DREAMS: Addressing the Elevated Risk for HIV Infection among Young Women

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2 DREAMS: Addressing the Elevated Risk for HIV Infection among Young Women Kawango Agot, PhD, MPH Impact Research and Development Organization, Baring Road, Milimani Estate, P.O. Box Kisumu, Kenya

3 DREAMS: Determined, Resilient, Empowered, AIDS-free, Mentored, Safe

4 THE TRIGGER!! ADOLESCENT GIRLS Young women acquire HIV faster than young men: 5x greater in Zimbabwe 8x greater in Malawi 14x greater in Zambia Source: UNAIDS, 2016 Source: PHIA Surveys, from PEPFAR web-site

5 DREAMS RESPONDS TO THE 3 RIGHTS

6 COVERAGE AND GOAL OF DREAMS Geographical coverage: Currently being implemented in 10 subsaharan African Countries DREAMS main goal: 40% reduction in HIV incidence among AGYW in the target areas in 3 years

7 DREAMS: ONE PROBLEM, MULTIPLE SOLUTIONS HTS, Condoms, Post-violence care, Contraceptives, PrEP

8 DREAMS INNOVATION CHALLENGE Focus areas

9 COUNTRIES IMPLEMENTING DREAMS-LIKE ACTIVITIES Countries: Cote d Ivoire, Rwanda, Namibia, Botswana, Haiti Focus: Risk-avoidance among 9-14 year olds Activities: Education Support Community Mobilization Violence Prevention and Response Economic Strengthening Sexual and Reproduction Health Services Supportive Parenting

10 DREAMS IMPLEMENTATION IN KENYA: EXAMPLE OF SIAYA COUNTY

11 DISTRIBUTION OF ADULT HIV INCIDENCE IN KENYA BY COUNTY 65% of new HIV infections occur in 9 of the 47 counties 46 of all new infections occur among adolescents and young people 16 DREAMS Wards in Siaya County

12 Orphaned and vulnerable girls Out of school adolescents AGYW living in grannyheaded household Girls from childheaded households AGYW with male sexual partners Girls with disabilities Married adolescent s Girls undergoing GBV

13 RESULTS FROM GIRL-ROSTER & OTHER SOURCES 16 Wards, Siaya County 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, ,068 25,506 17,562 20,480 21,587 13,640 14,375 6, YRS Eligible 7, YRS Target TOTAL Enrolled

14 CHARACTERIZATION VULNERABILITIES OF AGYW IN THE DREAMS PROGRAM IN SIAYA COUNTY (n=21,587) Unmarried Age Group (78.9%, n=17,080) In School = 11,305 (66.2%) Total Has a Child n=4,481 (26.2%) Married (21.1%, n=4,507) With Disabilit y Has No Child n=12,599 (73.8%) Has a Child 13% married Has No Child Out of School = 5,775 (33.8%) Living with both Parents Partial Orphan Total Orphan Living with both Parents Partial Orphan Total Orphan 5,649 (50.0%) 4,194 (37.1%) 1,462 (12.9%) 2,717 (47.0%) 2,212 (38.3%) 846 (14.7%) 39% out of school 4,202 (93.2%) 305 (6.8%) 712 (3.4%)

15 EXAMPLES OF ACHIEVEMENTS UP TO JUNE, 2017 Stregnthenning Families 12,000 11,330 10,272 10,000 7,672 8,000 8,292 9,097 6,732 6,000 4,923 3,314 3,109 4,000 2,000 0 Cash Transfer - DEC 2016 Eligible Targets Education Support - JULY 2016 Achieved Enterpreneurship Training NOV 2016

16 EXAMPLES OF ACHIEVEMENTS UP TO JUNE, 2017 Interventions to Empower Girls and Young Women 25,000 20,000 21,587 16,368 16,630 21,587 16,368 15,000 15,124 11,663 11,368 13,011 8,794 10,000 3,474 5, Condom Prom & Prov - MAY 2016 HTS - MAY 2016 Eligible Targets PrEP - JAN 2017 Achieved Contraception - MAY 2017

17 EXAMPLES OF ACHIEVEMENTS UP TO JUNE, ,000 Community Mobilization & Norm Change Interventions 21,587 18,414 20,000 15,000 10,000 10,202 10,086 8,379 3,121 5,000 0 MHMC - MAR 2016 Eligibles SASA! - JUNE 2016 Target Achieved

18 PrEP UPTAKE BY AGYW (FEB-JUNE, 2017) INDICATOR AGE (YEARS) TOTAL Number Screened eligible for PrEP Enrolled in PrEP Currently on PrEP Discontinued PrEP Restarted on PrEP HIV Seroconversion Reasons for discontinuation: 2 experienced physically violence by their spouses => undergoing post-violence care 5 experienced side effects, which they associated with inadequate food => referred to Cash Transfer program 7 felt no-longer at risk => risk-reduction counseling and monitoring of risk continues

19 DREAMS SERVICE UPTAKE LAYERING % % ,726 12,703 10, % 12% 1,297 2,309 1,012 EXITED AGYW 20% 7,456 18% 2,292 4,024 3, % 2, ,234 1,732 1,220 90% 80% 70% 60% 50% 7,023 3,530 40% 30% 20% 10% 0% Number of services Total % Uptake 6+ Total with atleast a service Data Source: IRDO s DREAMS Data DATIM data base

20 REASONS AGYW EXIT FROM DREAMS PROGRAM Total exited Summary 17, 1% 547, 24% n= 2, , 7% 1066, 46% 514, 22% Dead Voluntary exits Temporary exits (On follow up) Parmanent Migration Lost to follow up

21 VIEWS OF DREAMS BENEFICIARIES IN KENYA AND SOUTH AFRICA A talk in 2016 with beneficiaries reports that

22 Lingering Concerns Acknowledgements PEPFAR, through Centers for Disease Control and Prevention More men than women do not know their HIV status Ministry of Health, Siaya County and sub-counties Of those positive, majority are not on treatment AGYW enrolled in the DREAMS program IRDO DREAMS staff And IAPAC, for the sponsorship to be here! More work needs to be done to reach male sexual partners of AGYW with HIV prevention activities Of those on treatment, a large number are not virally suppressed. DREAMS is a multi-solution program how do we mainstream it into government prevention activities? Pauline Lwandeh Rachel Ogolla Daniel Oginga Florence Awuor Spala Ohaga

23 ATTRIBUTION OF SUPPORT AND DISCLAIMER This publication was made possible by support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through cooperative agreement # 5U2GPS from the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV/AIDS (DGHA). The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the funding agencies.