DREAMS: A P3 Partnership

Mary Margaret Frank and Maggie Morse

Public-Private Partnerships That Are Changing the World

The Darden School of Business’ Institute for Business in Society partners with Concordia and the U.S. Department of State Secretary’s Office of Global Partnerships to present the annual P3 Impact Award, which recognizes leading public-private partnerships that improve communities around the world. This year’s award will be presented at the Concordia Annual Summit 24–25 September 2018. The five finalists will be highlighted on Darden Ideas to Action on Fridays leading up to the event.

The Partnership: DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe Women)

The Partners:

  • Bill & Melinda Gates Foundation
  • Gilead Sciences
  • Johnson & Johnson (J&J)
  • Girl Effect
  • The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
  • ViiV Healthcare

The Social Challenge: Health and Sanitation

Despite considerable progress in the global response to the HIV epidemic, young women ages 15 to 24 in sub-Saharan African countries face alarming rates of new HIV infections. Adolescent girls and young women account for two-thirds of all new HIV infections among adolescents in sub-Saharan Africa and are up to 14 times more likely to be HIV infected than boys the same age. Many adolescent girls and young women lack a full range of opportunities and are devalued because of gender bias, leading them to be seen as unworthy of investment or protection. Social isolation, economic disadvantage, discriminatory cultural norms, orphanhood, gender-based violence and school dropout all contribute to girls’ vulnerability to HIV.

The Idea and the Action:

Launched on World AIDS Day 2014, the DREAMS public-private partnership helps girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women. DREAMS utilizes a multisector approach to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. These 10 countries continue to make up more than half of all new HIV infections among adolescent girls and young women globally.

The DREAMS partners — PEPFAR, the Bill & Melinda Gates Foundation, Girl Effect, J&J, Gilead Sciences and ViiV Healthcare, deliver a layered, evidence-informed approach that go beyond the health sector, addressing factors that directly or indirectly increase girls’ HIV risk, including lack of access to secondary education, gender-based inequality and violence, and poor economic opportunities.

DREAMS embraces the layered approach to the range of health, education and community offerings it provides; resources that directly address health needs are essential, but without shifts in social norms, girls will not pursue such critical services. The partnership provides condoms, HIV testing and counseling, and antiretroviral medication — both for high-risk youth as a preventative measure and for those with the virus to help prevent transmission. But it also engages boys, men and the broader community to participate in gender-based violence prevention programs, as well as offers programs involving parents and caregivers, which have proven effective in changing HIV-related sexual behaviors. DREAMS creates social safety nets by connecting girls with peers and adults for emotional support, information and social skill building. And not only does the partnership provide sexual education, but also educational subsidies to keep girls in school, and PEPFAR provides financial savings programs; both economic and social empowerment are effective in promoting healthy behavioral changes.

To deliver this layered collection of solutions, the DREAMS partnership developed an innovative approach to leverage the different skillsets of each partner. For example, J&J used its consumer insights methodology to interview girls about what is important to them. These insights are used to determine how to reach certain girls, using a market segmentation approach, which ensures the interventions are implemented effectively. Meanwhile, DREAMS tracks and evaluates the data on the impact of each intervention to ascertain the most effective combination, which can be used to scale the partnership.

The Impact:

The DREAMS partnership not only transforms girls’ lives individually, but by challenging and changing perceptions and norms, it works toward an AIDS-free future. If adolescent girls and young women are empowered, educated and employed, they can grow up healthy and have the opportunity to realize their full economic and social potential.

To date, through DREAMS, more than 2.5 million adolescent girls and young women have received critical comprehensive HIV prevention interventions. And, for the first time, PEPFAR data show significant declines in new HIV diagnoses. In the 10 African countries implementing DREAMS, the majority — over 60 percent — of the highest-HIV-burden communities achieved a greater than 25 percent decline in new HIV diagnoses among young women. Importantly, new diagnoses declined in nearly all DREAMS intervention communities.

In 2017, five countries with similar rates of HIV diagnoses — Botswana, Cote d’Ivoire, Haiti, Namibia and Rwanda — were added to the partnership. Additionally, the national governments of these countries have adopted the DREAMS layering approach into their national HIV agendas, serving as an opportunity for long-term sustainability and scalability of the partnership.

The Faculty Insight:

The devaluation of women is a systemic problem. Systemic problems arise because of factors inherent in the overall system, and DREAMS recognizes the need for a multifaceted approach to address these types of challenges. The partnership recognizes that the desired impact — reduction of HIV cases among young women — is not solely about securing more resources or improving logistics for supplying more antiretroviral medication. It is about the fundamental need to change social norms to effect a change in human behavior. Efforts to achieve sustainable impact must not only consider the direct factors, such as access to medication, but the indirect influences that discourage young women to act in their best interests.

Many of our societal issues are systemic, yet we attempt to address them with one approach and are disappointed when they have minimal impact. However, a layered, complex approach is difficult and potentially inefficient, which leads us to wonder if it’s worth the benefit. By measuring the impact of individual interventions, as well as the most successful combination of interventions, the partnership provides valuable information to scale more efficient and multifaceted solutions to address multiple factors inherent to the problem. Through the systematic use of data generated by its efforts, DREAMS not only helps young women, it can also scale more efficient approaches.

About the Faculty

Mary Margaret Frank

Frank’s expertise is in the integration of business and public policy, including cross-sector collaborations. She is a former board member of the Female Health Company, which works with public-private partnerships that empower women to fight HIV globally, especially in Africa.

Her additional expertise is in regulated disclosure focusing on tax, financial... Learn More