Young woman reading flier about PrEP (Photo credit: EMPOWER Malawi).

The Expanding Malawi HIV/AIDS Prevention with Local Organizations Working for an Effective Epidemic Response (EMPOWER) is a five-year project implementing Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) programming for adolescent girls and young women (AGYW) in the Zomba, Phalombe and Machinga districts of Malawi. Since its launch in March 2020, EMPOWER has delivered a core package of interventions under DREAMS which combine evidence-based approaches addressing the structural drivers that increase girls’ HIV risk. By May 2023, the project had reached more than 160,000 AGYW with integrated sexual and reproductive health (SRH), HIV prevention, and gender-based violence (GBV) services.

In collaboration with the Malawi Ministry of Health District Health Offices, EMPOWER provides high-quality integrated SRH and HIV services to AGYW ages 10-24 years through DREAMS clubs. These services include family planning, post-GBV support, STI testing and treatment, HIV testing—including index testing and HIV self-testing—and pre-exposure prophylaxis (PrEP) for HIV prevention. EMPOWER provides mobile services, traveling to numerous DREAMS clubs to provide services in adolescent friendly safe spaces with referrals for additional services.

Rebecca, an adolescent girl from Zomba, was afraid to get tested for HIV. After joining the Tikondane DREAMS Club in 2018, she received information on SRH and HIV services. Through the support provided by the DREAMS club facilitator, Rebecca decided she was ready to get tested. When a team from EMPOWER visited her club to offer HIV testing and SRH services, she jumped at the opportunity.

“The 20 minutes I spent waiting for the [test] results were the longest period of my life. A nurse did some counselling before giving me my results. I couldn’t believe it when the nurse said, ‘you are HIV negative’. I was very happy that all the worrying was over. Since then, I have always been careful, so I do not get HIV through any way,” Rebecca said.

Rebecca told EMPOWER staff that getting tested for HIV and knowing her status was the greatest decision she has ever made. She said knowing that she does not have HIV has motivated her to put more effort on her education and to take steps to stay HIV negative. The project has since linked her to PrEP services.

Catherine, another young woman in Malawi, says her life turned around when she joined the Tikondane DREAMS club in May 2021. She met with staff from the EMPOWER Project when they visited the club to provide SRH and HIV services, including information on PrEP. She shared that during the visit, she was asked about her life and realized that she was at risk for HIV because her husband was not always faithful. Catherine decided to start taking PrEP to protect herself. She says that PrEP boosted her confidence and gave her the courage to open a restaurant in June 2021. “I’m now able to run my business without stress, knowing I’m protected from HIV,” she says. Malawi EMPOWER prioritizes women’s health care services to enable women like Catherine to actively participate in efforts that make the world more sustainable.

EMPOWER also conducts GBV prevention and response activities to ensure the safety and well-being of the AGYW served. During a session in April 2022, 65 AGYW received information and services on HIV prevention, SRH, and GBV as part of EMPOWER’s programing at Miracle, Tisangalale, and Kachere DREAMS clubs. In October 2022, EMPOWER trained 136 health care workers in Phalombe on the World Health Organization LIVES (Listen, Inquire, Validate, Enhance safety, and Support) approach to responding to GBV that provides psychological first aid and aims to meet the needs of survivors, including access to post-violence clinical and nonclinical services. During that same period, the project held a similar orientation for 115 health surveillance assistants and community midwives who interact with AGYW at DREAMS clubs and the community to support screening for GBV and linkages to post-GBV services.

Funded by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), EMPOWER is led by FHI 360 and implemented in collaboration with the Christian Health Association of Malawi and Pakachere Institute for Health and Development Communication. To learn more about layering of DREAMS services under the EMPOWER project, watch this short video.

Featured image: Young woman reading flier about PrEP. Photo by EMPOWER Malawi.