Adolescent girls and young women (AGYW) in sub-Saharan Africa are between five and 14 times as likely to acquire HIV as their male peers. PEPFAR DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) program has made important strides toward reducing new HIV infections among AGYW. PEPFAR and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project works through DREAMS programming to make health services more accessible for AGYW and to improve the enabling environment for AGYW’s health and well-being. EpiC  programming for AGYW uses a package of evidence-based approaches and interventions to empower AGYW, reduce their vulnerability to HIV and violence, and promote their health and well-being.  

In Tanzania, EpiC has worked with AGYW to establish safe spaces and deliver community- and facility-based health services, including HIV, pre-exposure prophylaxis (PrEP), sexually transmitted infection (STI),  gender-based violence, and family planning services. The project held behavior change sessions with learning modules about HIV and STI prevention, family planning, gender-based violence support and awareness, and life skills, and scaled up the Families Matter! curriculum to capacitate parents and caregivers of AGYW to enhance protective parenting practices and promote parent-child communication. EpiC also implemented the Start, Awareness, Support, and Action (SASA!) community mobilization approach to challenge norms that put AGYW at increased risk of violence and HIV and led an economic strengthening intervention with training on savings and loans, entrepreneurship skills, and leadership skills. EpiC also used the HIV Prevention Ambassador Toolkit to train AGYW as HIV prevention ambassadors in Tanzania, increasing the number of AGYW initiated on PrEP from 1,075 AGYW in FY22 to 5,401 in FY23. As of the end of April 2024, 6,923 AGYW had initiated PrEP, representing a 644% increase in less than two years. 

In Malawi, through collaboration with district stakeholders, EpiC implemented social asset-building sessions from the My Dreams, My Choice curriculum in parallel with integrated HIV prevention and sexual and reproductive health services. These services included HIV testing and counseling, condom distribution, PrEP education and service provision, STI screening and treatment, gender-based violence prevention and response, cervical cancer screening, and family planning. From FY20 through FY24, EpiC reached 6,121 AGYW with HIV testing services and has initiated 3,845 AGYW on PrEP. EpiC has also promoted economic empowerment for AGYW through financial literacy training, assertiveness sessions, and opportunities to build economic assets, with 10,702 AGYW participating in economic activities during that same period. 

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This blog is part of a series highlighting EpiC’s technical approaches, key results, tools, and strategies that have driven positive change in HIV outcomes.