The month of March has a focus on women and girls that includes National Women and Girls HIV/AIDS Awareness Day on March 10 in the United States. It is a day intended to raise awareness about the need for all women to be tested and, if positive, treated for HIV. This links with International Women's Day on March 8, a global day celebrating the social, economic, cultural, and political achievements of women. For more than a century, this day has also focused on the call for gender equality. The theme for International Women's Day 2019 is Think equal, build smart, innovate for change. The theme focuses on innovative ways to advance gender equality and the empowerment of women, particularly in the areas of social systems, access to public services, and sustainable infrastructure. ANAC is joining in these efforts to spread the word about the impact of gender inequality and the intersection with HIV for women and girls across the globe.

We know that social and economic factors affect access to health care over all and that people living with or at risk for HIV are disproportionately affected because of poverty, inaccessible health care providers, stigma, poor health literacy, and potentially coexisting conditions that impede engagement in health care. In many communities across the globe, the impact on girls and young women is even more disproportionate. Girls and young women account for 74% of new HIV infections among adolescents in sub-Saharan Africa, and nearly 1,000 girls and young women become infected every day (https://www.pepfar.gov/documents/organization/252380.pdf). Family responsibilities, unfair cultural norms, gender-based violence, and interrupted schooling all contribute to girls' vulnerability to HIV.

It is encouraging that the rate of new HIV infections in women is declining in the United States. Between 2010 and 2015, HIV incidence among women decreased 21%. However, Black women in the United States are still disproportionately affected, accounting for 60% of new HIV diagnoses in women in 2016 (https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states). The greater prevalence of HIV in some African American communities contributes to a greater risk of acquisition for sexually active people living there, and this includes women. Higher levels of community viral loads are compounded by the social and economic disparities that affect HIV risk, acquisition, and treatment across the globe.

Sadly, I am hearing from ANAC members across the United States of an uptick in HIV vertical transmission. The cases I have heard about are women and adolescents who come into prenatal care late and may be struggling with mental health or substance use or are recent undocumented immigrants, usually from African countries. Although this is still anecdotal and small numbers, any baby born with HIV is a failure of our health care systems. It is also our failure to provide for vulnerable women living in our country. It may reflect denial and avoidance or a lack of awareness of all the health benefits of knowing one's HIV status. Either way, it is tied to fear and stigma: fear of the diagnosis, fear of disclosure and potential partner or family violence, fear of immigration authorities, and even perhaps fear of the disapproval or disdain of nurses or other health care providers.

A woman in the United States struggling alone and in secret with her HIV diagnosis and consumed by fear, shame, and stigma and an adolescent girl in South Africa, orphaned and forced to leave school and looking for support through any means available are both examples of lives not being lived to their full potential.

One big picture response is the DREAMS program, implemented in 10 sub-Saharan African countries by the President's Emergency Fund for AIDS Relief. It is an ambitious partnership to reduce HIV infection in adolescent girls and young women. The goal of DREAMS is to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women. But what about the women and girls who are not in DREAMS programs? What about the women and girls in your community? How do we respond so that women and girls can live up to their full potential? How do we contribute to the goal of International Women's Day: Think equal, build smart, innovate for change? Sometimes change begins small and starts with one person. Nurses have a trusted role in reaching out to women and adolescent girls; to talk with them, develop caring patient-centered relationships and offer HIV testing, prevention, PrEP, and treatment as prevention, and educate about Undetectable = Untransmittable (U=U). We combine these clinical messages with support and encouragement for life skills, reproductive health choices, and empowerment. How can we go further to help break the barriers of isolation, shame, and stigma that often get in the way of living to one's full potential? One way is to join with others in partnerships or coalitions.

And thus, for Women and Girls HIV Awareness Day, we are pleased to announce a partnership with the Well Project (https://www.thewellproject.org/partners?page=2) that you and your female patients could benefit from. The Well Project is a nonprofit organization with a comprehensive focus on women and girls to increase the availability and accessibility of meaningful and relevant information designed specifically for them. Over the past 16 years, The Well Project has established itself as an important online resource for women with HIV, nationally and globally, directly reaching more than one million users every year. Focusing on three critical areas related to women and HIV (information access, community support, and advocacy), the Well Project leverages technology through innovative outlets like the blog "A Girl Like Me" and downloadable evidenced-based fact sheets geared for women. Through their regular survey of women living with HIV, it was noted that more than three quarters of respondents said using The Well Project's resources made them more likely to communicate well with their providers, and more than half said they were more likely to both see providers regularly and take their medications as prescribed. Additionally, we know that attention to behavioral health, social support systems, and environmental conditions is equally important in sustaining an undetectable viral load and a good quality of life. We look forward to being an active member of the Well Project's partner community with the shared goals of easy dissemination of accurate, useful, and timely information about HIV for women and adolescent girls around the world. We invite you to share this resource with your female patients this month and throughout the year.

Disclosures

The author reports no real or perceived vested interests related to this article that could be construed as a conflict of interest.