I
n many ways, Malawi exemplifies the success of the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR). Over the last 14 years, new HIV
infections have declined by 34 percent.3
Despite being among the poorest
countries in the world, Malawi is approaching its HIV treatment targets. The
possibility of controlling the epidemic is within reach. 4
But Malawi also lays bare MAJOR CHALLENGES AND GAPS FACING THE HIV
RESPONSE, NOTABLY HOW TO PREVENT HIV AND ADDRESS HIV RISK FOR ADOLESCENT
GIRLS AND YOUNG WOMEN (AGYW) in low-resource settings: in Malawi, a 25-yearold
woman is three times more likely to be HIV positive than her male peers.5
Adolescent girls now comprise almost a third of new infections in Malawi,6
stemming from the social, economic, and cultural factors that fuel their risk
for HIV. Related indicators demonstrate the stark realities for young women,
including very low secondary school completion and high rates of adolescent
pregnancy, gender-based violence (GBV), and child marriage.7
Meanwhile,
Malawi’s population has doubled between 1990 and 2016 and continues to
grow; with nearly half of Malawians under the age of 15, there are more young
people to reach with information and services than ever before. This “youth
bulge” presents critical challenges to curbing the AIDS crisis in Malawi, and
highlights the importance of effectively addressing young people’s health and
development needs. In addition, Malawi is facing a severe food security crisis,
which also increases the vulnerability of adolescent girls and young women.
Malawi is 1 of 10 focus countries in east and southern Africa8
under DREAMS
(Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe), a publicprivate
partnership led by the President’s Emergency Plan for AIDS Relief
(PEPFAR) that aims to reduce the number of new HIV infections among 15- to
24-year-old women by 40 percent in geographic “hot spots.”9
As a prevention
program, it is attempting to reach young women and their male partners,
populations that have proven very difficult to reach thus far.10
This is a moment of heightened focus on the urgency of addressing HIV in
adolescent girls and young women by the United States, other international
partners, and the government of Malawi.11 To learn more about the status
of DREAMS implementation and lessons for other country programs, CSIS
conducted a research trip to Malawi in April 2017.