Saving Lives through the DREAMS Program

“Every great dream begins with a dreamer”—said Harriet Tubman, an American abolitionist and political activist. So is the case of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program, which aims for an AIDS-free future for girls and women aged 10 to 24. With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), DREAMS is comprised of a comprehensive, multi-sectoral package of core interventions that address key factors that make adolescent girls and young women (AGYW) particularly vulnerable to HIV.

Since 2015, CDC, through PEPFAR, has been supporting this program that aims to reduce AGYW’s vulnerabilities to HIV while increasing their knowledge, decision-making power, access to needed health services, and support networks, across 15 countries.

Despite substantial declines in new HIV infections globally, the HIV epidemic disproportionately impacts AGYW in many countries. For example, in sub-Saharan Africa, 67 percent of new HIV infections in young people occur in AGYW. In addition, data show that AGYW are up to 14 times more likely to become HIV-infected than their male counterparts.

In Uganda, while HIV prevalence peaks around age 45-49 among men, AGYW aged 10-24 years have more than three times the prevalence compared to boys of the same age. Even more concerning is that the rate of NEW infections remains twice as high among AGYW than among their male counterparts. Uganda implements DREAMS in four rural regions in Uganda, with a recent expansion to Kampala, Wakiso, and Mbarara Districts to respond to the high incidence of HIV among AGYW in these urban centers.

CDC’s Impact

As a leading PEPFAR-implementing agency in Uganda, CDC supports 15 of the 24 DREAMS districts. Building upon decades of experience implementing youth-friendly and community-centered HIV programing, the CDC in Uganda is reaching the most vulnerable with critical services tailored to individuals’ needs.

“Our DREAMS services target girls and young women aged 10-24 years—whether HIV positive or negative,” says Dr. Lisa Nelson, CDC Country Director. “We aim to reduce the risk of HIV infection, sexual and gender-based violence, provide reproductive health services, and promote female empowerment and economic strengthening interventions that protect them from early marriages, engaging in risky behaviors, and dropping out of school. Our services also aim at empower AGYW and their families to make decisions and engage in practices which promote the health of girls and foster healthy child-parent relationships.”

Through the DREAMS program, CDC works with its comprehensive regional partners, district and local leadership, faith-based and non-governmental organizations to mobilize AGYW, their families, and community leaders to create enabling environments for AGYW to reach their fullest potential. DREAMS layers multiple interventions at once so that AGYW are surrounded with critical support to keep them safe from HIV and other health and socio-economic risks.

2021 Achievements

In 2021, CDC reached 85% of AGYW in their districts with DREAMS core services, and of those, 86% received specific services based on their unique needs.

In response to the unique challenges posed by the COVID-19 pandemic, CDC innovated to ensure the continued delivery of critical programs to vulnerable AGYW. CDC and partners leveraged diverse platforms across local government and the private sector, scaled up the use of virtual learning where possible, printed and distributed learning materials to targeted beneficiaries at home when they could not be reached in other spaces, and leveraged teachers within the community to facilitate curricula-based interventions.

CDC recognized that during crises, AGYW can be a part of the local solution in their communities. For example, girls from the DREAMS program produced face masks using locally available materials and distributed them to communities. They also made low-cost liquid soap to improve handwashing, a critical prevention measure for COVID-19, while improving their economic livelihood from these products’ earnings. “Girls from our DREAMS programs made beautiful masks that they exhibited at the clinic reception. If a client came not wearing a mask, we would encourage them to buy one and give them two—free, for their household,” says Maya Benna, a health worker. “We also supported them with the cost of production for bounty production and distributed in neighboring communities like markets, churches, and taxi stalls.”

Success story

Janet is one of the DREAMS beneficiaries in Mityana District, supported by Mildmay Uganda, a CDC-DREAMS implementing partner. Born into a family of eight siblings, Janet’s family struggled with issues of domestic violence, divorce, and poverty. Janet was forced to leave school and with no options for financial support she started selling sex for money at 13 years old. Faced with selling sex and no ability to negotiate condom use, Janet assumed she had HIV and contemplated suicide.

DREAMS, my turning point

“I had just woken up after a busy night of work when a DREAMS coordinator came to me during her routine home visits in search of girls like me,” Janet recalls. “I for once felt loved and cared for. She gave me hope to live. I felt that the time had come for me to live a real happy life,” she adds.

Janet was enrolled in DREAMS and offered an HIV test at the DREAMS safe space. She was fearful of the results, “I couldn’t believe what the health worker told me,” Janet explodes with excitement. “Janet, you are HIV negative.’ This was Janet’s turning point.

While in DREAMS, Janet was equipped with health knowledge and skills in knitting, tailoring, marketing, and financial literacy. Through the vocational and agricultural skills, Janet set up a home vegetable garden and rears goats and is hopeful that this will improve her income. “I can now afford necessities. I can’t go back to my old life on the streets,” Janet says.

“I have learnt a lot about HIV/AIDS and how I can protect myself. I did not know about using condoms. I could not tell any man to put on a condom. Today, DREAMS has empowered me to make right healthy choices and negotiate for safe sex,” she adds.

Enrolling other girls

Janet’s life has completely changed. Her inspiring story has impacted many girls in her community and she now speaks to other AGYW about how to make healthy choices. She is a role model to both girls and boys and is seen as a mentor by many in her community- a value she attributes to DREAMS.