International Development Law Organization

DREAMS: HIV services for adolescent girls and young women

Adolescent girls and young women account for 71 percent of new HIV infections among young people in sub-Saharan Africa. They are more vulnerable to HIV because they are often subjected to a range of gender and age based biases, discrimination and violence, including sexual assault, forced marriage and trafficking. Despite growing HIV-related responses, they and their communities most often do not have the capacity, voice and power to hold these service providers accountable for improved delivery of quality HIV-related services.

Recognizing this urgent need, DREAMS, an ambitious $385 million partnership, has invested $85 million to support innovative solutions from 56 organizations. IDLO was selected as a winner of the DREAMS Innovation Challenge to infuse new thinking and approaches.

IDLO’s project focuses on the legal and social drivers affecting adolescent girls and young women and their communities’ ability to keep HIV service providers accountable in Tanzania (districts of Kahama and Shinyanga) and Uganda (districts of Gomba and Mukono). With an innovative blend of legal empowerment and social accountability strategies at national, regional and local levels, the project targets the drivers of accountability and gender inequality upon which challenges continue to thrive.


Program in focus

IDLO’s approach integrating legal empowerment (LE) and social accountability (SA) strategies from the outset within HIV prevention programming for women and girls is a methodology that holds promise for accelerating justice for women and ensuring no one is left behind in the achievement of SDG-16.

While LE and SA approaches have evolved separately, they share common aims and principles. Both are bottom-up methods that promote human rights and contribute to capacity enhancement, awareness raising, and mobilization of service providers as well as communities. Both approaches aim to achieve structural reform by influencing policy through high-level advocacy. When effectively integrated, LE and SA can help strengthen agency, support access to information, address grievances for marginalized individuals, mobilize collective action from community members, and exact accountability from responsible state actors. 

Underpinned by comprehensive capacity enhancement and peer-to-peer learning, IDLO’s programming integrated elements from both approaches, including the use of a rights-informed community scorecard. Sequenced activities allowed for a participatory social accountability process at a local level, complemented by legal empowerment initiatives raising awareness of legal entitlements in relation to HIV prevention services and providing a platform for individuals to voice needs and identify violations of rights. Girls and women were able to identify gaps in health and justice service delivery, voice their concerns, and note violations of their rights in the presence of government health and justice service providers.

By targeting different actors involved in HIV prevention service delivery, this approach also ensured that girls and women were at the center of programming, These included both health and justice professionals as well as local and national government representatives in order to tackle root causes of HIV incidence. Integrated strategies were utilized to:

Eliminate barriers to access justice, for example:

  • Promote legal aid: through multi-media campaigns and peer-learning, awareness was raised of legal aid services and matters were referred to paralegals and lawyers; and
  • Monitor legal progress: utilizing a case-tracking tool, progress of cases related to HIV and sexual and gender-based violence (a root cause) were tracked and support services were provided to survivors.

Strengthen user-provided feedback mechanisms, for example:

  • Enhance community capacity: existing village health committees were strengthened through training on their role and mandate to channel community feedback and complaints to service providers; and
  • Develop accountability tools: a community scorecard tool was developed and utilized during facilitated sessions where each constituency scored services from their perspective.

Build consensus and prioritize action, for example:

  • Joint action plans: utilizing the community scorecard method allowed for a common understanding of issues and prioritization of solutions through further dialogue.

Achieve higher-level advocacy and policy influencing, for example:

  • Open communication channels: by raising community issues to district, regional, and national levels, awareness of issues was raised and specific commitments were achieved or tabled for follow-up.
  • Funding and litigation support: through a dedicated fund to support costs of HIV-related cases (including sexual and gender-based violence matters), justice services were mobilized in support of health objectives.

In focus:

Community scorecard 

Eight community scorecard processes were held in total, involving around fifteen participants among health and justice professionals, community-based organization representatives, village health committee members, and local girls and women. In-depth discussions identified a range of issues all affecting the ability of girls and women to receive quality services:

  • long waiting hours to access services and non-availability of health workers;
  • inadequate storage of drugs;
  • poor road conditions reducing accessibility of facilities;
  • lack of certain regulated services and dispensers at facilities;  
  • negative attitudes by health workers towards girls and women seeking HIV services;
  • non-completion of forms by medical practitioners in instances of sexual and gender-based violence;
  • long wait times for health workers when appearing as witnesses in criminal trials related to sexual and gender-based violence;
  • use of full names rather than initials in court documents relating to sexual and gender-based violence; and
  • corruption, especially within justice institutions, that hinders effective access to justice for women and girls.

Interface meetings were then held in each facility to discuss challenges and issues arising from the separate discussions, allowing for identification of common solutions and action plans to follow-up on issues and monitor progress at the community level. Some issues that could be resolved immediately where directly dealt with at the joint meetings. This included instances of changed mindsets by health workers when delivering services as well as ways in which services were sought by girls and women. Other issues were raised to district, regional, and national dialogues. In one instance, road repairs were undertaken, removing a simple accessibility barrier.


The integration of LE and SA holds promise for accelerating women’s empowerment and realization of rights. Through the combined use of different strategies and tools under these approaches, shortcomings from singular approaches are addressed and the reach of strategies extended.





20 December, 2016

Adolescent girls and young women account for 71 percent of new HIV infections among young people in sub-Saharan Africa. Uganda reflects this disproportionality, with HIV prevalence among young people aged 15-24 estimated at 4.2% for women but only 2.4% for men.