A recent speaker in HEARD’s PhD webinar series was Janet Fleischman, who is a senior associate with the Global Health Policy Center at the Center for Strategic and International Studies, where she focuses on women’s global health and US policy. The title of her presentation was ‘Five years of DREAMS and what lies ahead.’

DREAMS is an acronym for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe and is a programme that was initiated on World Aids Day in 2014 as a partnership between the public and private sector. The DREAMS initiative aims to reduce the rate of new HIV infections among adolescent girls and young women in Southern and Eastern Africa. Janet Fleischman indicated that the DREAMS programme has been successful in reaching millions of adolescents and young women through various channels. However, the Covid-19 pandemic has disrupted HIV prevention and treatment activities because of restrictions in movement instituted by governments lockdowns to curb the spread of SARS-CoV-2.  In her seminar, she described how a large proportion of adolescents and young women have been further exposed to vulnerabilities such as gender-based violence, mental health issues, and food insecurity due to school closures as a result of these lockdowns. Going forward, it was emphasised that more accurate data needs to be gathered at sub-regional levels on the impact of the COVID-19 pandemic on adolescent targeted HIV programming so that there are appropriate responses to address these set-backs.

The seminar also discussed some of the challenges faced by the DREAMS programme. While the  DREAMS model was seen to be innovative, it was costly to implement and will likely prove difficult for national governments to replicate these initiatives in local communities and to sustain them. Additionally, because the various programmes are overlapping and complex, there still remains a need to generate more reliable evidence on what aspects of the DREAMS programme works in different settings.

Suggestions for the extension and improvement of DREAMS projects included the induction of male peers into efforts to address harmful gender norms, more support from private sectors for the implementation of DREAMS projects, and the importance of including the voices of adolescent girls and young women in advisory meetings. Further recommendations included the rapid acceleration of the roll-out of pre-exposure prophylaxis (PrEP) in many Southern and Eastern African countries; and that PEPFAR should work with other agencies to expand the integration of Sexual Reproductive Health (SRH) and HIV programming.

In conclusion, Janet Fleischman indicated that the funding future of the DREAMS initiative is not yet clear, with a new US Administration only half a year into its term of office. The Global Health Policy Center has been instrumental in advocating for continued US support for HIV prevention programming in the region. Over the course of 2021, HIV programmers will monitor funding developments in this space.