From dreams to reality: Championing a locally led HIV response to empower girls and young women

In the relentless fight against HIV in sub-Saharan Africa, PEPFAR’s DREAMS initiative has been a beacon of hope for adolescent girls and young women (AGYW), a group disproportionately affected by this epidemic. Launched in 2015, DREAMS exemplifies a holistic approach to HIV prevention, intertwining medical, behavioral, socio-economic, educational and community-level strategies. This effort, which includes addressing the foundational causes of HIV vulnerability among AGYW, marked a significant leap forward. 

Pact's involvement with DREAMS began shortly after its inception in Zambia, Eswatini and Tanzania, capitalizing on our extensive experience in community engagement and the trust we've built with communities. Our fundamental strategy involved supporting local organizations to deliver the comprehensive DREAMS package, enhancing local capabilities to sustain the DREAMS initiative even beyond Pact’s direct involvement. As our DREAMS programming expanded to Rwanda, South Africa, South Sudan and Namibia, our impact broadened.  

Through our DREAMS programming, we've worked with local partners and AGYW themselves to address the unique needs of AGYW more effectively, placing their participation and voices at the forefront. A notable example was the introduction of a mental health intervention in Zambia, addressing a significant, previously unmet need among AGYW. Our USAID-funded Zambia Community HIV Prevention Program piloted a group therapy approach and subsequently expanded the intervention across all its DREAMS sites. 

In Eswatini, under the USAID-funded Insika ya Kusasa project, we established Indabas, forums where AGYW directly engaged with local stakeholders and government representatives. In these gatherings, AGYW actively shared their experiences to influence policy and improve services aimed at addressing their unique challenges and needs. Innovations like these have been instrumental in advancing the DREAMS initiative, ensuring it remains dynamic and responsive and that AGYW are integral and empowered participants in shaping their own futures. 

In recent years, our approach to supporting DREAMS has undergone a transformation. Previously, our role involved primary oversight and capacity development for local partners. Now, we're advancing a model where local partners take the lead, with us providing demand-driven technical assistance in a supportive role. This shift is pivotal: it signifies a move toward true localization, with local entities not just participating but driving the initiative. Our USAID funded work in Zambia through the CHEKUP I project led by CIDRZ, and in Eswatini through the Sabelo Sensha project led by Young Heroes, exemplifies this new paradigm. 

Beyond empowering local partners to lead, we are also dedicated to ensuring sustainability by collaborating with governments. Under the USAID-funded ACHIEVE project in South Africa, for example, we are collaborating with the National Youth Development Agency to improve the provision of comprehensive economic strengthening interventions for youth, with a focus on AGYW. This intervention is carefully designed to cater to the specific needs of South African AGYW and align with the country’s unique context. Under ACHIEVE, we are also engaging with the Government of Tanzania to assess the costs of the DREAMS package and its components. This essential step is foundational for securing future financing for the DREAMS initiative.  

Over the past nine years, Pact has expanded DREAMS programming in six countries and partnered with over 35 local organizations. More than one million AGYW have accessed our quality, evidence-based DREAMS interventions in sub-Saharan Africa. Bolstered by evidence of what works and our dynamic partnerships with governments, local partners and AGYW themselves, our approach to DREAMS is still evolving. This next iteration, DREAMS NextGen, is adopting a more nuanced approach that is responsive to the specific contexts of each country. This includes supporting DREAMS activities at regional and national levels to impact a broader geographic area and enhance the sustainability of the initiative. Not only will these shifts build more supportive environments for AGYW and expand reach, but they will also promote a more enduring HIV prevention response with AGYW at the forefront.  

As the first cohorts of DREAMS AGYW age out of adolescence and young adulthood safe and protected from HIV, future DREAMS programs will continue to create protective environments for millions more AGYW, enabling them to make educated and supported choices about their health.