Evaluating the impact of DREAMS in South Africa
Has the Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program had any impact on the rate of new HIV infections in adolescent girls and young women (AGYW) in South Africa since it was launched in November 2015? That is the big question that CDC South Africa and its partner, Epicentre, are hoping to answer by the end of 2018.
Fieldworkers from Epicentre have been working around the clock to survey 18,500 AGYW in four of the five districts in South Africa where the DREAMS program is being implemented. These districts – uMgungundlovu and eThekwini districts in KwaZulu-Natal, and Ekurhuleni and the city of Johannesburg districts in Gauteng – have been chosen based on the HIV/AIDS epidemic, and socioeconomic and demographic factors.
The Epicentre study, which began in April 2017, will also measure other elements that contribute to the high rates of HIV infection in AGYW in these four districts. It will do this by determining:
- the prevalence of HIV among AGYW and the proportions on antiretroviral therapy and treatment naïve with detectable and undetectable viral load.
- changes in the prevalence of pregnancies and sexually transmitted infections.
- changes in HIV risk behavior (for example, the number of sexual partners, condom use, and age of sexual activity), gender-based violence, and key milestones of development, including academic progress and school completion.
- The impact of changes in empowerment of AGYW, and parenting skills on the HIV incidence among AGYW and occurrence of violence against AGYW.
Cherie Cawood, Chief Executive Officer of Epicentre, is happy with the progress of the survey. She said: “We have passed the halfway mark in the targeted number of participants. We anticipate that the survey will be completed in the next few months.”
This study is important for South Africa because the country continues to have the highest rate of new HIV infections every year. In 2016, the UNAIDS estimated that 270,000 new infections occurred in the country and that the majority of the infections occurred in AGYW.
The DREAMS initiative is one of the programs that CDC, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the South African government are implementing to reduce the HIV incidence in AGYW. About 2,000 AGYW are infected with HIV every week in South Africa. More than one-third of South Africa’s adolescent girls have reported that their first sexual encounter was forced. The DREAMS program is crafted to change this picture by ensuring that all girls and young women are given an opportunity to live DREAMS lives.
Kassahun Ayalew, a statistician at CDC, elaborated on the importance of the Epicentre study: “The study is important in evaluating whether the study has brought the expected impact to the lives of AGYW in South Africa, especially in terms of preventing them from HIV infection, unwanted pregnancy, STI, keeping girls at school, resilience, acquiring life skills, access to health services, positive behavioral change, and gender-based violence.”
It also contributes to research efforts to understand what interventions are required to prevent new HIV infections among AGYW, and which intervention packages will benefit this at-risk group. This data can be used for identifying the right package of interventions, designing and implementing programs targeting AGYW and for planning, monitoring and evaluation South Africa.”