Abstract:
This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through
a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable.
Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening
model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe
(DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS
implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed
on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring
data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and
medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only
did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and
hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase
in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change,
away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening
initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection;
however, challenges around taking such initiatives to scale and tracking long-term outcomes remain
