Evidence over Ideology: HIV Interventions that Work

Bergen Cooper

Center for Health and Gender Equity (CHANGE) | Director of Policy Research
Adolescent girls and young women enrolled in DREAMS through Hope Worldwide Kenya after meeting with CHANGE in Mukuru Kwa Reuben, Nairobi, Kenya.

Adolescent girls and young women enrolled in DREAMS through Hope Worldwide Kenya after meeting with CHANGE in Mukuru Kwa Reuben, Nairobi, Kenya. Courtesy of Bergen Cooper.

We know what works to prevent HIV. Over the course of the epidemic, we have seen the body of evidence grow. Unfortunately, in too many cases, we have also seen donors and implementers favor interventions based on ideology rather than data. In order to address HIV, there’s no question that we need to program the standard interventions like condoms, pre-exposure prophylaxis, and post-exposure prophylaxis. Yet we also need to address areas not consistently included in HIV prevention, including family planning, gender-based violence, education, access to employment, and social norms. On this World AIDS Day, I am filled with hope: A program is finally doing just that.

This past July, I spent a month in Kenya and South Africa assessing the rollout of the Determined, Resilient, Empowered, AIDS-free, Mentored, Safe Partnership (DREAMS). DREAMS is a public-private partnership from PEPFAR, the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and Viiv Healthcare. It aims to reduce new HIV infections in adolescent girls and young women in 10 countries within sub-Saharan Africa. Adolescent girls and young women are at the heart of the epidemic in sub-Saharan Africa, constituting 90% of new infections in adolescents. In South Africa, 2,000 girls are infected each week. While we have seen global incidence decline, women and girls still bear a disproportionate burden of HIV.

In Kenya and South Africa, I met with a variety of DREAMS stakeholders: Adolescent girls and young women engaged in program activities, civil society groups doing advocacy work, private- and public-sector organizing partners, and implementing organizations. The detailed findings can be found in a new report from CHANGE: The U.S. DREAMS Partnership: Breaking Barriers to HIV Prevention for Adolescent Girls and Young Women. I casually refer to DREAMS as “everything and the kitchen sink.” For the first time, the U.S. Government is throwing everything that works at the problem of HIV by addressing adolescent girls and young women, their families, their sexual partners, and their larger communities. The program is entirely evidence based.

In South Africa, I met a teenage girl enrolled in a DREAMS program. I asked her what she liked about the program. She smiled, look me straight in the eye, and said, “I didn’t know that female condoms existed. Now I know what they are and how to insert them.” She made the insertion movement with her hands as we both laughed. DREAMS is finding new ways to help girls like her.

Although we know that adolescent girls and young women are at the heart of the HIV epidemic in sub-Saharan Africa, there is still a shortage of programs that focus on their needs in a holistic way. Now is the time to increase evidence-based funding in foreign aid. We cannot afford to lose ground on HIV prevention, treatment, and care. As a community of advocates, programmers, and researchers, we must come together to ensure that the new administration doesn’t endanger the health and lives of adolescent girls and young women. This is the time to publish the results of our interventions and increase our body of evidence. We must document what works and share evidence so that we never revert to a time of ideology-based programming.