In defending their stance that antiretrovirals (ARVs) should be prioritized for treatment over prevention, Cowan and Macklin [1] argue that young women in sub-Saharan Africa (SSA) are ‘neither the most vulnerable, nor do they have the greatest immediate need for ARVs’. The overwhelming and compelling evidence indicates otherwise. Young women in SSA aged 15–24 comprise more than two thirds of the global population of young people living with HIV [2]. Seventy-two percent of young people (aged 15–24 years) living with HIV in SSA are women [3]. Young women are more than twice as likely to be infected with HIV, than young men [4]. In Kenya, young women are four times more likely to be living with HIV than men [5], whereas, in South Africa, which harbors the world's highest burden of HIV, young women are three times more likely to be infected than young men [6]. Fearing violence or rejection, 58% of South African girls (<18 years) avoid discussing condom use with their partners, which increases their vulnerability to HIV [7]. With respect to HIV incidence, young South African women in the age group 20–29 years have an incidence rate of 5.6% compared to 0.9% among men in the same age group [8]. This is despite scaled-up prevention and treatment efforts in these settings. These alarming statistics highlight that we have failed to effectively address the HIV prevention needs of young women, and speak to the urgent need for HIV preexposure prophylaxis (PrEP) if PrEP efficacy is confirmed or if drug regulatory authorities indicate its use based on existing evidence