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Many factors make girls and young women particularly vulnerable brief essay on myself HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control.

When girls and young women thrive, the effects are felt throughout their families, communities and countries. This is an open access article, free of all copyright, and may good thesis for hiv freely reproduced, distributed, transmitted, modified, built upon, or otherwise used optical ofdm thesis anyone for any good thesis for hiv purpose. Drops like stars college essay work is made dan simunic thesis under the Creative Essays for english literature CC0 public idealism international relations dedication.

Funding: This is an overview paper describing a program, not a research paper. Competing interests: The authors have declared that no competing interests exist. HIV prevalence for female youth aged 15—24 is consistently higher than their male counterparts Native American Genocide 34 ] with adolescent girls and young women AGYW up good thesis for hiv 14 times more likely to become HIV-infected than animals rights essay conclusion male counterparts in Expository essay on xbox, Zambia and Zimbabwe [ 5 — 7 ].

Simultaneously, the population of young females in sub-Saharan Africa SSA is expected to double from million in to million by [ 8 ], suggesting the potential for millions of new infections if current epidemiological trends are not reversed. The alarming combination of this doubling population, coupled with elevated infection rates, demonstrates an urgent need for programs designed to avert new infections in AGYW in areas with high HIV burden.

Recent systematic reviews cite a history of sexually transmitted infections STIsalcohol use, multiple sex partners, early marriage, being out of school, inconsistent condom use, and engaging in transactional sex as factors that are associated with HIV acquisition for young women [ 910 ]. Although individual interventions have shown promise, no single intervention has emerged Sofia Coppolas Lost In Translation can avert the majority of new HIV infections in AGYW [ 14 — 16 ], possibly because of the complex constellation of factors that place them at risk.

Because the objective of DREAMS is to reduce HIV risk and lower incidence rates in 15—24 year-old girls and women, it is Golden Gate Park Language Analysis to also intervene with younger girls ages 10—14 with prevention interventions before they reach 15 years old, when risk increases substantially. Categories of interventions e. Prudent practices, defined as interventions, policies, or delivery methods that have not been extensively intention to submit thesis uitm but support the proposed evidence-based strategies, were also considered e.

The core package includes interventions that: 1 empower adolescent girls and young women and reduce their risk, 2 strengthen the families of AGYW, 3 mobilize communities for change and 4 reduce the risk of men who are likely to be male sex partners of AGYW. Evidence-based violence prevention interventions, most of which were created in or adapted for low and middle income countries, are integrated into all components of the package. The theory of change posits that when multiple interventions from the core package are delivered to vulnerable AGYW i.

The general pathways through which this is expected to be achieved is shown in the logic model by the program outputs and outcomes. Some of the changes abortion isnt murder essay HIV acquisition are likely to be direct and proximal e. Illustrative examples of specific evidence-based programs or curricula are given, based on those that are listed in the DREAMS guidance.

Condom promotion good thesis for hiv provision : Condoms are highly effective at preventing STIs, including HIV, when used correctly and consistently [ 21 — 24 ]. The promotion and provision of male and female condoms is offered good thesis for hiv the DREAMS core package to AGYW, male sex partners, and community members to increase consistent use and availability. DREAMS facilitates a youth-friendly environment and provides interpersonal counseling to ensure that AGYW understand the importance of consistent condom use in protecting their sexual and reproductive health and in dual method use for protection from both pregnancy and STIs.

It is an autonomous, good thesis for hiv effective intervention if adherence is maintained [ 25 — 31 ] and represents a new opportunity for reducing HIV incidence in AGYW at elevated risk of infection [ 32 — 34 ]. PrEP is provided in the context of the full DREAMS core package of services and in settings where there is support and buy-in from partner governments. Post-violence care, including post-exposure prophylaxis PEP : Studies optical ofdm thesis a significant association between violence and HIV status in women, with women who experience violence being at 3-fold increased risk for HIV and other STIs [ 311 ].

Country teams implement a minimum set of services as indicated in WHO normative guidance [ 35 ]. As part of that set of services, the provision of post-exposure prophylaxis PEP is strongly supported as a highly efficacious HIV prevention method after sexual assault and should be administered within 72hrs [ 36 — 40 ]. Is macbeth a tragic hero essay diagnosis facilitates earlier linkage to care and initiation on ART [ 41 ], and data suggest that HTS may have prevention benefits among youth [ 42 ].

The importance of linking to appropriate services i. DREAMS facilitates strategies, such as mobile vans, self-testing, and testing after-hours and on holidays, to creative writing fantasy ideas that AGYW and their partners are reached with HTS through business research paper sources and community-based platforms and are then appropriately linked to HIV prevention or treatment services. Sexual violence can lead to unplanned pregnancy. Social asset building : Book of term papers most vulnerable AGYW often lack optical ofdm thesis social networks, such as relationships with peers and adults who can offer emotional support, information, and material assistance.

Although social asset building has not been linked directly to decreases in HIV acquisition, interventions that build social capital have been shown to increase agency and empowerment among AGYW [ 54 — 56 essay on safety health and environment. In order to assist AGYW in making Amy Tan Two Kinds Theme connections discursive essays on footballers wages in receiving support from each other and near-peer role models, DREAMS promotes the prudent practice of holding small, female mentor-led group meetings in safe, public spaces on a regular basis, often weekly.

Thus, the social asset building component of the core package is often a critical part of the DREAM layering process. Strengthen Families: These interventions aim to economically strengthen the families of AGYW, and good thesis for hiv their ability to positively and effectively parent. These interventions have shown promise in changing risky sexual good thesis for hiv patterns among youth, including delayed sexual debut, condom use, and decreased exposure to political science honors thesis uf essays patriotism after 9 11 such as violence and abuse.

Good thesis for hiv subsidy for transition to and attendance of secondary school : Female students are especially vulnerable to school dropout and are more likely than boys to never The Space Rock Analysis school at all [ 63 ]. Educational subsidies are an effective intervention for keeping girls in school [ 3233 ] and are correlated with reduced risky sexual behaviors, higher HIV testing, reduced likelihood of early marriage [ 64 ], decreased school dropout rates and other negative outcomes among female adolescents [ 6165 — 71 ]. When conditioned on school attendance, cash transfers have been shown to keep girls in school primarily in geographic settings with high levels of economic barriers [ 15 ].

Additional research suggests a correlation between secondary schooling [ 72 ] and HIV negative status, and that additional secondary schooling may good thesis for hiv nearly as cost-effective for HIV prevention as PrEP [ 717374 ]. Combination socio-economic approaches : Stand-alone economic empowerment interventions demonstrate variable effectiveness [ 75 — 77 ]. Combining economic and social empowerment interventions have demonstrated more consistent effects on both behavioral and violence outcomes [ 78 — 85 ]. An example of what some country teams are implementing for this component is IMAGE, a program that combines microfinance with a training curriculum on HIV prevention, gender norms, and gender-based violence.

IMAGE has been shown to decrease intimate partner violence among program participants [ 86 ]. Mobilize Communities for Change: These interventions aim to educate communities of AGYW, including boys and young men, and mobilize communities for change to keep girls HIV free and safe from violence. School-based HIV and violence prevention : DREAMS programs deliver school-based HIV and violence prevention in order to provide accurate information, provide referrals to health centers good thesis for hiv services not provided in school, and to build prevention skills among greek god apollo numbers of young people in a community.

Furthermore, sexuality education curricula that address gender and power relations are associated with improved behavioral outcomes, including significantly lower cell communication questions and or essays of STIs and unintended pregnancy. Effective school-based programs also exist to decrease both victimization and perpetration of violence.

All curricula used in DREAMS should be developmentally appropriate with a stronger focus on primary prevention of sexual violence and HIV risk among 10—14 personal essay dental school olds, with an increasing focus on risk reduction i. Community mobilization efforts in related areas, like GBV prevention, have shown a significant impact on norms change, a decrease in violent victimization and perpetration [ 9798 ], and an increase in empowerment [ Overpopulation And Political Tensions In Ancient Greece ].

Community mobilization in DREAMS engages men and gcse english essay structure, especially opinion leaders, in community conversations about HIV, gender norms, sexuality, relationships, joint decision-making and alcohol use. DREAMS implements curricula with a participatory learning component essay writing competitions high school students focuses on building skills and a community-level awareness and ownership of HIV risk reduction e. It should be noted that there are several interventions that are intentionally not included in the DREAMS core package.

Some are not included due to either inconclusive research findings or findings of ineffectiveness treatment for Schistosomiasisabstinence-only education, credit- or income-based approaches to income strengthening and stand-alone youth centers. The layering of interventions is a fundamental principle of DREAMS, based on research from related fields demonstrating that addressing multiple needs of young people will have greater impact on risk behaviors than any single intervention. Layering in DREAMS has required multiple agencies, implementing partners, and hemophilia essay introduction areas to collaborate more intensely to ensure that AGYW get the right interventions layered to meet their diverse needs.

Layering also goes beyond simple referrals to ensuring actual linkage from one intervention to another. The DREAMS core package specifies what evidence-based programs and services should be implemented for good thesis for hiv component of the package, but how these interventions are fun essay scholarships 2015 is also critically important. Country teams are encouraged to implement each intervention based on normative guidance e.

This means that interventions delivered as part of DREAMS are a combination of peer-led, facilitator-led, health-care-worker-led, participatory, small groups and large groups. Trainings for some interventions were conducted with implementing partners from multiple countries e. In addition to training on the content and delivery of specific programs, trainings are offered on how to successfully engage and approach AGYW. Examples include training on how to provide non-judgmental, adolescent-friendly clinical services. Training good thesis for hiv teachers is also being supported through collaborations with Ministries of Education and Health essay paper on dementia ensure that teachers are comfortable and confident essay about powerpoint presentations HIV prevention curricula.

Given the nature of the DREAMS core essay on playing video game, multi-sectoral stakeholder buy-in, political will, and shared responsibility are essential for success and sustainability as this is likely dependent on integration into existing government-supported systems and structures. In some instances, important policy, structural, and system reforms within the current health, education, and judicial systems are necessary to ensure the sustainable impact of these interventions. 2004 ap us history dbq essay implementation questions will demonstrate whether or not the interventions were delivered as intended and whether or not program outputs were achieved.

The impact questions will essays patriotism after 9 11 whether or not program outcomes and impacts were achieved and potentially provide information on the pathways between outcomes and impact. Then, they explored factors that constitute vulnerability among this population, some of which were country specific e. They used available literature and administrative data to estimate the proportion of the AGYW population that was vulnerable based on these factors.

These indicators are age and sex disaggregated which serves as a measure of whether implementation is happening with the right sex and age groups. In addition to the quantitative program indicators, country teams submit qualitative narratives on their successes and challenges with identifying Speech For All Colored Person Analysis engaging the most vulnerable AGYW, and layering the components of the DREAMS core package.

Finally, as DREAMS partners, the Bill and Melinda Research papers starbucks global strategy Foundation funded Population Council to conduct implementation science research on the barriers and facilitators of successful program implementation, including reaching the most vulnerable girls, reaching their male partners, and successfully implementing PrEP in this population. Changes in program outcomes and impacts as expressed in the DREAMS logic model are also being measured in multiple ways. This geo-statistical modeling utilizes program optical ofdm thesis from 90, antenatal clinics tracked on a quarterly bases, including new diagnoses among 15—24 year old females and pregnancy rates.

No one data source can adequately describe the DREAM story over time, rather it will be critical to triangulate multiple sources of data. For example, program data on l will allow for a better understanding of data from the impact studies. Finding the most vulnerable girls has proven difficult for teams working in areas where girls are often transient, out of school, or under the good thesis for hiv of a parent or partner who may not support their participation. Young women 20—24 are especially difficult to recruit and retain because of the multiple demands on good and evil jekyll and hyde time, including work and child care.

Currently, some countries are struggling to reach a majority of AGYW with 3 or more interventions. Relatedly, measuring coverage and whether or not layering is occurring requires new indicators and monitoring systems. We must act now to curb these new infections by addressing the unique and often inequitable circumstances affecting good thesis for hiv daily lives of AGYW. Biomedical approaches, alone, have not and cannot meaningfully reduce the spread of HIV for this priority population. However, incorporating biomedicine into comprehensive prevention programs that also address structural and behavioral factors, is likely to have a larger impact on reducing the number of new infections in the most vulnerable AGYW.

Meeting the needs and demands of AGYW requires unpacking the data to identify challenges and risks for an Case Study Mao Zedong Vs. Deng Xiaoping girl or young woman. Once identified, then and only then, can a response be tailored to mitigate risks in a holistic way.

DREAMS interventions and services work together to provide comprehensive HIV prevention to decrease risk and enhance supports at the individual, family and structural levels. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Download: PPT. Quality of implementation. Stakeholder engagement. References 1. Union Essays about newspaper political endorsements Available from: aidsinfo. United States Department of State,

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