Blog series of the SVRI Faith & GBV CoP, Working Group 1
Written by Palikena Kaude, public health and development expert
HIV, teenage pregnancies, and Gender Based Violence (GBV) are deeply interlinked challenges rooted in systemic social inequalities, harmful socio-cultural norms and power imbalances. These intersecting issues disproportionally affect women, Adolescent Girls and Young Women (AGYW). Understanding the connections between these issues is crucial for developing comprehensive interventions, particularly in sub-Saharan Africa, where they are more prevalent.
This blog explores the intricate linkages between HIV, teenage pregnancy, and GBV, and highlights the importance of integrated, multi-sectoral responses that address their shared foundations.
Adolescent girls and young women (aged 15-24) are reported to be twice as likely to acquire HIV as their male counterparts. About 50% of women who experience partner violence are likely to get infected with HIV.”
The linkage between gender-based violence and HIV
Gender-based violence (GBV) is a major driver of HIV infection, particularly in sub-Saharan Africa. Adolescent girls and young women (aged 15-24) are reported to be twice as likely to acquire HIV as their male counterparts. About 50% of women who experience partner violence are likely to get infected with HIV. This disparity is exacerbated by gender inequalities, including unequal power dynamics, early marriage, sexual violence and exploitation, especially where girls engage with older partners [1].
AGYW face significant barriers to accessing sexual and reproductive health services, compounding their risk of teenage pregnancy, HIV infection and gender-based violence. They also experience stigma and discrimination, particularly when reporting early pregnancy or sexual abuse, and are often subjected to victim-blaming [2].
A cycle of vulnerability: Teenage pregnancy and gender-based violence
Teenage pregnancy rates are highest in sub-Saharan Africa, where 25% of girls aged 15-19 have begun motherhood compared to a global average of 13%. Many of these pregnancies are linked to GBV, including sexual abuse, exploitation and child marriage [3]. In Malawi, 42% of AGYW are married before the age of 18, contributing to the country’s rising rate of teenage pregnancy, which has increased from 26% in 2010 to 32% in 2024 [4].
Other social inequalities also increase vulnerability. For example, teenage pregnancy is more common in rural areas (34%), compared to urban areas (19 %), and among girls with no education (56%), compared to those who have completed secondary school (18%).
Teen mothers often experience socio-economic challenges, including school dropout, limited economic opportunities and restricted access to sexual and reproductive services. These challenges increase the risk of child marriage, exposure to gender-based violence, HIV infection, and repeated teenage pregnancies. Notably, pregnancy and childbirth remain the leading causes of death amongst AGYWS aged 15-19 [5].
The role of social norms and structural inequalities
Harmful socio-cultural norms continue to reinforce cycles of GBV, teenage pregnancy, and HIV. In many parts of sub-Saharan Africa, patriarchal systems limit women and girls’ decision-making power and access to education and economic opportunities [6]. These limitations reduce their ability to negotiate safe sex and increase their exposure to violence, child marriage and health risks. In many Malawian communities, discussing sexuality remains taboo. AGYW are often labelled, stigmatised, or silenced, leaving them without the knowledge or agency to protect themselves [7].
Preliminary findings from the Malawi Demographic and Health Survey show an increase in teenage pregnancy, alongside limited and unequal knowledge of HIV prevention: only 34% of AGYW were found to have accurate HIV knowledge, compared to 44% of adolescent boys, despite several programmes to address these challenges.
In many parts of sub-Saharan Africa, patriarchal systems limit women and girls’ decision-making power and access to education and economic opportunities. These limitations reduce their ability to negotiate safe sex and increase their exposure to violence, child marriage and health risks.”
Integrated solutions for a complex problem
Addressing these interconnected challenges requires concerted multi-sectoral efforts that tackle root causes while empowering women and girls. Some key strategies include:
- Community Engagement: Implement gender-transformative approaches to challenge harmful socio-cultural norms and promote positive masculinity. Communities should be empowered to lead and own interventions. In Malawi, for example, there has been support for locally led bylaws to challenge child marriage.
- Legal Framework and Policy Reform: Advocate for strong policies and laws that protect women and girls from harmful norms, including child marriage, GBV, stigma and discrimination. Malawi’s Education Readmission Policy, which encourages girls to return to school after pregnancy, is one such initiative. Both Malawi and Ethiopia have raised the legal age of marriage to 18, criminalising child marriage, complemented by laws instituted by traditional leaders.
- Economic Empowerment: Provide education and economic opportunities to enhance women and girls’ agency and decision-making power. Financial independence can reduce the vulnerability to exploitation and early marriage.
- Adolescent-friendly services: Ensure that sexual and reproductive health services are accessible, integrated and safe for young people. This should include contraception, HIV prevention and response services, and GBV survivor support with clear referral pathways. Malawi’s Ministry of Health has developed a Youth-Friendly Health Service Strategy aligned to these goals.
Conclusion
The intersection between HIV, teenage pregnancy and GBV highlights the urgent need to understand AGYW as a priority population in efforts to drive social and behavioural change. Gender transformative approaches are essential. Building women and girls’ agency is not optional; it is a prerequisite for breaking the cycles of vulnerability and realising long-term, sustained change.
References
[1] UNAIDS. (2022, July 27). In danger: UNAIDS global AIDS update 2022.
[2] Maharaj N. R. (2022). Adolescent pregnancy in sub-Saharan Africa – a cause for concern. Frontiers in reproductive health, 4, 984303.
[3] Akinsolu, F. T., Adewole, I. E., Lawale, A., Olagunju, M. T., Abodunrin, O. R., Ola, O. M., Chukwuemeka, A. N., Gambari, A. O., Eleje, G. U., & Ezechi, O. C. (2024). HIV and pregnancy among adolescents in Sub-Saharan Africa: A scoping review (Version 1) [Preprint]. medRxiv.
[4] Bunker, S., & Kashiwase, H. (2020, December 1). Connecting the dots between HIV incidence, social norms, and gender-based violence. World Bank Blogs.
[5] The National Statistical Office and ICF International(2024). Malawi Demographic and Health Survey Key Indicator Report.
[6] Murewanhema, G., Musuka, G., Moyo, P., Moyo, E., & Dzinamarira, T. (2022). HIV and adolescent girls and young women in sub-Saharan Africa: A call for expedited action to reduce new infections. IJID regions, 5, 30–32.
[7] Bhushan, N. L., Shangase, N., Kimaru, L. J., Gomez-Olive, F. X., Kahn, K., & Pettifor, A. E. (2023). HIV-Related Behaviors Among Male Partners of Adolescent Girls and Young Women in Rural South Africa. AIDS and behavior, 27(5), 1469–1477.
About the author
Palikena Kaude has over 14 years of experience working in the public health and development sector; more concretely, in sexual and reproductive health and rights, gender, HIV programming, and policy advocacy. Currently, she is a co-facilitator for Cultural Transformation within UNAIDS, a programme aimed at transforming the traditional leadership to create a more inclusive, equitable, and diverse organization. She holds an MA in Development Studies from the University of Melbourne, Australia; a BSc in Nursing, and a postgraduate certificate in Midwifery from Kamuzu College of Nursing.
