Directed and target focused multi-sectoral adolescent HIV prevention: Insights from implementation of the 'DREAMS Partnership' in rural South Africa
Directed and target focused multi-sectoral adolescent HIV prevention: Insights from implementation of the 'DREAMS Partnership' in rural South Africa
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DOI：
10.1002/jia2.25575
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发表时间：
2020-09-01
影响因子：
6
通讯作者：
Shahmanesh, Maryam
中科院分区：
文献类型：
--
作者：
Chimbindi, Natsayi;Birdthistle, Isolde;Shahmanesh, Maryam
“DREAMS伙伴关系”促进采取多部门办法，减少撒哈拉以南非洲少女和青年妇女感染艾滋病毒的脆弱性。尽管人们广泛呼吁将结构、行为和生物医学艾滋病毒预防干预措施联合收割机结合起来，但这并没有得到大规模实施。在这篇评论中，我们回顾了在南非北方夸祖鲁-纳塔尔的艾滋病毒高发病率、农村和贫困社区为期两年的DREAMS推出，以严格评估中央协调和以AGYW为重点的方法的能力，以结合艾滋病毒预防来支持青少年的可持续发展。“梦想”项目采用了一种有针对性的、以目标为重点的办法，在这种办法中，地方执行伙伴得到资源，在两年时间里在选定的地理区域向青年妇女咨询小组提供确定的一揽子计划。我们认为，在政府和资助者的高级别监督下，这种方法使AGYW能够迅速推出雄心勃勃的多部门艾滋病毒预防。当它利用现有的基础设施和能力，和/或分配资源解决社区现有的青年发展问题时，它在为青年和女青年协会提供多种干预措施方面最为成功。如果该办法包括一个征求并回应青年妇女关切的问题的机制，例如与性别有关的规范和青年妇女如何体验其性行为，如果这种倾听得到适应社会环境的多样性的支持，这种办法就会得到加强。在所有青少年都很容易感染艾滋病毒的情况下，过分强调以特定群体为目标，无论是在地理上还是在风险状况上，都可能妨碍干预措施的可接受性和覆盖面。青年妇女协会没有切实参与干预措施的制定、交付和领导，这就失去了在青年人中实现可持续发展目标和改变性别规范的机会。结论：在南非农村地区，集中指导和有针对性地扩大确定的艾滋病毒预防一揽子计划在很大程度上是成功的。然而，要实现可持续和成功的长期青年发展和性别规范的转变，就需要增强青年妇女咨询小组的适应能力、经济赋权和有意义地参与干预措施的制定和实施。实现这一目标需要政府和供资者的持续承诺。
Introduction The "DREAMS Partnership" promotes a multi-sectoral approach to reduce adolescent girls and young women's (AGYW) vulnerability to HIV in sub-Saharan Africa. Despite widespread calls to combine structural, behavioural and biomedical HIV prevention interventions, this has not been delivered at scale. In this commentary, we reflect on the two-year rollout of DREAMS in a high HIV incidence, rural and poor community in northern KwaZulu-Natal, South Africa to critically appraise the capacity for a centrally co-ordinated and AGYW-focused approach to combination HIV prevention to support sustainable development for adolescents. Discussion DREAMS employed a directed target-focused approach in which local implementing partners were resourced to deliver defined packages to AGYW in selected geographical areas over two years. We argue that this approach, with high-level oversight by government and funders, enabled the rapid roll-out of ambitious multi-sectoral HIV prevention for AGYW. It was most successful at delivering multiple interventions for AGYW when it built on existing infrastructure and competencies, and/or allocated resources to address existing youth development concerns of the community. The approach would have been strengthened if it had included a mechanism to solicit and then respond to the concerns of young women, for example gender-related norms and how young women experience their sexuality, and if this listening was supported by versatility to adapt to the social context. In a context of high HIV vulnerability across all adolescents and youth, an over-emphasis on targeting specific groups, whether geographically or by risk profile, may have hampered acceptability and reach of the intervention. Absence of meaningful engagement of AGYW in the development, delivery and leadership of the intervention was a lost opportunity to achieve sustainable development goals among young people and shift gender-norms. Conclusions Centrally directed and target-focused scale-up of defined packages of HIV prevention across sectors was largely successful in reaching AGYW in this rural South African setting rapidly. However, to achieve sustainable and successful long-term youth development and transformation of gender-norms there is a need for greater adaptability, economic empowerment and meaningful engagement of AGYW in the development and delivery of interventions. Achieving this will require sustained commitment from government and funders.