Expanded access to PrEP contributes to HIV prevention among girls and young women in Zomba and Machinga

The Expanding Malawi HIV/AIDS Prevention with Local Organizations Working for an Effective Epidemic Response (EMPOWER) Activity is intensifying efforts to get the HIV prevention pill – Pre-exposure prophylaxis (PrEP) – into the hands of adolescent girls and young women (AGYW) who are at risk of getting the infection, in Zomba and Machinga. Malawi EMPOWER Activity through its outreach clinics, has been providing PrEP information as well as screening of AGYWs (15 to 24 years) enrolled in DREAMS Clubs.  The AGYW identified to be at risk of HIV infection are referred to designated health facilities – co-located with EMPOWER Activity – for PrEP initiation.

Angela (not real name) is one of the AGYW enrolled in DREAMS Clubs who – through Tiyamike DREAMs Club – was once referred to Likangala Health Facility in Zomba for PrEP initiation in November 2020. Angela, 22, is HIV negative and has a sexual partner who has multiple partners but always refuses to use condoms during sexual intercourse. In addition, her partner refuses to go for an HIV test.

“I accept to have unprotected sex with him because I do not want to lose him. However, the fact that he has multiple partners used to trouble my heart as I feared contracting HIV,” she confesses.

Following the PrEP initiation, Angela says she now has peace of mind because PrEP would help her prevent contracting HIV and at the same time, she will secure her relationship. She feels PrEP is her best chance at staying HIV negative.

“It’s so frustrating when a man doesn’t want to use a condom. Now when he refuses, we obviously don’t use protection, but I no longer panic because I know PrEP will control the HIV risk. “I will continue using PrEP until my partner changes his behavior and accepts to go for an HIV test,” she says. “You can never be too sure or too safe.”

To avoid getting unwanted pregnancy, Angela accesses family planning services which are among the integrated Sexual and Reproductive Health (SRH) services provided by EMPOWER with support from the Ministry of Health through AGYW Outreach Clinics.

According to Shira Gavina who is the DREAMS Club facilitator for Tiyamike Club, Angela is one of the first 14 young women who got a referral for PrEP initiation from Tiyamike Club. Shira says the integrated SRH services that EMPOWER Provides to the AGYW have played a very critical role in preventing them from getting unwanted pregnancies, and contracting HIV as well as sexually transmitted infections.

“The benefits will definitely contribute to shaping a very good future that would see them achieve their goals,” she says.

EMPOWER is a is a five-year (5^th March 2020 to 4^th March 2025) Project implemented by a consortium of FHI 360 (lead) and two local organizations, Christian Health Association of Malawi (CHAM) and Pakachere Institute for Health and Development Communication (Pakachere).  The Project goal is to support the Government of Malawi’s commitment to epidemic control by stopping HIV transmission and preventing new HIV infections among adolescent girls and young women (10–24 years of age) in Zomba and Machinga districts towards achieving the UNAIDS 95-95-95 goals by 2030. From October 2020 to June 2021, the Project reached 46,616 AGYW with standardized SRH/HIV evidence-based interventions and provided HIV testing services to 11,851 AGYW, while 28,948 AGYW accessed a wide range of short acting family planning services in mobile clinical outreach sites. From October 2021 to September 2022, the project plans to scale up to 53 health facilities from 40 and continue offering integrated comprehensive SRH/HIV and GBV services through mobile clinical outreach in adolescent friendly safe spaces.