Dreams of reducing HIV infections among women and girls
Deborah Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy.
When we reflect on what the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the global movement for an AIDS-free generation have achieved to date — and they have achieved a lot — there still are gaps. Global development efforts have progressed greatly on issues ranging from food security to economic advancement, but one population consistently left behind encompasses over half of our planet: women and girls. The low status of women and girls has contributed to a rampant AIDS epidemic among adolescent girls and young women in sub-Saharan Africa. They experience many vulnerabilities that affect their risk of contracting HIV, including biological factors, harmful gender norms, limited schooling, reduced job opportunities and high levels of physical and sexual
violence. Almost one third of new HIV infections among adult women globally occur among young women in Africa.
On World AIDS Day in 2014, I launched DREAMS (determined, resilient, AIDS-free, mentored and safe women), a public-private partnership with the Bill & Melinda Gates Foundation and the Nike Foundation. The goal of DREAMS is to reduce new HIV infections among adolescent girls and young women in up to 10 sub-Saharan African countries. Countries that are eligible for funding under the DREAMS partnership will implement a core package of programmes for adolescent girls and young women, including programming that strengthens their families, mobilizes their communities and reduces the risks posed by their sexual partners. Emerging research shows that the best way to address complex problems is through implementing a combination of evidence-informed prevention interventions, producing a synergistic effect whereby those who receive multiple interventions do better than those who receive only one.
With DREAMS, PEPFAR is aiming to have a swift and effective impact on incidence. The youth population in sub-Saharan Africa is expanding rapidly, and there is a growing population of vulnerable adolescent girls and young women. The DREAMS partnership will be used to deliver more effectively across sectors and to experiment with various models to assess impact. Using implementation science, existing surveys, PEPFAR indicators and additional measurement and evaluation methods, the DREAMS package of interventions will be scrutinized for impact. If its interventions and approach are found to be reducing new infections, the DREAMS partnership will create a model for HIV prevention.
Because of the interventions in the core package, DREAMS could transform lives in many ways: by decreasing HIV incidence, reducing unplanned pregnancy, increasing economic mobility, reducing violence and raising the status of women and girls in their communities. Expanding and tailoring DREAMS for varied contexts could create an approach that could be used globally to improve the lives of women and girls.
