Council Commentary

Making the Dream to End HIV a Reality by Empowering Adolescent Girls and Young Women: Emerging lessons from the DREAMS partnership

The Center for Global Development and the Population Council co-hosted a high-level discussion on emerging insights from the DREAMS initiative, an ambitious partnership to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries.  Supported by the Bill and Melinda Gates Foundation, Girl Effect, and the President’s Emergency Plan for AIDS Relief (PEPFAR) through Project SOAR, the Population Council leads the DREAMS implementation science and capacity building portfolios.

Read a companion post on this event by the Center for Global Development here.

The discussion revealed key lessons for DREAMS partners:

  • Profiling vulnerabilities: Understanding the diverse lived experiences of hard-to-reach girls at risk for HIV, including where they are and the complex nature of the marginalization they face, is essential to developing interventions and service delivery that best addresses their needs.
  • Addressing GBV and gender norms: DREAMS is a groundbreaking initiative in part because of the tremendous strides it is taking to integrate services and approaches, and to test innovative ways to address social drivers of HIV, including gender-based violence and gender norms.
  • Building capacity: Integrating capacity-building efforts with country partners from the beginning of project implementation is crucial for building program sustainability.

Putting adolescent girls and young women at the center of the HIV response

Ambassador Deborah L. Birx, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, PEPFAR, spoke about the genesis of the DREAMS initiative and progress to date, including how the Population Council’s large body of research on adolescent girls – and notably Council expert Judith Bruce’s work identifying and reaching marginalized girls and young women at highest risk for HIV– played a critical role in shaping the DREAMS approach.

Patience Ndlovu, Director, World Education in Zimbabwe & Chief of Party, DREAMS, also presented on her experience as an implementing partner, reflecting on how the Council research tools, including the Girl Roster™ , has helped partners identify most at-risk girls and young women and connect them to layered services – including HIV prevention, education, and empowerment interventions – differentiated by girls’ unique needs. She noted how the DREAMS approach has strengthened coordination between Ministries of Health, Education, and Social Services and enabled ownership of DREAMS at the country level that could be sustained beyond the program’s duration.

Making programs work for the most vulnerable

Sanyukta Mathur, DREAMS Implementation Science Project Director, then presented preliminary implementation science findings, highlighting results from studies that are: 1) assessing the effectiveness of girl-centered programming; 2) identifying and reaching male partners of adolescent girls and young women (AGYW); and 3) introducing oral PrEP (Pre-Exposure Prophylaxis) to at-risk AGYW. Early results indicate that:

  • Adolescent girls and young women (AGYW) have a high-multi-faceted risk of HIV. While DREAMS has reached many vulnerable AGYW in Kenya and Zambia, for example, better identification of context-specific vulnerabilities through innovative analyses and tools could inform more targeted outreach and programming (such as to specific sub-populations of out-of-school girls).
  • Male partners of AGYW in South Africa engage in high-risk behaviors, but also experience high rates of trauma and violence in their own lives; these experiences in turn increase HIV risk for AGYW.
  • Effective introduction and provision of PrEP for AGYW requires the engagement of AGYW and key actors in their lives; in Tanzania, for instance, documenting AGYW’s willingness to take PrEP and parents, partners, and health care providers support has been critical to introducing this prevention technology for AGYW.

Assessing impact and implications

Isolde Birdthistle, Assistant Professor of Epidemiology and Project Director for DREAMS Impact Evaluation Studies concluded presentations, showcasing how the DREAMS partnership is leveraging existing country data platforms to assess impact. Early results show that awareness and uptake of DREAMS was high among adolescent girls, but low among key populations, including men who have sex with AGYW and female sex workers. DREAMS is also having important secondary effects, such as increasing the number of adolescent girls who know their HIV status. These early results indicate opportunities for greater focus, including on how to better reach specific key populations and assessing whether AGYW who now know their HIV status continue onto treatment.

Finally, Amanda Glassman, Chief Operating Officer and Senior Fellow at the Center for Global Development, moderated a distinguished panel, including Julie Pulerwitz, Program Director for HIV and AIDS at the Population Council, Chewe Luo, Chief of HIV/AIDS, Programme Division, UN Children’s Fund; and Jirair Ratevosian, Director of Government Affairs, Gilead Life Sciences. Panelists discussed preliminary findings and their implications for future policy and programming around HIV and adolescent girls and young women.

"It's time to address these underlying structural and cultural issues that affect many of the outcomes that we care about," Pulerwitz noted, citing the need for further research on the role of stigma and other cultural barriers to preventing HIV.