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Joy Cunningham is a Senior Technical Officer at FHI 360 where she manages a portfolio of global youth activities, including oversight for activities conducted under USAID’s Interagency Youth Working Group (IYWG). 

Ukraine has one the fastest growing HIV epidemics in the world; the virus is spreading faster there than anywhere else in Europe. Youth are disproportionately affected: more than 80% of the approximately 440,000 Ukrainians living with HIV are under the age of 30. It’s also estimated that between 40,000 and 300,000 young people are living on the streets, and they are often engaged in injection drug use (IDU) and trading or selling sex for drugs, activities that put people at high risk of acquiring and transmitting HIV. 

In a recent issue of AIDS, the link between orphaned status, homelessness, IDU, and HIV risk among street youth in Ukraine is documented. In the same issue, FHI 360 experts in youth and HIV wrote an editorial comment, calling for an urgent and comprehensive approach to address the needs of most-at-risk young people. The authors argue that the response to this crisis must involve a multisectoral approach that:

  • Strengthens social welfare policies and programs to support the needs of orphaned youth and young people living on the streets
  • Improves the national child protection system to better prevent abuse, provide effective methods for reporting cases of abuse, and support those who have been affected by violence and abuse
  • Addresses the quality of institutional care services for homeless youth, with particular attention paid to the needs of orphaned adolescents
  • Reduces stigma and discrimination against homeless youth, including decriminalizing the act of living on the streets
  • Includes a rights-based, evidence-informed approach with combination interventions that allow young people who inject drugs to gain full access to HIV prevention and treatment services

Too often, most-at-risk young people fall into a gap between HIV prevention programs for the broader youth population and programs for most-at-risk people that fail to address the specific needs of adolescents. Prevention and mitigation are crucial to address the growing HIV crisis in the Ukraine.

For more information on steps that programs can take to address the needs of young people most at risk of HIV, visit or download a copy of “Young People Most-at-risk of HIV” here.


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Laura Dickinson is communications officer for Girls Not Brides: The Global Partnership to End Child Marriage. You can follow Girls Not Brides on Twitter @GirlsNotBrides or join them on Facebook:

Photo Credit: Cibele Vieira, Clinton Global Initiative

“Nobody seems to talk about child brides,” says Archbishop Desmond Tutu, Nobel Peace Prize winner and Chair of The Elders. “But I cannot stay silent.”

 The plight of child brides has long been ignored by the international community, despite the sheer scale of the problem: in the next year alone, 10 million girls around the world will marry before they are 18. That’s 100 million girls within the next decade who will marry as children.

Child brides are among the world’s most voiceless and vulnerable people. Rarely do they have any choice in when or whom they marry, nor do they have a voice in their relationship with their often much older husbands. They usually drop out of school, too, which only serves to reinforce their isolation.

Hard to reach and invisible, child brides rarely benefit from aid and development programs designed to curb maternal deaths, infant mortality or the spread of HIV and AIDS – despite the fact that they are among those who could most benefit from such support. Pressured to prove their fertility, young brides often become pregnant before their bodies are physically ready for childbearing. The results can be devastating: girls under 15 are five times more likely to die in childbirth than women in their 20s.

Photo Credit: Ashenafi Tibebe,The Elders

Child brides rarely receive support and guidance on issues such as family planning and safe sexual health. They are less likely to space out their children and, unable to negotiate safe sexual practices with their husbands, they are more likely than their unmarried peers to contract HIV and other sexually transmitted infections.

The repercussions of early marriage are serious, even dangerous – so why has it received so little attention from leaders and policy makers?

Desmond Tutu is right: very few people talk about child brides. Not only are they invisible, talking about their plight is deemed taboo – a topic too closely related to sensitive issues of tradition and culture for leaders to address.

That’s why he and his fellow Elders, an independent group of global leaders working for peace and human rights, brought together Girls Not Brides, a partnership of  nongovernmental organizations from around the world that work to tackle child marriage at the grassroots, national and global levels.

The aim of the Partnership is to give girls a voice, to connect those who work closely with girls vulnerable to early marriage to the leaders and policy makers who have a real opportunity to implement policies that protect and empower young girls and help them avoid early marriage.

Addressing sensitive issues such as child marriage can be lonely work, and organizations have long had to act in isolation. By coming together in partnership, Girls Not Brides members find strength in unity, sharing experiences and learning from each other about the successful programs that have helped to reduce child marriage. It also enables them to raise their collective voice, increasing awareness of the solutions that help to end child marriage and calling on leaders to take action.

Girls Not Brides and its members are determined to show that there’s a growing, global movement to end child marriage and enable millions of girls to fulfill their potential. We won’t be staying silent.

Find out more about Girls Not Brides at, follow us on Twitter @GirlsNotBrides or join us on Facebook. Watch our video, featuring Graça Machel, Mary Robinson and Desmond Tutu of The Elders: Traditions can change: ending child marriage

This is the third and final post of our Gates Foundation series, “The Stories Behind the Statistics.” The following was originally posted on the Gates Foundation Blog, “Impatient Optimists” and is available here.

Jaevion Nelson is the executive director of the Jamaica Youth Advocacy Network (JYAN).

Last August, during World Youth Day in Madrid, I was conducting outreach to encourage Catholic youth to use condoms. It was there that I heard one of the most frightening things ever: One young man told me that an HIV-positive person had no right to have sex.

It wasn’t the first time I had heard such disparaging comments about people living with HIV. Shocking as it was, this conversation was instructive. It reinforced the importance of the work my colleagues and I have been doing alongside a number of organizations worldwide, particularly Advocates for Youth, in speaking out for the more than 215 million women and girls who face an unmet need for modern contraception and the 16.5 million women of reproductive age who are living with HIV.

Worldwide, too many young people are still being denied access to essential services and commodities such as modern contraception, condoms, and HIV treatment.

As I’ve seen through my outreach and advocacy in Jamaica, the heartrending thing here hasn’t been so much a matter of limited funding. Rather, as young people, our access is too often restricted on the basis of inadequate and ideology-driven programs, policies, and laws.

It’s almost as if the existing data about our needs—even when the evidence stares policy makers right in their faces―are irrelevant. 

Within this context, women and girls and young people living with HIV are severely and disproportionally impacted. They aren’t provided the resources they need to avoid HIV transmission, prevent unintended pregnancies, and plan desired pregnancies. Just as important, they aren’t respected as central stakeholders in their own health care outcomes—as change agents that can help transform their communities for the better.

Worldwide, too many young people are still being denied access to essential HIV services and care, free from stigma.

Ultimately, the reproductive health needs of young people living with HIV aren’t so unique. After you factor in our age, sexual orientation, location, income, and HIV status, we all want to have the same things. Young people living with HIV want access to friendly services that are free from stigma just as much as the young person who is not HIV-positive, and just as much as the adult for whom policies around reproductive health are usually more favorable.

Stigma and discrimination make things needlessly complex for a young person living with HIV. While I have met a number of young people who have been bold enough to demand resources on the local and governmental levels, many others are too dis-empowered to do so. I have seen too many young girls scoffed at (at health clinics, no less) because of an unplanned pregnancy―and the discrimination is almost always exacerbated when these young people are HIV-positive.

Why must we be so cruel? It costs nothing to respect people living with HIV. It takes no effort to show compassion. We aren’t so naïve. Why should we continue to deny young people living with HIV the right to live happy, healthy lives like everyone else? We all have to play our part in advancing the rights, welfare, and dignity of young people living with HIV.

This is the second post of our Gates Foundation series, “The Stories Behind the Statistics.” The following was originally posted on the Gates Foundation Blog, “Impatient Optimists” and is available here.

Catherine Gathoni works at K-Note as a field officer in the prevention program where she leads a support group for mothers ages 12-19, in Kenya.

I lead a support group for mothers ages 12-19, in Kenya. Most of the mothers I work with are out-of-school youth; many live on the streets, work in the informal economy, or are orphaned. As a part of our support program, we provide weekly peer-to-peer sessions focusing on uptake of antenatal care, child welfare, family planning services, post-rape care, and antiretroviral therapy.  The support groups for the adolescent mothers are formed to provide social support and reduce stigma.

The majority of the girls who get pregnant at this age never plan the pregnancies. Most of the unplanned pregnancies are a result of transactional sex; sexual and gender-based violence, including rape and incest; or alcohol and substance abuse. Many of these girls have grown up in challenging family environments, and within their communities early pregnancies are often accepted as normal.

I remember one girl telling me that when she visited a clinic, the nurses told her that family planning services were for women not girls, and if they provided her with these services it would be equal to them permitting her to go have sex.

It can be very hard for a young woman to receive family planning information or contraceptives. There are many myths and misconceptions in our community about contraceptives, and many girls do not know about the services available for pregnancy prevention.  Those who do know about the services are often afraid of being judged by health care workers. 

Many health service providers are hesitant to offer these services to girls less than 21 years old who do not yet have children.  I remember one girl telling me that when she visited a clinic, the nurses told her that family planning services were for women not girls, and if they provided her with these services it would be equal to them permitting her to go have sex.  It is this sort of judgment that often prevents young women from seeking reproductive health services.

Without access to family planning services, many young women end up unintentionally pregnant. 

When “Shiro” first came to our group she looked like a 9-year-old. She asked me to take her to the hospital; she said she had stopped going to school after developing vaginal discharge that would wet her dress and make pupils ridicule her. An examination and some tests established that she had not only contracted an STI (sexually transmitted disease), but she was also pregnant. She did not seem to comprehend what this meant. She only wanted to get treated so that she could go back to school.

“Shiro” never went back to school and currently works in an illegal liquor den.

Life is very challenging for adolescent mothers. Often they are unable to secure a meaningful source of income and end up working in illegal liquor dens, as sand harvesters, or as sex workers. Or they marry very early.

One young woman in my support group, “Rozie,” is 18 years old. She has never admitted to being involved in sex work but will occasionally mention having slept with someone in exchange of cash or food. This is sometimes the only means she has to feed her two sons, whom she lives with on the street.   Sometimes when I am working with girls like Rozie, I feel totally helpless.

Making family planning and pregnancy prevention services more accessible would greatly improve the lives of girls. They would get to have an education, escape becoming involved in sex work, and avoid HIV infection. We need interventions to reduce their vulnerability, empower them to take charge of their own health, and allow them to become economically independent.  The needs of adolescent girls are serious and pressing but currently they are not being addressed.


“The Stories Behind the Statistics” is a series we put together for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in this three part series. The original post, located on “Impatient Optimists,” is available here.

By the end of today, 2,500 young people will become infected with HIV and 1,400 girls and women will die in childbirth.

These are alarming statistics. Half of the world’s population is under 25 and nine out of ten young people live in developing countries, where they face profound challenges, such as high rates of early marriage, unintended pregnancy, HIV and other sexually transmitted infections, and maternal mortality and morbidity. 

Young people account for almost one-quarter of all people living with HIV, and nearly 60 percent all HIV-positive young people are female.  The number of young people living with HIV is rising as children who are pertinently infected gain access to life-prolonging ARV treatment and new infections among youth continue. Young people living with HIV are just as sexually active or curious as other teens, yet they are seldom offered information or support about their emerging sexuality or their reproductive choices. Furthermore, they may be less inclined than their peers to access reproductive health services due to fear of stigma and judgment from their providers. There is a vital need to address the sexual and reproductive health needs of this population.

Young women face a dual challenge: in addition the threat of HIV, pregnancy is one of the most significant threats to the health of adolescent females. 

Approximately 16 million girls between the ages of 15 and 19 give birth each year and, in developing countries, approximately one-third of adolescent girls give birth before their 20th birthday.  An unintended pregnancy can be a difficult experience for any women, and can be especially upsetting for an unmarried adolescent. 

Adolescent pregnancy is life-threatening for many girls. Childbirth-related complications are the number one cause of death among girls ages 15-19. Fortunately, unintended pregnancy and adolescent maternal mortality are preventable; yet in some regions of the world the unmet contraceptive need among adolescents is as high as 68 percent.  This lack of access to family planning services leads to approximately 7.4 million unintended adolescent pregnancies each year.

Ensuring that young people’s reproductive health needs are met has never been more critical.  In 2011, the IYWG developed a set of programming and strategy recommendations to improve youth sexual and reproductive health. The document was created with the input of both professionals in the field of youth sexual and reproductive health and young people themselves. The purpose of these recommendations is to inform programing and guide investment at international, country, and local levels. 

The 2,500 young people who will become infected with HIV and the 1,400 girls and women who will die in childbirth today represent more than striking statistics: each of these numbers represents a young person whose fate could be different if provided with access to reproductive health services. 

The IYWG recommendations are meant to accomplish more than simply lowering statistics; we want them to help improve young people’s quality of life. In this short series, we will share the stories of two young people who have experienced first-hand the sexual and reproductive health challenges young people around the world face every day.

Yesterday was the first day of the SexTech 2012 conference. SexTech is an annual conference hosted by ISIS Inc. that focuses on technology and youth sexual and reproductive health. The conference opened with a panel of young people who discussed why they use social media.

 During the panel discussion, one young woman stated that she had used social media, “basically her whole life.” Ten years ago, before the launch of Facebook or Twitter, this statement was inconceivable; today, however, social media is pervasive in our society. Understanding why and how people communicate through social media allows us to better understand how to optimize social media in youth sexual and reproductive health programs.

The popularity of social media among young people makes this technology ideal for reaching youth with sexual and reproductive health information. The use of social media and other new technologies for this purpose is relatively new, and many questions about the best way to do so remain unanswered. This presentation was a good opening to what will surely be a great conference. It will be interesting to hear how organizations are using social media and other new technologies to advance youth sexual and reproductive health.

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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