DREAMS

Overview

Adolescent girls and young women (AGYW) in urban settings are particularly vulnerable to HIV acquisition due to structural drivers like poverty, gender inequality, sexual violence, and lack of education.

These young girls and women face diverse challenges, including finding decent sources of income. Some jobs, such as commercial sex, expose girls and young women to a higher risk of acquiring HIV, while other jobs offer meager pay that does not allow them to meet their basic needs, causing them to get involved in transactional sex. Many of these women have some knowledge of HIV; however, the information they hear is often distorted by misinformation. Furthermore, many young girls and women receive reproductive health and relationship advice from the elderly that can be judgemental and informed by social and gender norms.

The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) model was created to address these concerns by implementing a core set of interventions to keep AGYW safe and AIDS-free. DREAMS was founded on the premise that when evidence-based interventions are scaled and targeted to the most vulnerable adolescent girls, they could alter the trajectory of the worldwide HIV epidemic. DREAMS interventions included gender-based violence (GBV) prevention, mitigation, and response; adolescent-friendly health services, such as HIV testing and post-rape care; and families and community building, such as offering parenting/caregiver programmes and providing safe places for girls.

Although the DREAMS model has often been implemented in rural areas, the Elizabeth Glaser Pediatric AIDS Foundation introduced evidence-based adaptations in Mbarara City, Uganda to address the unique challenges of urban girls and women to reduce HIV infections and unwanted pregnancy. By the end of 2022, Regional Health Integration to Enhance Services in Southwest Uganda (RHITES –SW) successfully mobilized, screened, and enrolled almost 29,702 adolescent girls and young women (AGYW) into DREAMS programming.