Limited reproductive health care options contribute to high pregnancy rates for adolescent girls which often forces them to drop out of school. To help keep adolescent girls in school, the APHIAplus project in Western Kenya, with funding from PEPFAR’s DREAMS partnership, provides a package of interventions to support adolescent girls and young women, like Doreen.
Credit: PATH / Peter Abwao
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. 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, 4,000 adolescent girls and young women (aged 15–24 years) became infected with HIV globally in 2022 and 3,100 of these infections occurred in sub-Saharan Africa. Social isolation, poverty, discriminatory cultural norms, orphanhood, gender-based violence, and inadequate schooling all contribute to their HIV vulnerability and a life not lived to its full potential. 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. The DREAMS core package 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; and
- Strengthen families with social protection (education subsidies, combination socio-economic approaches) and parent/caregiver programs.
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 all components of the DREAMS comprehensive package HIV prevention services, leveraging expertise in economic growth, education, and democracy and governance sectors. Services are tailored 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 and are delivered to all DREAMS AGYW, 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 responsive sexual and reproductive health care including equitable access to contraception.
- 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.
- 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.
- 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 for primary and secondary school, an emphasis is placed on keeping AGYW in school especially as the transition from primary to secondary levels and supporting AGYW to return to school.
- 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.
Two young women, empowered with sewing skills through the DREAMS program, sew masks in response to the COVID-19 pandemic. Credit: Maynard Muchangwe
DREAMS Zimbabwe: Young women gain employment skills to reduce HIV vulnerability
The USAID-funded 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: Economic Strengthening for Young Women in 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.