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It's Time to Consider the Girl Effect on HIV

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Last month some 20,000 researchers, policymakers and grassroots advocates got together for the International AIDS Conference in Vienna. If you noticed an uptick in HIV-related mentions in trending topics on Twitter, Yahoo or here on The Huffington Post, this is probably why. Together they presented more than 6,000 papers.

As someone who spends most waking moments trying to convince people that adolescent girls in developing countries are the key to massive social and economic change, I pay a lot of attention to what comes out of this conference. Girls are the center of the HIV epidemic. In many countries, they are hit hardest, yet our prevention strategies have rarely focused on them specifically.

One example is so promising that I'd go so far as to say that thinking about how to include girls is an emergency.

In one of the most talked about pieces at the conference, a vaginal microbicidal gel showed hugely positive results with young women in South Africa. Overall, participants were 39 percent less likely over all to contract HIV than those who used a placebo. The number jumped to 54 percent for those who used the gel most regularly.

This is a big, big deal because it potentially shifts the power of prevention to the woman. One article aptly referred to it as the "invisible condom." It's promising and it's exciting, but it doesn't mention girls. This is the kind of thing we have to look at and say "Ok, what are the implications for girls? If it gets to market, how does it get into the hands of a girl?" Right now a girl under 18 can't get access to such life saving tools -- how do we address those access issues for girls?

And while the gel is a useful first step to build on, how do we go beyond access to medical solutions and also address other underlying issues that make girls particularly vulnerable and heighten their risk of contracting HIV? Girls struggle to negotiate condom use, are vulnerable to sexual violence, lack access to prevention information and are more likely to use transactional sex to support themselves -- how can we ensure that these vulnerabilities surrounding HIV are tackled as well?

These are important questions everywhere. In South Africa, nearly 13 percent of girls (15-24) are infected, a rate that's more than three times than it is for boys. The big reason? They're getting it from older men.

Research shows that providing actionable information on how to reduce own risk can change sexual behavior of teenagers: telling girls that older men were more likely to be infected with HIV than young men dramatically reduced child bearing with older men. (Abdul Latif Jameel Poverty Action Lab - MIT, 2010)

This brings me to another report released last week that has huge implications for girls. In Outlook, UNAIDS executive director Michel Sidibé argues that "Recognizing and addressing the factors that drive young women and men to have sex with older people is paramount." He goes on to say that it's linked to development issues like education and employment - "When basic necessities are not met, vulnerability increases."

It's hard for me to express how excited I was to read that. It gets to the heart of exactly what we've been seeing on the ground. When the only asset a girl has is her body, her wellbeing is a risky financial investment. She's pulled out of school, married off, dependent on a sugar daddy, or forced into transactional sex.

All of these things increase her risk for contracting HIV (yes, even marriage). What the report shows and we've found in our investments is that economic empowerment changes the equation. With access to economic opportunity, her education, health and well-being become a wise investment of limited resources.

At the Nike Foundation, we're investing in girls' economic empowerment in a number of ways: microfinance, safe spaces, pathway to employment, financial literacy and programs that address the attitudes of men and boys, to name a few. I've written about all of this in previous posts, so let me instead focus on another game-changer that came out last week.

Two years ago the World Bank sponsored a study in Malawi that offered cash to girls and their families. Sometimes it was on the condition of girls' regular school attendance, sometimes there were no strings attached. This idea isn't totally new, but what's different here is the study was designed to look at the connections between schooling, income and HIV.

Within 18 months, girls who received cash had an HIV infection rate 60 percent lower that girls in the control group. This was true whether the cash was conditional or not. It turns out the girls who received cash engaged in sex less frequently and when they did, they chose safer (i.e., younger) partners.

The bottom line is that the cash provided an incentive to invest in girls' education and well-being. There was, after all, a return on the investment. It's the same thing we've seen time and again. When a girl has assets other than her body, priorities in the family shift rapidly. She transitions from economic burden to economic actor, and everyone around her is better off for it.

Chances are, we won't be able to give cash to every girl on the planet, but we can recognize their economic potential and invest accordingly. From the research, it looks like girls are the key to solving poverty and HIV. Imagine that.