ondele, one of Kisumu’s busiest and most densely populated informal settlements, sits at the intersection of a national highway, a major market, and one of the highest HIV prevalence rates among adolescent girls and young women anywhere in Kenya. For years, HIV prevention messaging here was pitched at the general population, largely missing the specific pressures — transactional relationships, limited negotiating power in sexual partnerships, and inconsistent access to testing — that put girls aged 15 to 24 at disproportionate risk.
DREAMS was built to close that gap directly. Girls join weekly safe-space groups facilitated by trained young women from Kondele itself, where HIV prevention sits alongside broader conversations about relationships, financial pressure, and goal-setting. From there, the program layers in services that used to require a clinic visit girls often couldn’t or wouldn’t make: HIV self-testing kits that can be used privately, and PrEP (pre-exposure prophylaxis) made available through community-based distribution rather than only through hospital pharmacies.
The combination matters. Self-testing removed the single biggest barrier program staff had identified — the fear of being seen entering an HIV clinic by neighbors or family. Uptake of self-testing among enrolled girls has consistently outpaced uptake through standard facility-based testing in the same neighborhoods. For girls who test negative and are assessed as being at ongoing risk, peer navigators walk them directly into a PrEP initiation conversation, cutting out the multi-step referral process that previously caused many girls to fall away before ever starting.
Three years into implementation, new HIV diagnoses among girls enrolled in DREAMS safe-space groups in Kondele have declined markedly relative to girls in similar Kisumu neighborhoods without the program. Just as importantly, girls who complete a full cycle of DREAMS programming report far higher confidence negotiating condom use and are more likely to know their partner’s HIV status — both established predictors of long-term risk reduction that outlast any single testing or prevention encounter.
“A self-test kit she can use in her own room, at her own time, does more for a girl in Kondele than a clinic appointment she’s too afraid to keep,” one DREAMS peer navigator explained — a line that has since become something of a guiding principle for how the program designs new services.
“A self-test kit she can use in her own room, at her own time, does more for a girl in Kondele than a clinic appointment she’s too afraid to keep,”
Population Council researchers are now examining which combination of DREAMS components — safe spaces, self-testing, or PrEP access — drives the largest share of the observed decline, work that will shape how the program’s core elements are prioritized as DREAMS expands into additional high-prevalence counties along the Lake Victoria basin.