Pervasive gender inequalities mean that girls especially face numerous violations to their sexual and reproductive health and rights, including sexual initiation before they are physically or emotionally ready. Girls who live in extreme poverty, among marginalized populations, without family support, or in situations of conflict and displacement are particularly vulnerable to coerced sexual encounters and abuse.

HIV/AIDS AMONG YOUTH
Half of new HIV infections worldwide are in women, and in 2007, young people, ages 15–24, accounted for about 40 percent of new HIV infections among people age 15 and older. Globally, there are 5.4 million young men and women who are living with HIV, and nearly 60 percent of them are female.

ADOLESCENT GIRLS’ EXPERIENCES OF SEXUAL COERCION AND VIOLENCE
Girls are highly vulnerable as children and adolescents to sexual abuse and violence in their homes, neighborhoods, schools, and communities. Early sexual initiation is strongly associated with sexual coercion in many places.

SEXUAL VIOLENCE AND GIRLS’ VULNERABILITY TO HIV/AIDS
The use of physical force or emotional coercion during a sexual act greatly increases the risk of HIV transmission to the female if the male is infected. The female genital tract is highly susceptible to sexually transmitted infections (STIs), including HIV. Violence and rape can further increase HIV risk by causing abrasions, bleeding, and tearing, especially among young girls whose genital tracts are not yet fully mature.

Many girls and young women, especially the very young, cannot refuse unwanted sex or negotiate protection from pregnancy and STIs, including HIV, particularly when they fear retaliation. They can suffer multiple adverse physical, social, and emotional outcomes. In situations of force or coercion, whether by strangers, acquaintances, family members, boyfriends, “sugar daddies,” or husbands, negotiating condom use is virtually impossible.

POLICY AND PROGRAM RESPONSES
Effective strategies, policies, and programs are urgently needed at national, provincial, and local levels to protect young people, especially girls and young women, from sexual abuse or coerced sex and its consequences, including HIV infection. Continuous advocacy, strategic investment, and committed leadership are essential to addressing the triple jeopardy of sexual violence, HIV/AIDS, and adolescence.