Despite substantial declines in the number of new HIV infections globally, the HIV/AIDS epidemic among females ages 15-24 in select countries remains uncontrolled, with 67 percent of new infections in young people in sub-Saharan Africa occurring in adolescent girls and young women, or an estimated 280,000 new infections annually. HIV prevalence rates among female youth ages 15-24 are consistently higher than among their male peers, with adolescent girls and young women (AGYW) being up to 14 times more likely to become HIV-infected than their male counterparts.
The alarming rate of new HIV infections in AGYW, compounded by a projected doubling of the youth population (15- 24 year olds) in sub-Saharan Africa from 100 million in 1990 to 200 million by 2020, was a call to action for the global health community. PEPFAR recognized the need to rapidly evolve its programming to prevent the reversal of critical gains achieved in reducing HIV transmission. To disrupt these epidemiological trends, and accelerate progress toward control of the HIV/AIDS pandemic, it became imperative for programs to more effectively prevent HIV acquisition among AGYW in areas with a high HIV burden.
PEPFAR announced the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Partnership on World AIDS Day 2014. In 2015, DREAMS was planned with full grassroots participation. In 2016, DREAMS implementation began in ten countries that represented over half of all infections occurring among AGYW globally in 2014: Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. In 2017, DREAMS evolved from a centrally-funded, two-year partnership to an integrated part of PEPFAR’s country operational planning process. PEPFAR also added five additional DREAMS countries – Botswana, Cote d’Ivoire, Haiti, Namibia, and Rwanda – and brought its total four-year investment in DREAMS to more than $800 million. DREAMS provides a comprehensive package of core interventions to address many of the factors that make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. When girls and young women thrive, the effects are felt throughout their families, communities, and countries.