Keeping the Essentials in Place: Lessons Learned from a Qualitative Study of DREAMS in Northern Uganda.
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Programs aiming to shift entrenched gender norms must invest in facilitators’ own transformation and ensure implementation stays true to evidence-based designs. Without careful attention, interventions risk reinforcing rather than challenging norms that sustain GBV. Funders should allow time for piloting and local adaptation to maximize transformative impact.
Objectives The study aimed to explore how adolescent girls and young women (AGYW) in northern Uganda experienced the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe Women) program, particularly its impact on HIV prevention, reproductive health, and gender-based violence (GBV), and to draw lessons for scaling up evidence-based social norms interventions like Stepping Stones.
Methods Researchers conducted semi-structured interviews with 56 AGYW from nine peer groups participating in DREAMS in early 2017. The purposive sample targeted groups with the highest exposure to Stepping Stones sessions, economic empowerment training, and GBV workshops. Interviews focused on perceived changes, program appreciation, and implementation experiences.
Intervention Details DREAMS, funded by USAID and PEPFAR, integrates biomedical, behavioral, and structural HIV prevention strategies, combining HIV testing, family planning, GBV awareness, and income-generation activities. In Uganda, it used the Stepping Stones curriculum facilitated by peers to address gender norms and health risks.
Results Participants reported positive outcomes: increased HIV testing, better understanding and use of contraception, greater self-confidence, and improved communication skills. However, some peer discussions framed GBV prevention as women’s responsibility to “manage” male partners, reflecting unintended reinforcement of gender inequality. Implementation challenges included rushed facilitator training, lack of full adherence to the original program design, limited adaptation time, and unmet expectations for economic or educational support.
Conclusions While DREAMS improved health knowledge and behaviors, its impact on shifting harmful gender norms was mixed due to implementation gaps. Successful scale-up of norms-shifting programs requires fidelity to original designs, careful adaptation, strong facilitator preparation, and sufficient time and resources.
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