Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women: Findings from a prospective cohort in Kenya.
Outcomes: Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways While DREAMS aimed to shift gender norms as part of its comprehensive HIV prevention strategy, the study found limited evidence that DREAMS invitation impacted individual attitudes toward gender norms among adolescent girls and young women (AGYW) in Kenya. Equitable attitudes toward sexual and reproductive health (SRH) decision-making were already high, limiting potential improvement, and the programme had little to no measurable effect on norms related to violence. Broader and more intensive community-level engagement, especially among male peers and family influencers, may be necessary to transform deeply held gender norms.
Objectives To evaluate whether invitation to DREAMS, a multi-component HIV prevention initiative, led to more equitable attitudes toward gender norms—particularly around SRH decision-making and intimate partner violence—among AGYW in Kenya.
Methods A prospective cohort study followed AGYW aged 15–22 years in urban Nairobi and rural Gem from 2017–2019. Using data from surveys linked to demographic surveillance systems, attitudes were measured via a validated, adapted version of the Gender Equitable Men (GEM) scale. Propensity score-adjusted analyses were used to estimate the causal effect of DREAMS invitation on two dimensions of gender norms: SRH decision-making and violence-related norms. Comparisons were made between those invited to DREAMS and those not invited, and among young men for contextual contrast.
Intervention Details DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is a multi-layered intervention targeting AGYW to reduce HIV risk by addressing structural and behavioral determinants, including gender norms. Its core package includes SRH education, HIV testing, post-violence care, social asset building, community mobilization, parenting programs, and social protection initiatives. The intervention was rolled out in Kenya beginning in 2016, with full implementation in the study areas by 2017.
Results Across both sites, equitable attitudes toward SRH decision-making were already high (≈90%) and did not significantly differ between DREAMS beneficiaries and non-beneficiaries. Attitudes towards violence-related norms were lower—particularly in rural Gem—but DREAMS had no significant effect. Some improvements in equitable attitudes were observed over time, especially in Nairobi, but these could not be attributed directly to DREAMS.
Conclusions Despite DREAMS’ ambitious design, its measurable impact on shifting gender norms among AGYW was minimal within the study timeframe. To achieve normative change, future programs must engage broader community actors—including young men and caregivers—and invest in long-term, multi-level strategies that go beyond individual behavior change to address the relational and institutional reinforcements of gender inequality.
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