PEPFAR DREAMS NextGen Guidance

WHAT WAS THE PROBLEM?

Adolescent girls and young women (AGYW) face an increased vulnerability for HIV acquisition when compared to their peers. In 2022, girls and women accounted for 63% of new infections in sub-Saharan Africa with 4,000 adolescent girls and young women acquiring HIV every week (UNAIDS). Additionally, data show that AGYW are a priority population to target in order to reduce new infections to reach HIV epidemic control. Pillar 1 in PEPFAR’s 5-year strategy, “Health Equity for Priority Populations,” affirms PEPFAR’s commitment to addressing the largest global HIV prevention and treatment gaps that remain in adolescent girls and young women, children, and key populations. Focus area 1 under Pillar 1, “Advancing Gender-Equitable Programming,” emphasizes addressing gender inequality and preventing and responding to gender-based violence in PEPFAR’s HIV prevention and clinical cascade services. This is essential to achieving new infection reduction goals.

Routine HIV prevention activities have not been effective in reaching this subpopulation, because they are not responsive to the unique circumstances and lived experiences that often place AGYW at greater risk for HIV acquisition. An evidence-based and comprehensive program is necessary to meet the needs of AGYW, which prevents new infections to support global progress towards controlling and ultimately ending the global AIDS epidemic.

WHAT IS THE RESOURCE & TOOL?

In response to AGYW’s disproportionate HIV risk, PEPFAR launched the ambitious Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) partnership, on World AIDS Day 2014. Now implemented in 15 countries, DREAMS provides a comprehensive package of core interventions to address key factors that make AGYW particularly vulnerable to HIV. These include lack of access to comprehensive reproductive health knowledge, family dynamics and structural barriers (i.e., gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school).

Although AGYW incidence has dramatically decreased, on-going elevated levels of new infections among AGYW in some areas and continued disparities in HIV acquisition between AGYW and adolescent boys and young men (ABYM) remain a concern and threaten achieving and maintaining control of the HIV epidemic. Thus, AGYW combination prevention programming should remain a priority, but DREAMS programming should evolve in response to specific country contexts and the remarkable reduction in new infections among AGYW. DREAMS NextGen is the next phase of DREAMS that will take a more nuanced approach that is responsive to the current context within each country. The DREAMS NextGen Guidance details the process for planning, implementing, monitoring and evaluating a DREAMS NextGen program. It utilizes findings from literature, evidence-based best practices, and specific DREAMS studies.

For more information: PEPFAR DREAMS NextGen Guidance [2 MB]