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DREAMS HIV Interventions Linked to Favorable Behavioral Outcomes Among Young Women in South Africa


Adolescent girls and young women in South Africa were more likely to practice favorable sexual behaviors if they accessed DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe)–like interventions such as school-based HIV prevention and HIV testing.

For adolescent girls and young women in South Africa at risk of contracting HIV, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS)–like interventions were associated with favorable behavioral outcomes such as less-risky sexual behaviors, according to a study published JAMA Network Open.

The DREAMS program was launched by the US President's Emergency Plan for AIDS Relief in December 2014 with the goal of significantly reducing new HIV incidence among adolescent girls and young women in Haiti and 15 sub-Saharan Africa countries. In these areas, women in these age groups are between 2 and 14 times more likely to contract HIV than their male counterparts.

Investigators used the term “DREAMS-like interventions” to capture all HIV prevention initiatives occuring in the study period because they could not distinguish between interventions that were part of the DREAMS program and other, similar interventions put in place by governments or other programs.

The study also reported more exposure to DREAMS-like interventions such as school-based HIV prevention among high school– and college-aged females compared with other forms of interventions involving parents or caregivers, as well as social protection and postviolence care.

However, the authors found no association between exposure to DREAMS-like interventions and HIV status.

“There was evidence of an association between layered interventions and favorable behavioral outcomes, but further research is needed to assess the beneficial aspects of layering HIV interventions to support the sexual and reproductive health of adolescent girls and young women,” the study authors said.

To come to these findings, the authors conducted a cross-sectional survey including 18,296 female participants in South Africa aged between 12 and 24 years, with a median (IQR) age of 19 (15-21) years. With a total of 10,642 households between the Gauteng province and KwaZulu-Natal province, a parent or caregiver at each household was also interviewed.

According to the survey, approximately half (49.9%) of participants said they engaged in sexual activity, and 48.1% of those participants said they used a condom during their most recent sexual encounter.

The survey also revealed higher HIV prevalence in the KwaZulu-Natal province (15.1%) compared with the Gauteng province (7.8%). Further, women aged between 20 and 24 had the highest HIV prevalence for any age group, with a prevalence of 23.9% in the KwaZulu-Natal province and 12.3% in the Gauteng province.

Regarding HIV intervention, 17.6% of participants said they were not exposed to any interventions, while 43.7% were exposed to at least 3 interventions.

There were also varying rates of access to different types of interventions. DREAMS-like interventions such as school-based HIV prevention (63.2%) and HIV testing (51.5%) had much higher uptake than social protection (5.0%), parental or caregiver intervention (0.8%), or postviolence care (1.2%).

Additionally, those who were exposed to at least 3 interventions were more likely to have been tested for HIV (adjusted odds ratio [AOR], 2.39; 95% CI, 2.11-2.71; P < .001) and to have used condoms consistently in the past 12 months (AOR, 1.68; 95% CI, 1.33-2.12; P < .001) compared with those who did not access any interventions. However, the rate of condom use was still generally low.

“Layering also appeared to have a greater effect size than exposure to only 1 intervention,” the authors found. “Although the cross-sectional design precludes interpretations of causality, the findings of this study suggest that layered HIV interventions may be a useful strategy for supporting the sexual and reproductive health of adolescent girls and young women.”

As this research only reflects areas where the DREAMS program was implemented and was based on self-reported data, the authors noted the results should be interpreted with caution and require further research.


Govender K, Beckett S, Reddy T, et al. Association of HIV intervention uptake with HIV prevalence in adolescent girls and young women in South Africa. JAMA Netw Open. 2022;5(4):e228640. doi:10.1001/jamanetworkopen.2022.8640

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