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Directed and targetfocusedmulti‐sectoraladolescent HIVprevention: Insightsfrom implementationof the ‘DREAMSPartnership’ in ruralSouth Africa Natsayi ChimbindiIsolde BirdthistleSian Floyd2020 год

Directed and target focused multi‐sectoral adolescent HIV prevention: Insights from implementation of the ‘DREAMS Partnership’ in rural South Africa
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Аннотация: Abstract Introduction The “DREAMS Partnership” promotes a multi‐sectoral approach to reduce adolescent girls and young women's (AGYW) vulnerability to HIV in sub‐Saharan Africa. Despite widespread calls to combine structural, behavioural and biomedical HIV prevention interventions, this has not been delivered at scale. In this commentary, we reflect on the two‐year rollout of DREAMS in a high HIV incidence, rural and poor community in northern KwaZulu‐Natal, South Africa to critically appraise the capacity for a centrally co‐ordinated and AGYW‐focused approach to combination HIV prevention to support sustainable development for adolescents. Discussion DREAMS employed a directed target‐focused approach in which local implementing partners were resourced to deliver defined packages to AGYW in selected geographical areas over two years. We argue that this approach, with high‐level oversight by government and funders, enabled the rapid roll‐out of ambitious multi‐sectoral HIV prevention for AGYW. It was most successful at delivering multiple interventions for AGYW when it built on existing infrastructure and competencies, and/or allocated resources to address existing youth development concerns of the community. The approach would have been strengthened if it had included a mechanism to solicit and then respond to the concerns of young women, for example gender‐related norms and how young women experience their sexuality, and if this listening was supported by versatility to adapt to the social context. In a context of high HIV vulnerability across all adolescents and youth, an over‐emphasis on targeting specific groups, whether geographically or by risk profile, may have hampered acceptability and reach of the intervention. Absence of meaningful engagement of AGYW in the development, delivery and leadership of the intervention was a lost opportunity to achieve sustainable development goals among young people and shift gender‐norms. Conclusions Centrally directed and target‐focused scale‐up of defined packages of HIV prevention across sectors was largely successful in reaching AGYW in this rural South African setting rapidly. However, to achieve sustainable and successful long‐term youth development and transformation of gender‐norms there is a need for greater adaptability, economic empowerment and meaningful engagement of AGYW in the development and delivery of interventions. Achieving this will require sustained commitment from government and funders.
Год издания: 2020
Авторы: Natsayi Chimbindi, Isolde Birdthistle, Sian Floyd, Guy Harling, Nondumiso Mthiyane, Thembelihle Zuma, James Hargreaves, Janet Seeley, Maryam Shahmanesh
Издательство: International AIDS Society
Источник: Journal of the International AIDS Society
Ключевые слова: Adolescent Sexual and Reproductive Health, HIV/AIDS Research and Interventions, Food Security and Health in Diverse Populations
Другие ссылки: Journal of the International AIDS Society (PDF)
Journal of the International AIDS Society (HTML)
LSHTM Research Online (London School of Hygiene & Tropical Medicine) (HTML)
UCL Discovery (University College London) (PDF)
UCL Discovery (University College London) (HTML)
UCL Discovery (University College London) (HTML)
PubMed Central (HTML)
PubMed (HTML)