What is the PEPFAR-funded DREAMS program?
DREAMS is a global, public-private partnership between the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, ViiV Healthcare, and Gilead. This interagency program seeks to reduce new HIV infections in adolescent girls and young women (AGYW) between 10 and 24 years old across 15 sub-Saharan African countries. DREAMS is designed to meet the complex needs of adolescent girls and young women by helping them become more determined, resilient, empowered, AIDS-free, mentored, and safe.
Why Adolescent Girls and Young Women?
Globally, AGYW are the most vulnerable to new HIV infections, unplanned pregnancy, and sexual violence. In southern Africa, 79% of new HIV infections among 10 and 19-year-olds were among females.1 In Zambia, HIV prevalence among young people between 15 and 24 years old is 3.4% with a disproportionate burden on girls and young women (4.9%) as compared to their male age counterparts (1.8%). Sixty-nine percent of Zambian girls and young women have had sex by age 18 and 26% report their first sexual experience as coerced. 2,3 Additionally, 20.3% of adolescent girls and young having experienced sexual abuse during childhood.4 Such violence has immeasurable negative health and social consequences for girls and young women throughout their lives.
1 UNAIDS 2019. Women and HIV – A spotlight on adolescent girls and young women.
2 Zambia Demographic and Health Survey (ZDHS) 2018.
3 Zambia Violence Against Children Survey (VACS) 2018.
4 Zambia VACS 2018.
DREAMS in Zambia
Since 2016, PEPFAR has steadily increased investment in DREAMS. As of 2020, PEPFAR invests $30 million per year in the DREAMS initiative in Zambia. Working across 14 districts in seven provinces, DREAMS Zambia targets the most vulnerable adolescent girls and young women in 77 health facility catchment zones with high HIV burdens. DREAMS Zambia has developed a unique model structured around DREAMS centers, where adolescent girls and young women meet in safe, confidential spaces to access a package of HIV prevention services tailored to their individual needs. These services include mentor-led safe spaces, gender-based violence care and support, HIV testing and counseling, family planning, pre-exposure prophylaxis, school scholarships, and economic strengthening. When combined with safe spaces, economic strengthening interventions, such as financial literacy and vocational training, can reduce the economic dependency that can lead to gender-based violence and sexual risk-taking behaviors.
DREAMS also works with adolescent girls’ and young women’s sexual partners, parents, schools, and communities. School-based HIV and violence prevention programs address gender and power relations and build prevention skills among youth. Community mobilization in DREAMS engages men and boys in community conversations about HIV, gender norms and sexuality to build community ownership of HIV risk reduction. These community-based interventions strengthen the supportive network necessary for girls and young women to thrive.
Since DREAMS inception, over 775,000 Zambian adolescent girls and young women have enrolled in the HIV prevention program, with nearly 725,000 completing at least one prevention service with support from DREAMS mentors. Girls and young women who have participated in DREAMS have demonstrated increased knowledge of healthy practices and behaviors that can reduce their risk of contracting HIV. Over time, DREAMS Zambia has observed improved use of modern contraceptive methods and pre-exposure prophylaxis through adolescent-friendly health services offered in DREAMS centers in partnership with government health facilities. Such prevention services are critical to reducing new HIV infections and achieving epidemic control in Zambia.