DREAMS: Partnership To Reduce Hiv/Aids In Adolescent Girls And Young Women

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AGYW DREAMS beneficiaries gathering outside at a mobile ‘safe space’ meeting in Kanyakwar village in Kisumu, Kenya, with universal masking and physical distancing observed during the meeting. DREAMS Mentors create ‘safe spaces’ where AGYW can build their supportive social networks and learn about HIV and violence prevention.
AGYW DREAMS beneficiaries gathering outside at a mobile ‘safe space’ meeting in Kanyakwar village in Kisumu, Kenya, with universal masking and physical distancing observed during the meeting. DREAMS Mentors create ‘safe spaces’ where AGYW can build their supportive social networks and learn about HIV and violence prevention.
Photo credit: USAID/PATH DREAMS (Independent photographer: Kency Mmbone Mahindu, April 2020)

 

Overview

The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) partnership is an ambitious public-private partnership aimed at reducing rates of HIV among adolescent girls and young women (AGYW) in the highest HIV burden countries. DREAMS was announced on World AIDS Day 2014, and in 2015 USAID began activities in ten countries in sub-Saharan Africa: eSwatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. These countries accounted for nearly half of all the new HIV infections that occurred among AGYW globally.

Adolescent girls and young women account for 74 percent of new HIV infections among all adolescents in sub-Saharan Africa and nearly 1,000 AGYW are infected with HIV every day. Social isolation, poverty, discriminatory cultural norms, orphanhood, gender-based violence, and inadequate schooling all contribute to their vulnerability to HIV and a life not lived to its full potential. The DREAMS partnership goes beyond individual health initiatives to address these factors, working toward meeting the Sustainable Development Goal of ending AIDS by 2030. In 2017, DREAMS expanded to five new countries: Botswana, Côte d’Ivoire, Haiti, Rwanda, and Namibia. In 2020, South Sudan began to implement two components of the DREAMS package of services, Violence Prevention and Economic Strengthening.

The DREAMS core package aims to:

  • empower adolescent girls and young women and reduce risk through youth-friendly reproductive health care and social asset building;
  • mobilize communities for change with school- and community-based HIV and violence prevention;
  • reduce risk of sex partners through PEPFAR programming, including HIV testing, treatment, and voluntary medical male circumcision; and
  • strengthen families with social protection (education subsidies, combination socio-economic approaches) and parent/caregiver programs.

USAID Impact

USAID is the lead implementer of DREAMS in both funding and geographic reach. DREAMS builds upon USAID’s decades of experience empowering adolescent girls and young women and advancing gender equality across many sectors including global health, education, and economic growth. USAID partners with community, faith-based, and non-governmental organizations to mobilize significant numbers of community leaders and members, helping to address the structural inequalities that impact vulnerability to HIV.

USAID is uniquely positioned to deliver components of a comprehensive package of HIV prevention services, leveraging expertise in economic growth, education, and democracy and governance sectors. Services are delivered by age bands and are packaged by primary, secondary, and contextual activities. Services in the primary package are intended to meet the immediate needs of adolescent girls and young women, while services in the secondary and contextual packages address other critical vulnerabilities associated with HIV risk. Services include:

  • HIV screening, testing, and counseling
  • School and community-based HIV and violence prevention programs
  • Education subsidies
  • Comprehensive Economic Strengthening
  • Post-violence care for survivors of gender-based violence
  • Pre-Exposure Prophylaxis (PrEP)
  • Condom promotion and provision for AGYW and their partners
  • Improved access to youth friendly sexual and reproductive health care and a full range of contraceptive methods
  • Parenting/caregiver programs
  • Community mobilization and norms change programs

The package of services are determined based on the specific needs of each adolescent girl and young woman. Scaling up impactful and evidence-based interventions across multiple sectors has allowed USAID to accelerate efforts to control the HIV/AIDS epidemic.

2020 Achievements

In 2020:

  • 1,661,685 AGYW (ages 10-29), across the PEPFAR DREAMS program, completed at least one prevention service, the complete primary package, or the primary package plus a secondary service; USAID contributed to reaching 1,497,255 of these AGYW.
  • USAID managed 72 percent of the DREAMS budget across 15 countries and between 91 and 100 percent of the budget in eSwatini, Namibia, Rwanda, Zambia and Zimbabwe.
  • USAID programmed in 92 percent of the 105 DREAMS implementation areas across the 15 countries.
  • USAID provided PrEP, as part of a package of services, to 43,264 AGYW ages 15-24; in addition to the primary package of services, PrEP is one of the secondary services that could be offered to a young woman based on her additional prevention needs.

COVID-19 Adaptations and Innovations

As COVID-19 had an impact on DREAMS implementation in several countries USAID’s innovative teams and partners adapted programming to keep people safe, continue service delivery, and respond to the pandemic.

Virtual support:
In order to mitigate challenges due to COVID-19, several countries adapted to virtual support. While virtual approaches worked well for older AGYW and those in urban areas, access to mobile phones and/or cellular coverage was a major barrier for AGYW in rural areas. To overcome this barrier, USAID/Zimbabwe developed the Sexual Reproductive Health Referral Network , a new model which linked a DREAMS Ambassador in each village with a project field worker, clinic nurse, gender-based violence response provider, and other professionals as relevant. The DREAMS Ambassador was equipped with a mobile phone and air-time, and was responsible for sharing information with DREAMS participants in her village during one-on-one routine safe interactions, distributing condoms and menstrual health supplies, and coordinating appointments for clinical services to be brought to the village.

Face coverings:
USAID Zambia previously designed The Kozo Initiative, as part of their DREAMS program, to address the widespread problem of AGYW missing school because they couldn’t afford menstrual hygiene products; 40 DREAMS centers were developed across five provinces and were equipped with sewing machines and supplies. As COVID-19 began to impact local communities, DREAMS participants pivoted from producing menstrual health management products to producing cloth face coverings, selling as well as donating them to vulnerable members of the community.

In response to the Covid-19 pandemic, Susan, Sarah, and 250 other young women in DREAMS, in Lusaka, Zambia, have actively participated in sewing of masks. Earnings from masks have been reinvested into various income-generating business activities the young women are involved in while some of it has been utilized in sustaining their everyday lives.
In response to the Covid-19 pandemic, Susan, Sarah, and 250 other young women in DREAMS, in Lusaka, Zambia, have actively participated in sewing of masks. Earnings from masks have been reinvested into various income-generating business activities the young women are involved in while some of it has been utilized in sustaining their everyday lives.
Photo Credit: USAID Project PACT/DREAMS (Photographer: Maynard Muchangwe, 5th May 2020)
Petronella is a DREAMS project beneficiary, in Lusaka, Zambia, who participated in the Kozo Initiative.
Petronella is a DREAMS project beneficiary, in Lusaka, Zambia, who participated in the Kozo Initiative. Petronella contributed her profits from sales to a pool fund in collaboration with other beneficiaries. This fund enabled the young women to purchase the pastry-making machine shown in the photo. Petronella reserves profits from selling pastries and is now able to save money needed to pay her school fees.
Photo Credit: USAID Project PACT/DREAMS (Photographer Maynard Muchangwe, September 2020)

Additional Resources

Last updated: June 01, 2021

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