In 2016, the Presidents Emergency Plan for AIDS Relief (PEPFAR) initiated the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) programs in10 sub-Saharan Africa countries including Uganda to reduce risk of HIV and domestic violence in adolescent girls and young women aged 15-24 (AGYW). We used population-based data to evaluate the impact of DREAMS in Rakai, south-central Uganda
We identified girls aged 15-24 years who participated in Rakai community cohort study (RCCS) survey between June 2018 – August 2019 and provided information on HIV risk behaviors and were tested for HIV. Risk behaviors were sexual debut, being sexually active, having non marital sexual partners, transactional sex, alcohol use and condom use with non-marital partners. DREAMS packages assessed were; participation in any DREAMS programs, stepping stones (ST) a participatory intervention for HIV prevention and strengthening relationship skills, combined social economic approaches (CSEA), HIV testing and counseling (HTC). Generalized linear models was used to estimate prevalence rate ratios (PRR) and 95% CI associated with risk behavior outcomes.
A total of 1945 AGYW participated in the RCCS; 979 (50.3%) aged 15-19 years of whom 40.5% (397) had participated in the DREAMS programs. Among women aged 20-24, 24.1% (233) had participated in DREAMS. Among girls aged 15-19, ≥10 sessions of ST were associated with significant reduction in non-marital sexual partners (aPRR 0.54 ,95% CI=0.36 -0.93), sexual debut (aPRR 0.61 ,95% CI=0.42 -0.86) and being sexually active (aPRR 0.55,95% CI=0.37 -0.81), while receiving ≥5 ST sessions was associated with a significant reduction in alcohol use (aPRR 0.23,95% CI=0.10 -0.52). Among girls aged 20-24, receiving ST had no significant impact on any risk behaviors. CSEA and HTC were not found to affect risk behaviors in either age groups.
In this population-based study , a minimum of 10 ST sessions of the DREAMS ST program are required to reduce risk sexual behaviors among girls aged 15-19 years but no effects were observed with CSEA and HTC. No DREAMS interventions affected risk among women aged 20-24. DREAMS should be modified.