Data doesn’t always sway people in the right direction. (If it did, the U.S. wouldn’t have wasted $1.4 billion on ineffective Abstinence and Be Faithful programming.) But as a researcher and women’s rights advocate at the Center for Health and Gender Equity (CHANGE), I know that when data is centered, policies are driven by science, fueled by evidence and backed by truth.
One such example is the DREAMS Partnership—which stands for Determined, Resilient, Empowered, AIDS-free, Mentored and Safe. Established in 2012 by PEPFAR, or the U.S. President’s Emergency Plan for AIDS Relief, DREAMS is a public-private partnership that was launched in 10 countries in sub-Saharan Africa and has the lofty goal of reducing HIV infections by 40 percent within two years.
I often refer to DREAMS as “the kitchen sink approach.” PEPFAR embraced all of the evidence-based, structural and biomedical interventions that we know are effective and employed them simultaneously. This means they addressed the structural drivers of HIV—including education, isolation, economic disadvantage and violence—and also incorporated effective biomedical interventions like contraceptive provision and PrEP. Interventions focused on adolescent girls and young women, but also reached families, sex partners and religious and community leaders. In CHANGE’s first DREAMS report, we recommended that PEPFAR prioritize civil society engagement and intentionally include LGBTQI, sex workers and adolescent girls and young women living with HIV into DREAMS programming. We were pleased to see almost all of our recommendations adopted by PEPFAR.
Women- and girls-led organizations have been advocating for PEPFAR to focus on women and girls since the start of the epidemic. Adolescent girls and young women account for 74 percent of new HIV infections among adolescents in sub-Saharan Africa. As an advocate, I was thrilled about evidence-based prevention programing to address this crisis, but as a researcher, I was initially worried about DREAMS’s timeline. Reducing HIV infections by 40 percent in two years was an astronomical goal—but through fact-finding missions in Kenya and South Africa, as well as Swaziland and Uganda, CHANGE quickly learned that DREAMS was promising, and the data on the success of DREAMS that came out this past December proved that the programming is working.
DREAMS has reached a 25 to 40 percent decline in new HIV diagnoses among young women in the majority of DREAMS-targeted communities with the highest burden of HIV. The U.S. Government just released new research that shows they know how to prevent HIV infections in adolescent girls and young women. I met with civil society, the U.S. Government and adolescent girls and young women in DREAMS programing who had overwhelmingly positive insights into the partnership. I saw the impact of the Innovation Challenge, an $85 million investment committed to finding new ways to prevent HIV. The success we saw inspired us in our second DREAMS report to recommend that Congress and the Administration fully fund PEPFAR’s engagement to end the global HIV and AIDS epidemic.
We know DREAMS is working, but there are still challenges. When I visited DREAMS sites in Swaziland and Uganda in May of 2017, the policy landscape was different. President Trump had released his presidential memorandum reinstating and expanding the Mexico City Policy—renaming it “Protecting Life in Global Health Assistance.” The policy prohibits foreign non-governmental organizations from using both their U.S. money and their non-U.S. money to promote, perform or advocate for abortion. Ironically, the policy purports to decrease abortions, but is in fact associated with an increase in unsafe abortion. And for the first time, this policy applies to all of global health assistance, including PEPFAR. As with the last version of the policy, data show there has been confusion, misunderstanding and miscommunication on the ground.
This policy has the potential to greatly harm a highly successful intervention that prioritizes women and girls and their health and rights. I was concerned about how this would impact DREAMS. I still am. We know DREAMS works, but we must stay vigilant in our fight to prevent HIV in adolescent girls and young women.
DREAMS is being folded into the COP Guidance, meaning it will no longer be a standalone program. This has the potential to benefit and normalize investment in girls and women, but what will happen to civil society engagement? What will happen to the Innovation Challenge Fund? These are questions that advocates must continue to raise.
Evidence isn’t the basis of all legislation—but it is, and should be, a critical piece of policymaking. As we celebrate the success of the DREAMS Partnership, we must remember that it took advocates over a decade to get here. Our work is not done. In the meantime, we must hold steadfast to what we know. We must trust science and trust data.
