Change, Choice and Power - Young Women, Livelihoods and HIV Prevention - Literature Review and Case Study Analysis

If poor young women and adolescent girls have access to their own incomes, will they better be able to protect themselves against HIV infection? Will economic independence and secure livelihoods result in economic empowerment so that they have the ability and power to refuse unwanted sex, to negotiate condom use and walk away from violent relationships? Will this improve their sexual and reproductive health? This paper sets out to explore these questions. Statistics are showing that young women and girls between the ages of 15 and 24 are the most vulnerable group. One-third of all women living with HIV are between the ages of 15 and 24, while 76% of young people who are living with HIV in sub-Saharan Africa are female. Given statistics such as these, it is clear that a focus on prevention, treatment and care for this age group is of extreme urgency. On the one hand such assumptions are difficult to assess as few interventions are directed towards young women and adolescents, and those that do have encountered many challenges in involving this age group. It is clear that there is no narrow linear link between increased income and increased livelihoods. Many other factors come into play that relate to gender inequality and the social, political and economic contexts that push and protect gendered power relations. In reviewing the literature, it was found that the majority of interventions concerning young women and adolescent girls are in sub-Saharan Africa. Three programmes in southern and eastern Africa provide case studies for this paper which also references a number of interventions in other regions of the world. Although many of the objectives of such interventions include enhancing sexual and reproductive health, and empowerment of young women and adolescent girls, there is a lack of clarity about what this means and how it can be measured in the short lifespan of the projects. All however provide lessons from which recommendations can be drawn, some of which are incorporated into the last section of this paper. They also provide some positive experiences and promising results to build on. These include a better understanding of the needs of young women and adolescent girls that are separate from those of the older generations of women. The emergence of useful indicators as ways of measuring empowerment are also being tested. The importance to be innovative and experimental and to involve young women and adolescent girls in imagining their futures, futures that are more hopeful and more self-directed, cannot be over-emphasized. The paper focuses in particular on southern and eastern Africa as these are the hardest hit areas, where prevalence rates are highest and where concerted efforts are being made to address young women in terms of prevention. It also looks more particularly at the role of microfinance, as this is often the only potential source of income for poor young women and adolescent girls. Vocational training is also reviewed. The impact of formal employment or paid work in the informal sector is not considered in this paper, as analysis is still limited and the majority of poor young women can only hope to access the informal sector. Nonetheless some of the findings regarding the need to provide a supportive environment for economic independence may be useful to illuminating issues relating to young women’s empowerment in the context of HIV in the formal sector. The urgency of addressing the vulnerability of young women and adolescent girls of all backgrounds, but particularly the poor, cannot be over stated. Innovative, far-reaching and rapid responses are needed to impact whole generations so that the Millennium Development Goals to reduce poverty can be within reach.