Figures & Tables
Figures
- FIGURE 1
I-TECH DREAMS Regions in Namibia
Abbreviations: DREAMS, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe; I-TECH, International Training and Education Center for Health.
- FIGURE 2
Flowchart of DREAMS Enrollment Activities and Interventions for All AGYW, and Additional Interventions for Eligible AGYW Based on HIV/GBV Risk in Namibia
Abbreviations: AGYW, adolescent girls and young women; DREAMS, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe; GBV, gender-based violence; PrEP, preexposure prophylaxis; SRH, sexual and reproductive health.
Tables
Program Component Bottlenecks Program access Limited availability of AGYW for enrollment after school let out
Considerable time needed to administer baseline and HIV/GBV risk forms
Requirement for written parental consent for almost all AGYW (aged 9–19 years) added several weeks to the preparation time for beginning activities
Requirement for constant Internet access and equipment to review records to identify duplicate IDs
Considerable time needed to develop formal agreements with colleges to allow for DREAMS recruitment reduced program access for these AGYW
Health education Difficulties identifying and establishing safe spaces for peer mentoring
Labor-intensive tracking of attendance for funder reporting reduced time for improving program quality
Outdated curricula and AGYW reports that format was insufficiently engaging
Variable levels of prior training and facilitation experience of peer mentors who delivered sessions and mentors were often in their first professional position
Delayed consensus on what curriculum to use for women aged 20–24 years
Health services Stock-outs of commodities during implementation
Challenges and considerable time to transition to implementation of AGYW-preferred community-based PrEP follow-up versus follow-up at clinics
Lack of Government of Namibia–finalized national PrEP implementation plan (at the time)
Refusal of some schools to allow family planning services for AGYW and lack of sexual and reproductive health in school health policy
Lack of communication to all levels of government about DREAMS program objectives
Social services Insufficient number of MoGEPESW staff to handle GBV referrals from DREAMS
Considerable access issue for postrape care in Namibia, which is centralized at GBV units located only at large tertiary hospitals
Considerable time and effort to transport AGYW to GBV units and to provide other assistance
Substantial staff time needed to implement psychosocial interventions and counseling for any AGYW that screened positive for GBV
Lack of dedicated space to provide confidential psychology counseling to AGYW
Abbreviations: AGYW, adolescent girls and young women; DREAMS, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe; GBV, gender-based violence; MoGEPESW, Ministry of Gender Equality, Poverty Eradication and Social Welfare; PrEP, preexposure prophylaxis.
Program Component DREAMS Program Planning and Preparation Needs Program access Initiate enrollment in community and at schools before program start; plan with schools for enrollment during school hours and use community special events and/or one-on-one house visits to speed enrollment.
Consider online enrollment if feasible.
Work with schools to allow self-consent for students aged 18 years or older.
Plan ahead to efficiently obtain parental consent.
Expect resource and logistics complications relating to Internet, food, child care, transportation, and staffing.
Work in advance to allow program access to eligible AGYW in tertiary education settings.
Health education Plan strategically with ministries, the private sector, NGOs, churches, and local authorities to identify an adequate number of appropriate safe spaces.
Identify staff to manage most administrative tasks, such as program tracking, ensuring peer mentors can focus on their primary role and M&E staff can be free up to focus on data quality.
Identify evidence-based, locally adapted, and developmentally appropriate HIV/GBV prevention curricula before program start or add content to existing curricula while awaiting approved content.
Health services Carefully evaluate which PrEP model will work best for AGYW in your particular DREAMS setting and plan ahead for logistics. Consider that many AGYW do not prefer to access PrEP at health facilities.
Work with government supply chain offices to anticipate increases in stock use (e.g., HIV commodities and family planning) with onset of DREAMS program.
Clearly communicate health services components of DREAMS to all stakeholders, especially HIV testing, PrEP, and family planning.
AGYW program donors need to advocate for national school health policies that include provision of sexual and reproductive health services.
Social services Consider government managing high-risk GBV cases and DREAMS managing medium- and low-risk cases.
Anticipate a high GBV case load and consider cadres to help manage cases (e.g., lay counselors and part-time social workers), in addition to full-time social workers.
Work with stakeholders early in the planning process to explore possibilities for expanded post-GBV service delivery sites.
Provide staff with trauma counseling training.
Identify private spaces where AGYW can receive psychological counseling.
Participate in advocacy efforts related to HIV/GBV linkages.
Abbreviations: AGYW, adolescent girls and young women; DREAMS, Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe; GBV, gender-based violence; NGO, nongovernmental organization; PrEP, preexposure prophylaxis.
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