Impact of a multilevel HIV prevention programme on adolescent girls and young women’s empowerment for risk reduction

A mixed methods evaluation in Kenya

Bibliographic Data

ID19590804
AuthorsElizabeth Kemigisha (0000-0001-9137-8014, African Population and Health Research Center, corresponding author), Jane Osindo (0000-0002-4843-5586, African Population and Health Research Center, corresponding author), Vivienne Kamire (0000-0002-5558-8070, Kenya Medical Research Institute, corresponding author), Venetia Baker (0000-0002-0938-5109, London School of Hygiene & Tropical Medicine, corresponding author), Annabelle Gourlay (0000-0003-4387-1925, London School of Hygiene & Tropical Medicine, corresponding author), Stephen Gakuo (African Population and Health Research Center, corresponding author), Sarah Mulwa (0000-0003-0934-6780, London School of Hygiene & Tropical Medicine, corresponding author), Faith Magut (0000-0002-9758-2697, London School of Hygiene & Tropical Medicine, corresponding author), Thomas Gachie (0000-0003-4685-8734, London School of Hygiene & Tropical Medicine, corresponding author), Moses Otieno (0000-0002-9977-8220, Kenya Medical Research Institute, corresponding author), Sammy Khagayi (0000-0002-2470-1851, Kenya Medical Research Institute, corresponding author), Daniel Kwaro (0000-0002-0929-8072, Kenya Medical Research Institute, corresponding author), Sian Floyd (0000-0002-8615-7601, London School of Hygiene & Tropical Medicine, corresponding author), Abdhalah Ziraba (0000-0002-3417-6536, African Population and Health Research Center, corresponding author), Isolde Birdthistle (0000-0001-5742-6588, London School of Hygiene & Tropical Medicine, corresponding author)
EditorsNancy Angeline Gnanaselvam (0000-0001-7293-4839)
Year2025
Volume5
Issue6
Pagese0004151
Publication date2025-06-23
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0004151
PMID40549781
OpenAlexW4411551084
LanguageEN
References cited30

Empowerment is key to person-centered HIV prevention. This study aims to evaluate the extent to which the Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) Partnership promotes empowerment of adolescent girls and young women (AGYW) in Kenya. We conducted a mixed-methods study to examine DREAMS influence on empowerment precursors (resources, agency, institutional structures) and outcomes, guided by Kabeer’s framework for women’s empowerment. With representative cohorts of AGYW aged 13–22, followed since 2017/18, we estimated the impact of DREAMS on social support and self-efficacy by 2022. With a nested sample of cohort participants in 2022, we conducted qualitative inquiry through in-depth interviews and participatory action learning with DREAMS participants, implementers, and community members, for evidence of mechanisms, achievement and contextual influences on AGYW empowerment. We found statistical evidence of a causal impact of DREAMS on social support and self-efficacy among adolescent girls. Qualitatively, DREAMS enhanced AGYW’s access to and control of resources, including coveted material assets like educational subsidies, hygiene products, and business support, which reportedly reduced transactional sex through economic autonomy and bodily integrity. DREAMS enhanced intangible resources like HIV knowledge and financial skills. Greater confidence, courage, and critical consciousness enabled some AGYW to act on health choices, assume leadership roles, and continue education. In mentor-led activities, AGYW demonstrated collective action and solidarity and group saving skills for financial autonomy. DREAMS aimed to engage the broader community including leaders, parents, and young men, but social structures, dominant gender norms, gender-based violence, and widespread poverty mitigated its empowering impact for AGYW. We found compelling evidence that DREAMS strengthened many young women’s access to and control of resources and their intrinsic and collective agency. These are important precursors to empowerment but insufficient for the transformation of power relations without supportive institutional structures, including gender-equitable norms and viable livelihood strategies

Economic growth · Economics · Empowerment · Environmental health · Family medicine · Adolescent Sexual and Reproductive Health · Medicine · Microfinance and Financial Inclusion · Poverty, Education, and Child Welfare · Psychology