Dreams Core Package of Interventions

DREAMS
Core Package of Interventions

Summary
WORKING TOGETHER FOR AN AIDS-FREE FUTURE FOR GIRLS & WOMEN
DREAMS Background
DREAMS is an ambitious partnership, totaling $385 million, committed to help girls develop into Determined,
Resilient, Empowered, AIDS-Free, Mentored, and Safe women. DREAMS funds a Core Package of
evidence-informed approaches that go beyond the health sector, addressing the structural drivers that directly
or indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and lack of
education.
Despite considerable progress in the overall global response to the epidemic, HIV among young women
ages 15 to 24 in a subset of sub-Saharan African countries remains an urgent problem. AIDS is the leading
cause of death for adolescent girls in Eastern and Southern Africa, who account for 74 percent of all new
infections. As many as 7,000 new infections a week are occurring among the most vulnerable girls and
young women in this region – people who are critical to the future of their countries. This must change.
To address this urgent and complex issue, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR),
Johnson & Johnson, Bill & Melinda Gates Foundation, Girl Effect, Gilead Sciences, and ViiV Healthcare
partnered to create DREAMS. PEPFAR, Johnson & Johnson, and ViiV Healthcare mobilized an additional $85
million in funding for the DREAMS Innovation Challenge. DREAMS is already delivering a Core Package of
evidence-informed interventions in 10 countries, which account for more than half of all new HIV infections:
Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe.
The DREAMS Core Package of interventions goes beyond the health sector, addressing the structural drivers
that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and
lack of education, with the goal of reducing HIV incidence in females ages 15 to 24 by 40 percent in 2017. To
reach this goal, innovative approaches from new and existing players are needed.
The Core Package of Interventions Offered Through DREAMS
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DREAMS Core Package Evidence-Informed Interventions
Interventions to Strengthen Families

Parenting/Caregiver Programs
It is vital to young women to have a positive relationship with a parent, caregiver, or other
caring adult. This relationship has a consistent protective factor for young women and
adolescent girls against a variety of negative health and social outcomes. Programs that
involve parents and caregivers have shown to be very effective in changing HIV-related
sexual behaviors among all youth (e.g., use of male and female condom, delayed sexual
debut, as well as decreased exposure to negative outcomes such as violence and abuse).
Cash Transfers
Programs that provide financial support have demonstrated consistent positive
outcomes to the health and well-being of young women. Most governments in East and
Southern African countries are supporting unconditional or schooling-conditioned
financial support that will benefit vulnerable children. This type of program could be a
scalable platform to achieve DREAMS outcomes.
Educational Subsidies
Female students are especially vulnerable to dropping out of school. Providing
educational subsidies is an effective intervention for keeping girls in school. In most
settings, higher levels of education are associated with lower HIV risk and higher HIV
testing acceptance. Education also has countless other positive effects in the lives of
girls, young women, and their communities as a whole.
Combination Socio-Economic Approaches

The most effective social protection approaches for promoting healthy behavioral changes
and decreasing the risk of violence among adolescent girls and young women have been
those that use both economic and social empowerment. PEPFAR is already providing
financial savings programs and can provide a platform for DREAMS. Programs to increase
social empowerment can include discussion groups on gender-based violence, couples
communication, mentoring, and comprehensive, evidence-based HIV prevention
education programs. Providing these programs together can create lasting change in the
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lives of these young women.
Interventions to Reduce Risk of Sex Partners
Characterization of Male Sexual Partners

Medical antiretroviral drug treatment for men living with HIV is a highly effective intervention
to prevent transmission to their sexual partners. These medications are not a cure, but can
prevent spreading the virus. However, many men are reluctant to be tested at all and those
that test positive may be reluctant to be treated. There is a great need for better
characterization of the male sexual partners of at-risk girls and women in order to develop
services men are more likely to use and help them accept treatment.
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Interventions to Mobilize Communities for Change
School-Based HIV Prevention

Sexual education programs in school systems can provide a foundation of accurate
knowledge among young people and in some instances can help to decrease risky sexual
behaviors.
Community Mobilization/Norms Change

Community mobilization provides an essential support framework for HIV prevention
programs and serves as a way to engage boys, men, and the broader community in
addressing social norms that increase HIV risk for adolescent girls and young women.
Community mobilization efforts in related areas, like gender-based violence prevention,
have demonstrated a significant impact on norms change, as well as decreases in violent
victimization and perpetration.
Interventions That Empower Girls and Young Women

Increase Consistent Use and Availability of Condoms
Condom use is highly effective for preventing HIV/AIDS when used correctly and
consistently. Therefore, providing and distributing condoms is vital for reducing infections
among girls and women.
Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV, but who are
at substantial risk of getting it, to prevent HIV infection by taking a pill every day. This oral
antiretroviral medication has the potential for significant reduction in HIV infections among
young African women.
Violence Prevention and Post-Violence Care

There is a strong association between violence, especially intimate partner violence and
violence against children, and HIV status in women. Preventing, screening for, and treating
the negative effects of violence in adolescent girls and young women are ways to identify
those young women who may be at greater risk for HIV infection. In addition, high-quality
violence prevention and response may decrease young women’s risk for HIV.
HIV Testing and Counseling (HTC)

HTC is a crucial part of the entire Core Package of interventions. Testing young women
assists in linking them to care if infected, and linking them to DREAMS prevention
activities if uninfected. Testing men helps to prevent HIV among adolescent girls and
young women by linking uninfected men to voluntary medical male circumcision (VMMC)
and men living with HIV to HIV care and treatment.
Increasing Contraceptive Method Mix

Adolescent girls and young women in low income countries experience high rates of
unplanned pregnancy due to an unmet need for voluntary family planning, which increases
their risks for pregnancy-related morbidity and mortality and affects lifelong education and
economic opportunities. Unplanned pregnancy is often cited as the reason for adolescent girls
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dropping out of school. The promotion of dual protection, in which condom use is combined
with another modern contraceptive method, is a critical component of family planning/HIV
services and will help reduce the risk for HIV infection as well as unintended pregnancy.
Increasing the variety of contraceptive methods available to women will also help keep
them HIV free.
Social Asset Building

The most at-risk adolescent girls and young women often lack strong social networks.
Programs that connect adolescent girls and young women with peers and adults who can
offer emotional support as well as information and material assistance are needed.
Interventions that build social skills may improve girls’ abilities to protect themselves by
reducing their social isolation and providing them with social safety nets through mentors,
peer groups, civic engagement, and access to health information and services.
The DREAMS Innovation Challenge
The DREAMS Innovation Challenge seeks to award and implement solutions that further DREAMS’
commitment to reduce HIV infections by infusing new thinking and approaches to meet the urgent, complex
needs of adolescent girls and young women in sub-Saharan Africa. PEPFAR, Janssen Pharmaceutica, NV,
one of the Janssen Pharmaceutical Companies of Johnson & Johnson, and ViiV Healthcare have committed
$85 million in awards for solutions that address unmet needs not covered by the DREAMS Core Package.
For more information, visit www.dreamspartnership.org.

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Dreams Core Package of Interventions

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DREAMS

Core Package of Interventions

The Core Package of Interventions Offered Through DREAMS

DREAMS Core Package Evidence-Informed Interventions

Interventions to Strengthen Families

Combination Socio-Economic Approaches

Interventions to Reduce Risk of Sex Partners

Characterization of Male Sexual Partners

Interventions to Mobilize Communities for Change

School-Based HIV Prevention

Community Mobilization/Norms Change

Interventions That Empower Girls and Young Women

Pre-Exposure Prophylaxis (PrEP)

Violence Prevention and Post-Violence Care

HIV Testing and Counseling (HTC)

Increasing Contraceptive Method Mix

Social Asset Building

The DREAMS Innovation Challenge

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