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

Speeches Shim

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 Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) 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 since 2015 has expanded from the original 10 to 16 countries in sub-Saharan Africa: Botswana, Côte d’Ivoire, eSwatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Sudan, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe and Haiti.

Globally, around 5,000 adolescent girls and young women aged 15–24 years become infected with HIV every week. In sub-Saharan Africa, six in seven new HIV infections among adolescents aged 15–19 years are among adolescent girls. Around 4,200 adolescent girls and young women aged 15–24 years became infected with HIV every week in 2020. 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. 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 support including subsidies, materials, tutoring, and early warning drop out systems
  • Financial Literacy and 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

Scaling up impactful and evidence-based interventions across multiple sectors has allowed USAID to accelerate efforts to control the HIV/AIDS epidemic.

2021 Achievements

  • USAID contributed to supporting 2,414,719 adolescent girls and young women through the DREAMS program (86% of 2,818,337 reached by all of PEPFAR), an increase from 1.6 million adolescent girls and young women ages 10-24 years in DREAMS at the beginning of the fiscal year
  • 2,623,727 AGYW (ages 10-24), 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 2,223,228 of these AGYW
  • USAID managed 65 percent of the DREAMS budget across 16 countries and between 97 and 100 percent of the budget in Namibia, Rwanda, and South Sudan.
  • USAID programmed in 166 of the 201 DREAMS implementation areas across the 16 countries
  • USAID provided PrEP, as part of a package of services, to 153,931 (cumulative, FY21 Q1 through Q4) 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

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.

COVID-19 Best Practices in Zimbabwe:
During the beginning of the COVID-19 pandemic, DREAMS/Zimbabwe was able to successfully pivot a number of their programs in order to continue service delivery and respond to the pandemic throughout 2020 and 2021. DREAMS/Zimbabwe provided DREAMS Ambassadors with both additional cell phone data and bicycles to help them maintain contact with AGYW, employed social networking approaches used by DREAMS Ambassadors for recruiting AGYW, the most vulnerable to HIV, and moved delivery of HIV and violence prevention sessions from the school to the community for AGYW ages 10-14, making it easier to access services. DREAMS/Zimbabwe also used community schooling to assist AGYW to catch up with formal education, increased communication on where/how to access GBV response services, utilized the Sexual Reproductive Health Referral Network model, led by DREAMS Ambassadors, and increased community outreach and service delivery for HIV testing (including self test options), Family Planning, PrEP, and distribution of condoms and menstrual health supplies.

South Africa "co-location of DREAMS interventions in safe spaces such as community halls, schools, drop in centers and local churches etc.
Despite challenges faced during the beginning of the COVID-19 pandemic and lockdown restrictions, South Africa’s implementing partners managed to integrate their services through the co-location of DREAMS interventions to reduce movement of participants from one service point to another. For those participants who could not be reached through in-person group sessions due to lockdowns, implementing partners continued to engage with them by using WhatsApp and other social media platforms. DREAMS mentors continued to link participants to relevant services and followed up on service completion with similar online platforms. Participants who did not complete sessions were prioritized and welcomed back (during relaxed lockdown levels) to the sessions to ensure that the layering of other interventions was continued and the program was stabilized.

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: May 12, 2022

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