Empowering Young Women in the Fight Against HIV

FACT Malawi, or Forum for AIDS Counseling and Training Malawi, is a youth-led organization working to serve adolescent girls and young women by providing sexual and reproductive health services (SRH), which include testing, prevention, and treatment for HIV and sexually transmitted infections (STIs). Madalitso Juwayeyi is program manager at FACT-Malawi, and at AIDS 2024, she presented research on its Let Girls Shine program for underprivileged adolescent girls and young women, “Mitigating HIV Transmission Risks From Young/Teen Mothers to Children: Lessons From the Let Girls Shine Programme for Underprivileged Adolescent Girls and Young Women (AGYW).”

This transcript has been edited for clarity.

Transcript

Can you tell us about the founding of FACT Malawi and the services you provide?

Our work focuses on advancing access to sexual and reproductive health services and HIV prevention services, with the goal of finding solutions to issues of high HIV prevalence among young people, especially adolescent girls and young women; ending unintended pregnancies; finding solutions to sexual- and gender-based violence; as well as to [help] poor girls who are underschooled complete their education. We also want to do youth empowerment.

Our organization was founded in 2017 and has been operating since then. To focus more on projects that we have done in and around HIV, we have done projects that are mostly focused on advancing the need among young people, especially recent girls and young women, to seek HIV prevention services. So, that's including HIV testing, accessing PrEP [preexposure prophylaxis], and condoms as well. In 2020, due to the issues that young people that we are working with were raising—that they are not having access to services that are youth friendly, they feel shy to access the services, they can’t discuss the issues of sexual health, because it's seen as a taboo in our culture for a parent and a child to have this conversation—we opened a youth-friendly health center.

We have a youth-friendly health center that is completely young people, a clear, innovative youth-friendly center, from one young person to another. At the youth center, we provide HIV testing, we provide HIV prevention services like condoms and PrEP, and we also provide SRH services like family planning; we hold trainings, counseling, we provide spaces for victims and survivors of sexual reproductive health and pretty much everything. So that can empower young people to be the best citizens that they can be.

Our goal in the future is to make sure that our center is not only providing services, but we are also able to offer treatment options for young people. We have a program called Comfort Corner, which focuses on young people that are living with HIV. Also, we see that as much as we have Comfort Corner, where young people that are living with HIV can come and interact with us, at the same time when they want treatment, they still have to go and find that in other places where there are older people. So we have been getting complaints on that. So we want to make sure that our center has widened up and can become a main youth clinic where people can test and also get treatment around HIV, STIs, and anything to do with their sexual reproductive health.

Can you describe the Let Girls Shine program and its importance in reducing HIV risk among young women and teen mothers?

I have been working with youth, especially raising girls and young women for the past 6 years, and with our center, we happen to engage a lot with young people, especially young girls. Let Girls Shine, initially the term was for another project. But because of the successes that that project brought, we thought we could continue using the name and bring in other programs.

This one specifically, it says that adolescent girls and young women in Malawi, 29% of them are pregnant before their 18th birthday, [and HIV is 7 times more prevalent] than their male counterparts. And a lot of maternal health that happens, 10% is from adolescent girls and young women. So I saw this to be a gap. Why is it that adolescent girls are dying from sexual and reproductive health issues, and what can we do to help?

Through Comfort Corner, we also happen to have teen mothers that are mothers but also living with HIV. So we had a conversation with them to see what's going on, what is happening, and through that research, with getting case studies and stories from people, we found that a lot of adolescent girls and young women contract HIV because of intergenerational relationships. Because of issues with poverty, they end up being in relationships with men who are older than them for the sake of money, and because of that, of the power dynamic in these relationships, it's hard for them to negotiate for safe sex. In the end, they end up having planned sex and they get pregnant, they get HIV in the process.

Our project comes in to make sure to empower them, so that they can negotiate for safe sex, and at the same time to make sure that if they have tested negative by the time they have their baby, they don't transmit the virus to their child within the years breastfeeding. But also if they have tested positive and their baby has tested negative at discharge, this means they also have to make sure they don't transmit the virus. And if they are both negative, also to make sure that within those 2 years where the mom is breastfeeding, there is no transmission of HIV. Because there have been cases where adolescent girls have been discharged when, they are negative, but in the process, they get HIV because this is their baby now and they need resources to take care of the child. Maybe the husband is no longer in the picture, or they go back and contract HIV. And because they don't even think that they can contract HIV, they don't go for testing, and they go ahead and give it to their baby.

So we go out looking on our own to implement it. We want to make sure that we have centers that are specifically for teen mothers, where they can come, have conversation with one another, can bring their babies for testing, and is just a user-friendly environment where they can feel comfortable and learn from us.