DREAMS NextGen: Partnership to reduce HIV/AIDS in adolescent girls and young women
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, youth-led and and non-governmental organizations to help address the structural inequities that impact vulnerability to HIV.
The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) partnership is aimed at reducing the rate 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. In 2017, DREAMS expanded to five new countries: Botswana, Côte d’Ivoire, Haiti, Rwanda, and Namibia. In 2020, South Sudan also began to implement a targeted package of DREAMS services including violence prevention and economic strengthening.
Every week, 4000 adolescent girls and young women acquire HIV. In 2022, in sub-Saharan Africa, women and girls (of all ages) accounted for 63% of all new HIV infections. Only about 42% of districts with very high HIV incidence in sub-Saharan Africa are currently covered with dedicated prevention programmes for adolescent girls and young women (UNAIDS, 2023). Social isolation, poverty, discriminatory cultural norms, orphanhood, gender-based violence, and inadequate schooling all contribute to HIV vulnerability. The DREAMS partnership recognizes the need to address the individual health needs of AGYW as well as other critical socio-behavioral determinants, in support of meeting the Sustainable Development Goal of ending AIDS by 2030. Pillar 1 in PEPFAR’s 5-year strategy, “Health Equity for Priority Populations,” affirms PEPFAR’s commitment to addressing the largest global HIV prevention and treatment gaps that remain in adolescent girls and young women, children, and key populations. Focus area 1 under Pillar 1, “Advancing Gender-Equitable Programming,” emphasizes addressing gender inequality and preventing and responding to gender-based violence in PEPFAR’s HIV prevention and clinical cascade services. This is essential to achieving new infection reduction goals. DREAMS programming is evolving in response to specific country contexts and the remarkable reduction in new infections among AGYW.
In 2024, PEPFAR announced the next phase of DREAMS programming, DREAMS NextGen, that will take a more nuanced approach that is responsive to the current context within each country. DREAMS NextGen introduces the implementation of Enabling DREAMS activities–expanding on activities that have been implemented as part of DREAMS inception to create supportive environments for AGYW through structural interventions, systems change, etc. and take these activities to regional and/or national levels as well as including specific services for AGYW partners.
The DREAMS NextGen program aims to:
Empower adolescent girls and young women and reduce HIV 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 HIV risk of sex partners through referrals to complementary PEPFAR programming, including HIV testing, treatment, and voluntary medical male circumcision;
Strengthen families with social protection (education subsidies, combination socio-economic approaches) and parent/caregiver programs; and
Improve the enabling environment for HIV prevention for AGYW and all youth.
Our Approach and Results
USAID, through PEPFAR, 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, youth-led, 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 all components of the DREAMS comprehensive package of HIV prevention services, leveraging expertise in economic growth, education, and democracy and governance sectors.
DREAMS 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 responsive sexual and reproductive health care including equitable access to contraception
Parenting/caregiver programs
Community mobilization and norms change programs
Advocacy for policy change that will support AGYW combination HIV prevention
Systems changes that make it easier for AGYW (and other youth) to participate in HIV prevention
Demand creation for SRH services at regional or national levels
Caption: Gloria at her Juba shop where she tailors and sells clothes. / Credit: Jhpiego
USAID's work with adolescent girls and young women, through DREAMS, has led to achievements in the following areas:
In 2023, USAID supported up to two million AGYW aged 10-29 years, representing 80 percent of the total number of AGYW that PEPFAR supports, with DREAMS HIV prevention services. Tailored services include HIV and violence prevention training, HIV testing, education support, financial literacy, links to employment, PrEP, family planning services, and effective parenting courses for parents/caregivers and their adolescent girls.
USAID funded more than 10,000 DREAMS mentors to deliver HIV prevention services in a safe and supportive environment for AGYW. As USAID works with host countries to strengthen systems, these mentors play a critical role in health service delivery and linking youth to other platforms including education, civic engagement, economic opportunities, and mental health support.
In 2023, USAID's OVC and DREAMS programs supported more than 1.3 million girls and boys ages 10-14 to complete education and training focused on preventing HIV infection and reducing occurrance of sexual violence.
In DREAMS districts where USAID is implementing, over 250,000 AGYW received educational support which could include school and exam fees, uniforms and materials, tutoring, and/or basic literacy. While educational support is focused on secondary school, AGYW are supported to complete primary and advance to secondary levels and efforts are made for AGYW forced to leave school to return.
USAID managed 65 percent of the DREAMS budget across 16 countries and between 97 and 100 percent of the DREAMS program budget in Namibia, Rwanda, and South Sudan.
USAID provided education on and access to voluntary PrEP, as part of a package of services, to 209,551 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.
DREAMS Success Stories
DREAMS Zimbabwe: The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Re-Ignite Innovate Sustain and Empower (RISE) program, led by Zimbabwe Health Interventions, partnered with the private sector to offer market-oriented vocational skills training, internships, and mentorship for adolescent girls and young women (AGYW). In Bulawayo metropolitan, Next Generation Consulting, a commercial clothing manufacturing company, trained 17 young women. RISE then placed the young women in internships with several private clothing manufacturing companies. The program also linked the trainees virtually for further mentorship with Niki Moyo Designers, a Zimbabwean fashion designer based in London. In Gwanda district, RISE partnered with the Zimbabwe Red Cross Society to train 19 AGYW as nurse aides. The 19-week primary health care certification included training, workplace training, and concluded with an internationally recognized examination. The training comprised basic life support, special needs care, and emergency response. The program placed the trainees in internships at various local public health facilities.
DREAMS Eswatini: In the Eswatini DREAMS program, Cabrini Ministries provides young women with the business mentorship and equipment needed to start their own small businesses. With youth unemployment at 58% in Eswatini, job opportunities for young women are scarce. The Eswatini National Skills Audit report revealed that high school graduates remain unemployed for more than ten years. Without a steady stream of income, young women in Eswatini are more at risk for engaging in transactional sex and transactional relationships for financial stability which can lead to gender-based violence, HIV, and unplanned pregnancies. USAID works with local partners like Cabrini Ministries to ensure that the tools and resources needed for financial independence and HIV prevention reach the young women who need it most. Along with skills and resources, an enabling environment is critical for AGYW to thrive. This involves support from parents, partners, local community leaders, and trusted mentors. Gcinile Msibi is responsible for helping young women in the Tjedze community to become financially independent. For women who express an interest in entrepreneurship, Gcinile provides them with the business mentorship including help conducting a market assessment for the area, creating a business plan, and providing business management and skills training. “As a young woman entrepreneur, I am able to take what I learn and give that knowledge to the women I work with,” she says. Gcinile applies the lessons she’s learned as a business mentor to her own small business where she sells baked goods and cell phone minutes.
Resources
Banner photo: Felisters David is hard at work in Juba. She chose tailoring as part of the vocational training offered through DREAMS. / Jhpiego