence, are better equipped to make decisions affecting their sexual lives, and have higher income earning potential – all of which help them stay safe from HIV. Higher education levels are also clearly correlated with delayed sexual debut, greater HIV awareness and knowledge about HIV testing sites, fewer sexual partners, higher rates of condom use, and greater communication about HIV prevention between partners – all factors that substantially lower HIV risk.

By providing young women with greater economic options and autonomy, education also affords them the knowledge, skills, and opportunities they need to make informed choices about how to delay marriage and childbearing; have healthier babies; avoid commercial sex and other risky behaviors; and gain awareness of their rights.

"Access for All," the theme of next month's International AIDS Conference in Bangkok, sets an appropriately high standard for the world's response to the pandemic. Unfortunately, all too many prevention and treatment programs fail to address the needs of most of those living with the virus, especially in Africa: women and girls. It's time to design programs targeted to the risks that women and girls face in a world of AIDS.

Most prevention messages, and certainly those favored by the Bush administration, focus on the "ABC" approach to fighting HIV-AIDS: abstinence, be faithful, and use condoms. While important messages, these things are often not within women's power to control. It is urgent that we develop a "DEF" approach that responds to needs repeatedly expressed by women living with HIV-AIDS and by AIDS activists in Africa.

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International Women's Day, focusing this year on the plight of women and HIV/AIDS, carries special significance. In the worst-affected regions of sub-Saharan Africa, women and girls account for 58 percent of those living with HIV/AIDS, and girls age 15-19 are infected at rates four to seven times higher than boys, a disparity linked to sexual abuse, coercion, discrimination, and impoverishment.

The Bush administration's new five-year global HIV/AIDS strategy recognizes the urgent situation of women and girls, but much more is needed to translate this into action on the ground.

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Recent international initiatives to provide antiretroviral (ARV) treatment in resource-poor countries have changed the landscape of the HIV/AIDS debate and signal an unprecedented new phase in the struggle against HIV/AIDS. With an estimated 40 million people living with HIV/AIDS and 14,000 new infections every day, access to treatment is a challenge of global

proportions. In sub-Saharan Africa alone, almost 4.5 million people need antiretroviral treatment, yet only 100,000 currently receive it. To develop effective treatment programs, national governments, international donors, and community stakeholders should ensure equitable access to HIV treatment and care, notably for acutely vulnerable populations such as women and girls.

The catastrophe of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in Africa, which has already claimed over 18 million lives on that continent, has hit girls and women harder than boys and men. In many countries of eastern and southern Africa, HIV prevalence among girls under age eighteen is four to seven times higher than among boys the same age, an unusual disparity that means a lower average age of death from AIDS, as well as more deaths overall, among women than men.

Abuses of the human rights of girls, especially sexual violence and other sexual abuse, contribute directly to this disparity in infection and mortality. In Zambia, as in other countries in the region, tens of thousands of girls—many orphaned by AIDS or otherwise without parental care—suffer in silence as the government fails to provide basic protections from sexual assault that would lessen their vulnerability to HIV/AIDS.

Through girls’ own testimonies, this report shows sexual assault of girls in Zambia in the era of HIV/AIDS to be widespread and complex. It documents several categories of abuse that heighten girls’ risk of HIV infection, including (1) sexual assault of girls by family members, particularly the shocking and all too common practice of abuse of orphan girls by men who are their guardians, or by others who are charged to assist or look after them, including teachers, (2) abuse of girls, again often orphans, who are heads of household or otherwise desperately poor and have few options other than trading sex for their and their siblings’ survival, and (3) abuse of girls who live on the street, of whom many are there because they are without parental care. All of these situations of abuse must be addressed as part of combating the HIV/AIDS epidemic in Zambia.

This episode of the Global Health Policy Center's Take as Directed podcast examines the changing nature of war and conflict and why gender-based violence (GBV) has become a central feature in crises around the world. GHPC Senior Associate Janet Fleischman sits down with Melissa Dalton, senior fellow and deputy director of the CSIS International Security Program and Director of the Cooperative Defense Project (CDP); and Fatima Imam, executive director of Rehabilitation, Empowerment, and Better Health Initiative and Network of Civil Society Organizations in Nigeria.

Janet and the guests discuss how GBV impacts women and girls in crises, focused especially on the Middle East and northern Nigeria, and how these ubiquitous and traumatizing realities undermine global health security and community resilience. This conversation is linked to a new CSIS report, How Can We Better Reach Women and Girls in Crises? and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

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Janet joins host Beverly Kirk or a conversation about Janet's latest report, which examines why women and girls’ health and protection should be a top priority in emergency and humanitarian crisis situations. It also looks at U.S. policy on global health security. This conversation is linked to the report and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

The Smart Women, Smart Power (SWSP) Initiative convenes top-level women leaders in foreign policy, national security, international business, and international development to amplify their voices, spotlight their expertise, and discuss critical and timely issues. The Smart Women, Smart Power biweekly podcast features powerful, in-depth conversations with women leaders from around the globe who are experts in foreign policy, national security, international business, and international development. SWSP Director Beverly Kirk moderates the podcast series.

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The urgency and the challenges of advancing gender equity and equality are glaringly evident around the world. While the impacts of Covid-19 are reversing decades of health and development gains for women and girls, conflicts from Afghanistan to Ethiopia and, increasingly, Ukraine expose how failure to address gender dynamics significantly worsens those crises and further undermines global peace, prosperity, and security. This is an inflection point for U.S. policymakers—a year into a Biden administration that has made bold pronouncements on gender, with a world celebrating Women’s History Month—to assess the road ahead for the global dimensions of the new National Strategy on Gender Equity and Equality. Amid so many competing priorities, the question is, what will it take to propel this significant gender initiative to the next stage and establish the credibility and attention to deliver concrete results, not simply aspirational words?

On March 8, 2022, International Women’s Day, President Biden reaffirmed his commitment to advance gender equity and equality domestically and globally. Framed by the launch of the first-ever national gender strategy and supported by a $2.6 billion budget request for gender programs in foreign assistance, the administration is seeking to reinvigorate U.S. leadership with an ambitious vision for a whole-of-government approach. The administration has put in place exceptional leadership and capacity to deliver at high political levels, including at the White House, the State Department and the U.S. Mission to the United Nations, the U.S. Agency for International Development (USAID), and the Department of Health and Human Services (HHS). Yet the time window for action and impact is narrowing, and next steps for implementation involve protracted, inside government processes. At the same time, the path ahead is increasingly complicated, with multiple world crises, a global pandemic, toxic partisanship, and institutional resistance all threatening to derail the agenda. After the sustained attacks on gender-related issues under the Trump administration, especially around sexual and reproductive health and LGBTQI+ rights, the Biden administration is faced with the strategic imperative of advancing gender equity and equality as essential to achieving U.S. goals on global health and development, economic prosperity, and national security, and proving that this can be accomplished.

To demonstrate the necessity of prioritizing global gender issues, the strategy will have to be executed effectively and deliver results. This will require the administration to expedite the timeline, identify a limited number of top-line priorities, widen the circle of committed champions, and garner operational and political support from key external, global partners.

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Women and girls in Africa are at escalated risk of violence, exploitation, poverty, and HIV infection, due to the Trump administration’s abrupt shuttering of more than 80 percent of the United States Agency for International Development and 70 percentof the agency’s HIV programs, along with deep cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR). The dismantling of U.S. foreign assistance and global health programming perpetuates the reality that HIV has a female face in Africa, reversing recent progress: In 2023, women and girls accounted for 62 percent of all new infections, representing 3,100 new infections every week, down from 5,500 in 2018. These gains are now under distinct threat, with severe health security and economic consequences for the high-burden countries and the United States.

Countries with high HIV prevalence rates must now make tough choices about how to keep vulnerable young women healthy, safe, and economically productive, goals that donors, the private sector, and civil society organizations could help them achieve. Despite constrained domestic and global resources, national systems should be reinforced to provide sustainable, affordable, and accountable services. Otherwise, HIV acquisition among girls and young women, who are more than three times as likely to acquire HIV as their male peers, will be the leading edge of a resurgent epidemic that knows no borders.

The path forward will depend on national governments and their partners strategizing around four central challenges, which will require innovative financing and service delivery, prioritization, and leveraging U.S. and other bilateral and multilateral donors, and private sector capacities: (1) how to promote precision and efficiencies in public and private sector service delivery to address HIV risk for young women; (2) how to facilitate access for adolescent girls and young women to the most effective biomedical prevention products; (3) how prevention services focusing on social, economic, and health factors can be integrated into national platforms; and (4) where the use of advanced modeling and new diagnostic capabilities can help monitor impact and track progress. As Professor Quarraisha Abdool-Karim, a leading HIV researcher in South Africa, explained to me in a recent interview: “We can’t do everything everywhere all at once; we have to choose our battles and prioritize based on data and feasibility and logistics and coverage rates, and build from there.”

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Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.

This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.

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The HIV pandemic has long revealed the inequities and fault lines in societies, one of the most tenacious being the pandemic’s disproportionate impact on adolescent girls and young women. In east and southern Africa, renewed global action is needed to invigorate an effective yet undervalued approach to expanding HIV prevention and improving women’s health: integration of quality HIV and sexual and reproductive health (SRH) services. The urgency of advancing effective integration of these services has never been clearer or more pressing. In this piece, national health officials from Kenya, Malawi, and Zimbabwe and global health professionals have joined together in a call to catalyze actions by development partners in support of national strategies to integrate HIV and SRH information and services. This agenda is especially vital now because these adolescent girls and young women are falling through the cracks due to the cascading effects of COVID-19 and disruptions in both SRH and HIV services. In addition, the scale-up of pre-exposure prophylaxis (PrEP) has been anemic for this population.

Examining the opportunities and challenges of HIV/SRH integration implemented recently in three countries – Kenya, Malawi, and Zimbabwe – provides lessons to spur integration and investments there and in other nations in the region, aimed at improving health outcomes for adolescent girls and young women and curbing the global HIV epidemic. While gaps remain between strong national integration policies and program implementation, the experiences of these countries show opportunities for expanded, quality integration. This commentary draws on a longer comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi, and Zimbabwe, which highlighted cross-country trends and context-specific realities around HIV/SRH integration.

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