Protecting and Empowering Adolescent Girls: Evidence for the Global Health Initiative. Meeting Summary

These programs employed various approaches, including school-based interventions, advocacy, empowerment, targeting of especially vulnerable girls, physical activity, and male involvement. Reasons to focus on girls include their high vulnerability to HIV infection, driven by factors such as poverty, lack of education, absence of peer networks, early marriage, limited access to media, and absence of youth programs. Girls also experience high levels of discrimination, sexual coercion, and violence, making them more susceptible to HIV than boys of the same age. Despite this vulnerability, many HIV programs for youth favor treatment over prevention, and the young people with the fewest risk factors and most social assets (usually boys) receive the largest share of available services. Investing in adolescent girls, ages 10 to 14, is crucial for alleviating poverty, achieving universal primary education, promoting gender equity, and addressing other factors that put girls at risk of HIV infection and other negative RH outcomes. Programs focused on adolescent girls need to target the most in need and determine what they can change in a certain period using meaningful measurements. Health, social, and economic assets are closely linked to girls, making them good measures of program success. Programs such as the Global Health Initiative, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and the Joint United Nations Programme on HIV/AIDS (UNAIDS) are taking a broader approach to measuring success, including indicators such as changes in male norms and behaviors, decreases in violence and coercion, increases in access to education and resources, and increases in legal rights and protections for girls. More emphasis is being placed on supporting country ownership of programs for girls and promoting their sustainability. School-based interventions offer a unique opportunity to reach a large segment of youth, especially at young ages. New resources such as UNESCO's International Technical Guidance on Sexuality Education and the Population Council's It's All One curriculum provide helpful guidance for school-based sexuality education. However, gender and socio-economic status affect school attendance, so school-based interventions do not reach all children, especially those at the greatest risk. Advocacy efforts aimed at protecting adolescent girls from SRH risks are most effective when young people and other key stakeholders are involved in social change and decision-making processes. Access to accurate, regional data is essential for effective programming and policymaking. Strategic, specialized research is necessary for comprehensive and informed responses to the health challenges that girls worldwide face. Programs that have been unsuccessful in reaching girls have often targeted the wrong population or targeted the right population with the wrong intervention. The challenge now is to find the girls who are most in need of help and to reach them with effective ways of developing their protective assets. To do this, program managers need to understand the context in which girls live and recognize the factors that make them most vulnerable. They will also need to engage the community in this process. Empowerment can be defined as the process of transition from limited life options to more options and the freedom to choose among them. Empowerment necessitates both resources and agency, or the ability to act in one's own interest. Economic empowerment programs provide access to financial products and resources and contribute to the building of economic and personal assets, skills, and social and economic networks. Critical ingredients of success include encouraging school attendance, addressing violence, integrating girls and young women in development planning across sectors, and engaging religious leaders, men and boys, role models, and peer educators as key change agents. Follow-up research is needed to address the questions of how to implement a global program in local contexts, how to measure empowerment, and how to work with implementing staff to address their own social and gender norms and attitudes. Data collection on what happens after a girl's marriage is cancelled, after she receives a scholarship for education, or after participating in program interventions will inform next steps.