Reaching adolescent girls and young women with SRH/HIV and GBV Services within their Communities   

It is a sunny Friday afternoon at Thukuta Village, Traditional Authority Ngokwe in Machinga District. About 65 adolescent girls and young women (AGYW) belonging to Miracle, Tisangalale and Kachere DREAMS clubs – split into three age groups of 10-14, 15-19 and 20-24 – are seated under trees at Nachanje Community Based Childcare Centre; while waiting to receive information and services on HIV prevention, sexual and reproductive health (SRH) and Gender Based Violence from the Expanding Malawi HIV/AIDS Prevention with Local Organizations working for an Effective Epidemic Response (EMPOWER) Project.  

A few minutes later, spirits get high among the AGYW as the EMPOWER team in accompanied by staff from the Ministry of Health arrive at the site.

The DREAMS Facilitator for Miracle Club, Ethel Chiwaya, highlights that the AGYW are excited because they could now access integrated sexual and reproductive health and HIV prevention services right in their community instead of travelling long distances to access the services at Ngokwe Health Centre.

AGYW health education session

Part of the AGYW aged 20-24 engaging in health education motivation songs while waiting to access integrated SRH services from EMPOWER. Photo credit: Chikondi Lunduka/FHI 360

“This site is 14kilometres away from Ngokwe Health Centre where members of this community access health services. Our mode of transport is a bicycle and if one does not have one, it means they must walk. This takes a lot of time and energy. As a result, many AGYW hardly go to the health facility to access health services,” she explains.

Picture of Estere Langison

Estere is among the excited AGYW who says EMPOWER has enabled easy access to HIV prevention and integrated SRH services. Photo credit: Chikondi Lunduka/FHI 360

To support AGYW who fail to access health services due to long distances, EMPOWER also has Youth Community Based Distribution Agents (YCBDAs) who provide comprehensive SRH information and some services like condoms and other short term contraceptive methods right in the community. When the AGYW need services that cannot be provided right in the community like PrEP, they are escorted to a nearby health facility by a YCBDA or EMPOWER staff to access the service.

Estere Lingison, aged 22, is among the excited AGYW who say EMPOWER has enabled easy access to HIV prevention and integrated SRH services.

“I have been married for five years but I did not know my HIV status as I was dreading walking almost 10 kilometres just to get an HIV test,” says Estere. “I got an HIV test for the first time in October 2021 when I joined Miracle DREAMS Club; EMPOWER came to provide information and different SRH services to the club. I ow know my status and can responsibly take care of myself.”

Another member of the club – 20-year-old Eluby William who is in form 2 at Namiyala Community Day Secondary School – is optimistic she will realise her dream of becoming a nurse as she does not see herself dropping out of school due to unplanned pregnancy. She says apart from receiving HIV testing service from EMPOWER, she has easy access to condoms through the YCBDAs and other safer spaces provided by the project. She uses the condoms when sleeping with her boyfriend of two years.

“Sessions with EMPOWER have taught me important facts about HIV, including the correct use of condoms for prevention of HIV and pregnancy. I’m so thankful for the information and services I have easily accessed right in my community. Previously, it was hard for me to travel a long distance to Ngokwe Health Centre to get the condoms and access other SRH services since the facility is very far,” she narrates.

Eluby says she has become fully informed about HIV prevention, SRH as well as gender-based violence and is sharing the knowledge with her friends who are not club members.

“I also want my friends to stay protected from HIV and unplanned pregnancy so they can have a bright future. My wish is for my friends and myself to have children after we have finished our studies and have realized our career dreams,” says Eluby.

Malawi EMPOWER Senior Technical Advisor for AGYW Programming, Maria Mkandawire, says providing HIV prevention and SRH services beyond health facility walls has improved access and uptake of HIV prevention and SRH services among AGYW.

“The approach has increased adolescent girls’ condom use, PrEP uptake and voluntary HIV testing among girls and young women. This has also resulted in reduced adolescent pregnancy as the AGYW have easy access to contraceptives including condoms,” she explains.

Picture of Eluby William

Eluby shows off the condoms she received from EMPOWER

Since the project’s inception in March 2020, the project has reached over 80,000 adolescent girls and young women with integrated SRH, HIV Prevention and Gender Based Violence services. EMPOWER is a five-year USAID-funded project implemented by a consortium of FHI 360 (lead) and two local implementing partners; Christian Health Association of Malawi (CHAM) and Pakachere Institute for Health and Development Communication (Pakachere). EMPOWER Activity goal is to support the GoM’s commitment to epidemic control by stopping HIV transmission and preventing new HIV infections among AGYW, 10–24 years of age in the two DREAMS operational districts of Zomba and Machinga towards achieving the UNAIDS 95-95-95 goals by 2030.

The project implements proven interventions, promising practices, and innovative approaches with fidelity, bolstered by strong M&E and evidence, aligned with national and PEPFAR priorities and guidelines, and based on global best practices.  One of the specific objectives of the project is to increase availability of and access to high quality, integrated Sexual Reproductive Health and HIV (SRH/HIV) services for AGYW by taking the services closer to AGYW within their communities.

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