For millions of young women around the world, inequality affects many facets of their daily lives – with devastating, and often deadly, consequences. Inequality contributes to young women’s poor health outcomes, limited access to education , and inadequate employment opportunities . Inequality also helps drive the alarming rates of sexual violence that many young women experience , which can place them on a trajectory for additional trauma and risk.
This year’s International Women’s Day 2020 theme – “An equal world is an enabled world” – speaks to the urgency and necessity for us all to create a world that is more inclusive and equitable for women and girls.
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is deeply committed to this goal. PEPFAR invests nearly $2 billion a year to support women and girls in more than 50 countries worldwide. Data show that gender inequality is both a cause and a symptom of the global HIV epidemic. Inequality contributes to women, particularly adolescent girls and young women (AGYW), being far more likely (in some countries up to 14 times) to have HIV than their male counterparts.
PEPFAR’s pioneering DREAMS Partnership addresses these inequalities head-on through our evidence-based package of interventions that includes education subsidies, economic strengthening, and violence prevention . Inequality often begins at birth for AGYW. That’s why DREAMS is working at the community level to address harmful gender norms and help prevent HIV. DREAMS is driving frank conversations about what factors put AGYW at higher risk and supporting countries and communities to address these factors with a multifaceted approach. AGYW are the heart of DREAMS and we place them at the center of everything we do – meaningfully engaging young women to design, develop, and improve our efforts in real time so that they meet their most critical needs.
DREAMS is laser-focused on the geographic areas with the highest HIV prevalence and incidence among AGYW in 15 countries including Botswana, Cote d’Ivoire, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Since DREAMS’ inception, new HIV diagnoses among adolescent girls and young women have declined by 25 percent or more in nearly all these regions.
Betty’s Story

Betty is a young mother from Zimbabwe, who began engaging in sex work in the eighth grade to make ends meet after losing her parents. After suffering continuous setbacks through her adolescence, Betty was introduced to DREAMS, which provided her with critical services and support to build a brighter future. She enrolled at Mutare Polytechnic College to study auto electrics and received support for her son through PEPFAR’s orphans and vulnerable children program.
With assistance from DREAMS and PEPFAR, Betty is now a successful, empowered young woman. She supports herself and her son as a qualified, accredited auto mechanic. Betty also gives back to her community by conducting outreach to AGYW, mentoring and supporting them to access HIV and sexual violence prevention services. Thanks to DREAMS, Betty remains AIDS-free and passionately helps her sisters to become Determined, Resilient, Empowered, AIDS-free, Mentored and Safe.
On International Women’s Day, and every day, PEPFAR is proud to serve young women like Betty and provide them with a platform for advancing equality and inclusion in their communities – and for building their own brighter, AIDS-free futures.
About the Authors: Ambassador Deborah Birx serves as the U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy for the United States President’s Emergency Plan for AIDS Relief. Dr. Angeli Achrekar is the Principal Deputy Coordinator for the Office of the Global AIDS Coordinator and Global Health Diplomacy at the U.S. Department of State.