DREAMS program, Kenya, 2016-2019

The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program was developed in response to the disproportionately high rates of HIV infection among adolescent girls and young women (AGYW) aged 15-24 in sub-Saharan Africa. Due to overlapping factors, including limited educational and economic opportunities and gender-based violence, AGYW in the region are 2-3 times more likely to be living with HIV compared to their male peers. In Kenya, AGYW account for nearly half of all new infections among girls and women over age 15.

Key findings from the 2019 Kenya Violence Against Children and Youth Survey (VACS): 

• 15.7% of girls experience sexual violence in childhood
• Among girls who experienced sexual violence in childhood, 41.3% ever told someone, 12.5% sought help, and only 10.7% received services

From 2015 to 2025, DREAMS in Kenya, implemented through Afya Ziwani (PATH) with funding through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), addressed the multiple overlapping risk factors AGYW face in high HIV-burden counties such as Nairobi, Kisumu, and Homa Bay. 

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.  

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].