DREAMS program, Kenya, 2016-2019

What is it and how it works

DREAMS is a multisectoral combination prevention program that integrates interventions targeting individual, community, and societal factors influencing HIV risk, including sexual violence. It prioritizes education, economic empowerment, and mentorship along with violence prevention and response to create safe and enabling environments for at-risk AGYW. The program uses a layered approach, ensuring beneficiaries receive multiple reinforcing services tailored to their unique needs. Implementation partners include community-based organizations, health facilities, and schools.

DREAMS is implemented through a comprehensive core package of interventions [1] that aims to address multiple risk factors and reduce HIV acquisition through:

• Empowering AGYW and reducing their risk of HIV through social asset building (e.g., building trusted networks through mentoring and safe spaces), education subsidies, and socio-economic skill building, as well as youth-friendly sexual and reproductive health care such as post-violence care and access to HIV testing and treatment services and pre-exposure prophylaxis (PrEP). 
• Strengthening families through parent and caregiver programs, including sessions dedicated to reducing sexual violence.
• Mobilizing communities for change, including through school-based HIV and violence prevention programs and community programs such as SASA! and MTV Shuga that aim to prevent violence and reduce HIV risk behaviors.
• Reducing risk among sex partners, including through HIV testing and treatment services.

In Kisumu County, Kenya, trained female mentors provided interventions in community safe spaces alongside specialist service providers. Each youth received regular mentoring and a comprehensive package of support services that prioritized violence prevention [2].

Evaluation and program outcomes

To assess the impact of various combinations of DREAMS interventions on HIV-related outcomes in Kisumu County, Kenya, Mathur et al. [2] used classification and regression tree analysis to analyze survey data among AGYW who had been enrolled in the program for 14-16 months. Results show that alongside community participation in MTV Shuga and SASA!, exposure to various combinations of layered interventions leads to improved HIV and violence prevention outcomes.  

• Reduction in sexual violence: receipt of schooling support combined with participation in the Families Matter! parenting program increased reports of ‘no sexual violence’ in the past 12 months by 21 percentage points (from 79% to 100%) among adolescent girls (ages 15-19 years). Among young women (ages 18-24 years), exposure to the gender-based violence (GBV)  prevention program and male sexual partner program shifted experiences of ‘no sexual violence’ in the past 12 months by 17 percentage points (from 79% to 96%).
• Transactional sex prevention: schooling support reduced adolescent girls’ engagement in transactional sex by 8 percentage points (from 92% to 100% reporting ‘no transactional sex’).
• Increase in consistent condom use: exposure to PrEP awareness, schooling support, and the GBV prevention program increased the likelihood of consistent condom use by 58% (from 49% to 78%) among adolescent girls. Among young women, consistent condom use increased by 29 percentage points (from 21% to 50%) when schooling support was combined with the male sexual partner program [2].

These findings highlight the importance of layering interventions, particularly education, parent engagement, gender-based violence prevention, and HIV prevention strategies, to maximize impact.

Challenges

• Cultural resistance: In some communities, entrenched gender norms hinder program acceptance.
• Resource limitations: High demand for services has stretched program capacity.
• Data gaps: Monitoring and evaluation systems require strengthening to capture long-term impacts [1].

Lessons learned

• Community involvement: Engaging local leaders and families fosters acceptance and sustainability [1].
• Integrated services: The combination of exposure to community, education, and parenting interventions is associated with a decreased risk of sexual violence [2].
• Tailored approaches: Addressing the unique needs of AGYW in different contexts ensures better program alignment and outcomes.
• Recruitment and retention: Identifying and enrolling the most vulnerable AGYW, such as those not in school, can be difficult. This is particularly challenging among young women ages 20-24 as they may have multiple work and parenting responsibilities, among others [1].

For those interested in learning more, contact details will be provided soon.

[1] Saul, J., et al. (2018). The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PloS one, 13(12), e0208167. https://doi.org/10.1371/journal.pone.0208167

[2] Mathur, S., et al. (2022). Assessing layered HIV prevention programming: Optimizing outcomes for adolescent girls and young women. AIDS, 36 (Supplement 1), S75–S83. https://doi.org/10.1097/QAD.0000000000003242

[3] USAID. (n.d.). DREAMS Kenya overview. 

[4] DREAMS. (n.d.). Kenya Overview (2016-2019) factsheet. 

Disclaimer: These findings reflect program outcomes in the specific setting. Results may vary across settings due to differences in implementation, culture, or socio-economic factors. Successful scale-up requires careful adaptation, cultural relevance, and strong monitoring and evaluation to ensure quality, and continuous improvement.