HIV prevention initiative seeks to break barriers in sub-Saharan Africa

By Jennifer Ehidiamen

Ntokozo Zakwe went to a health facility to ask for information about safe sex when she was 19 years old but the negative response she received from a nurse discouraged her from going back.

A sign that says Anti-AIDS club at a university campus in Ethiopia. Photo by: Pudlowski / UNICEF Ethiopia / CC BY-NC-ND

Most girls and young women in South Africa who try to seek information on how to have safe sex are either shut down or discriminated against, Zakwe said. Such responses are a major barrier for those trying to make informed decisions about their sexual reproductive health, she added.

Perhaps this explains why despite the progress in the global response to curb the spread of HIV, adolescent girls and young women still account for 71 percent of new transmissions among adolescents in sub-Saharan Africa. South Africa alone records more than 100,000 new infections in young women between the age of 15 and 24 per year.

“For years, the global health community watched as the U.S. government spent more than a billion dollars — $1.4 billion, to be exact — on abstinence and fidelity programs that failed,” said Serra Sippel, president of Center for Health and Gender Equity, a nonprofit organization that promotes sexual reproductive health and rights for adolescent girls and women. “We cannot afford to lose the progress we’ve made in addressing the HIV epidemic globally. It’s pretty straight forward. We will not turn the tide on HIV without prioritizing women and girls.”

Local and international organizations have been working to curb the spread of HIV in sub-Saharan Africa, including in South Africa where Zakwe lives, through a variety of programs to varying degrees of success.

One of those programs, the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Partnership, or DREAMS, was launched in 2014 as a public-private partnership between the U.S. President’s Emergency Plan for AIDS Relief, the Bill & Melinda Gates Foundation, Johnson & Johnson and other organizations.

DREAMS seeks to reduce HIV incidence among vulnerable populations of adolescent girls and young women in the 10 African countries where it works and stop the spread of new infections. On Wednesday, the Center for Health and Gender Equity released a new report, “Breaking Barriers to HIV Prevention for Adolescent Girls and Young Women.”


The report serves as a working document to inform U.S. policymakers, donors and advocates on how the partnership is being implemented in South Africa and Kenya and to share some lessons the partnership has learned about what works, or what doesn’t in HIV prevention for adolescent girls and young women.

One of the findings in the report is that active engagement between PEPFAR and the civil society organizations that were selected to implement programs targeting girls and young women in local communities played a key role in ensuring its successful launch.

Zakwe who now serves as a youth ambassador for DREAMS in South Africa said that the program did not seek to impose foreign ideologies on the communities but rather engaged local nonprofit organizations in reaching out to adolescent girls and young women. And young people, who are the primary targets were at the center of the engagement.

“From the word go, it involved young people,” Zakwe said.

She explained that DREAMS has successfully created a platform for adolescent girls and young women to share challenges and access information that could help them make informed decisions about their sexual reproductive health and rights.

PEPFAR’s initiative to work with local organizations made it easier to effectively reach the communities being targeted.

“What we found is a partnership that addresses drivers of HIV infections for adolescent girls and young women like violence and lack of access to reproductive health services by utilizing a mix of evidence-based social, educational, and biomedical approaches, and that’s a first,” Sippel said.

While the report largely praised progress it also highlighted areas for improvement, including better coordination and communication between PEPFAR and civil society. Better engagement with grass-roots and community-based organizations as well as engaging vulnerable communities including sex workers and others could also further objectives, according to the report.

Moving forward U.S. policy restrictions such as abstinence-only programs or an anti-prostitution loyalty oath could serve as barriers to programs such as the DREAMS partnership, according to the report.

DREAMS aims to continue to engage different groups in its efforts to prevent new HIV infections among adolescent girls and women by:

  • Empowering adolescent girls and young women through a range of activities including condom promotion and social asset building through entrepreneurship.
  • Targeting men and boys and include them in programs, including voluntary medical male circumcision and antiretroviral treatment.
  • Strengthening families through social protection programs such as education subsidies and parenting programs.
  • Shifting the norms and mobilize communities through school-based HIV and violence prevention programs.