Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women: Findings from a prospective cohort in Kenya

TL;DR

This study examines how the DREAMS program in Kenya affects attitudes towards gender norms among young women and their male peers.

Contribution

The study provides new evidence on the impact of DREAMS on gender norms in two Kenyan regions using a causal inference framework.

Findings

DREAMS may slightly increase equitable attitudes around sexual and reproductive health in Nairobi but not in Gem.

No significant effect of DREAMS on attitudes towards violence-related norms was found in either location.

Initial equitable attitudes at enrolment limited the potential for improvement in some areas.

Abstract

The DREAMS partnership aims to deliver a comprehensive package to reduce HIV incidence among adolescent girls and young women (AGYW), including through shifting gender norms. We evaluate DREAMS’ effect on attitudes towards gender norms in two Kenyan settings. AGYW aged 15–22 in Nairobi (n = 852) and Gem (n = 761) were randomly selected for cohort enrolment in 2017–18 and followed-up to 2019. We described the proportion of AGYW and their male peers with equitable attitudes towards gender norms, using an adapted version of the GEM scale. We estimated the association between self-reported invitation to DREAMS (in 2017–18) and AGYW’s attitudes towards two dimensions of gender norms, and then applied a causal inference framework to estimate the difference in the proportion of AGYW with equitable attitudes under the counterfactual scenarios that all versus none were DREAMS beneficiaries. We estimated that overall, 90.2% versus 87.1% of AGYW would have equitable norms around sexual and reproductive health decision-making in Nairobi if all versus none were DREAMS beneficiaries (+3.1; 95%CI:-2.5, +9.0). In Gem, we estimated a risk difference of +1.0 (89.6% vs 88.6%, 95%CI: -3.6,+5.6). There was no evidence for an effect of DREAMS on attitudes towards violence-related norms (Nairobi: 82.7% vs 82.2%, +0.5; 95%CI: -5.3,+6.5; Gem: 44.3% vs 48.2%, -3.9; 95%CI: -11.7,+3.0). We found no evidence of an impact of DREAMS invitation on individual attitudes towards gender norms. In some cases, equitable attitudes at enrolment left limited scope for improvement, and additional effort may be required to shift inequitable violence attitudes among both AGYW and their male peers.

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