The Determined Resilient Empowered AIDS-free Mentored and Safe Program (DREAMS)is a HIV prevention program funded by PEPFAR to addresses multilinked demographic, geographic, behavioral, and structural challenges that increase the risk of HIV amongst the most vulnerable Adolescent Girls and Young Women (AGYW) aged 10 – 24 years.
With support from PEPFAR and administered through the U.S Centers for Disease Control and Prevention, Zim-TTECH is implementing the DREAMS program in the Matabeleland North province of Zimbabwe. DREAMS was launched in Matabeleland North in COP 20 as part of the 10 expansion districts in Zimbabwe. The program is being implemented in Bubi, Lupane, Nkayi and Tsholotsho districts under the Zimbabwe Partnership to Accelerate AIDS Control consortium, focusing on both the school and community-based interventions.
The main purpose of the DREAMS program is to reduce new HIV infections among the most vulnerable adolescent girls and young women by 40% in the highest HIV burden districts in Zimbabwe. DREAMS implementing partners (Bantwana and Pangaea Zimbabwe AIDS Trust and Africaid Zvandiri) prioritize AGYW’s health, wellbeing, and HIV epidemic control through the provision of evidence-based curricular and need-based secondary services. To date at least 27 000 AGYW have been mentored through the DREAMS program enhancing knowledge, strengthening social protection of AGYW, and building social assets.
AGYW aged 10-24 are receiving sub population specific “layered package of services” including HIV/GBV Prevention, social asset building, condom promotion, HTS, Pre-exposure Prophylaxis (PrEP), family planning services, social protection, economic strengthening, positive parenting, and other services. DREAMS services are being delivered by partners with expertise related to a particular component of the core package.
DREAMS Core Package
DREAMS employs a client-centered approach, in which the AGYW is always at the center. DREAMS requires the implementation of multiple interventions that target different risk factors or behaviors that may lead to HIV acquisition:
The DREAMS program establishes safe space groups for both in and out-of-school girls which act as a structure to deliver interventions/services to girls and as a safe space for girls to build their social assets. The DREAMS safe space groups are girls-only spaces, consensus is reached by the girls themselves on identification of the physical safe space and frequency of meetings and well as meeting times. The groups are segmented based on age (10-14, 15-19, 20-24 years) and similar characteristics so that girls interact with other girls whom they can share similar experiences with.
Primary Core Package
DREAMS is an HIV prevention program that capacitates AGYW with prerequisite knowledge on HIV, gender norms and financial literacy as part of creating protective assets. AGYW meet within their safe spaces were a specific trained cadre (Community based Mentor) delivers evidence-based age appropriate curricular using different facilitation skills ensuring that learning takes place in a fun way. These Health for Life sessions are also delivered in schools by trained Guidance and Counselling teachers. Songs, dance, poetry, and sports are used as part of delivery methods.
Secondary Service Interventions
DREAMS is delivered in partnership with the country’s government and relevant stakeholders, providing a comprehensive package of core interventions to address key factors that make adolescent girls and young women particularly vulnerable to HIV. These include behavioral factors (i.e., multiple sex partners, condom-less sex), and family dynamics and structural barriers (i.e., gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school). This model suggests a variety of interventions to synergize the approach to reduce risk of HIV and mitigate the factors that lead to HIV (i.e., school drop-out, alcohol use/misuse, unprotected sex). These interventions are:
- Parenting/caregiver programs (Families Matter Program)
- Educational Subsidies
- Community mobilization/norms change programs
- Economic strengthening
- Clinical service provision to reduce the risk of sexual partners and empower the AGYW.
Clinical service provision is a key element in DREAMS supported by DREAMS Program Nurses who offer youth friendly services to AGYW, cultivating protective assets. As part of empowering AGYW to reduce HIV risks, the following client-based services are offered:
- Comprehensive Family planning
- Condom Promotion, Demand Creation, Provision and Adherence
- Pre-exposure prophylaxis (PrEP) Promotion, Provision and Adherence
- Linkage to post violence care, including post-exposure prophylaxis (PEP)
- HIV testing services (HTS)
- Social asset building
- Economic strengthening