Youth HIV advocates have called on Malawi’s HIV prevention programmes to move beyond awareness campaigns and address the economic and social realities that continue to put adolescent girls and young women at high risk of infection.
Mothers to mothers, an international team working towards ending AIDS, established that despite years of public education on HIV prevention, girls and young women remain the most affected group in Malawi.
Elina Mwasinga, national coordinator for Y+ Malawi, a National Association of Young People Living with HIV, said many girls are aware of HIV prevention messages but lack the power or resources to act on them.
“Economic vulnerability forces some girls into relationships where they cannot negotiate safer sex. In these situations, knowledge alone is not enough,” said Mwasinga.
Mwasinga also pointed to gaps in youth-friendly health services, particularly in rural areas where young people must travel long distances to access care.
She said many facilities do not provide comprehensive services that integrate HIV prevention with sexual and reproductive health, leaving girls without reliable access to contraception, counselling and prevention tools.
“There’s still a gap between sexual and reproductive health services, especially in integrating family planning with HIV care. This leaves many young people living with HIV without vital information on preventing mother-to-child transmission.
“These gaps are a major factor contributing to increased risks for adolescents and young women, who may become pregnant while lacking access to crucial HIV-related guidance. Access remains a challenge in many communities, with some facilities located far away, forcing people to walk long distances just to reach a hospital,” she said.
She added that HIV programmes often focus narrowly on awareness, while ignoring coercion and unequal power relations that shape girls’ choices.
According to Mwasinga, some girls face pressure from older partners or depend on men for financial support, making it difficult to refuse sex or insist on condom use.
Mwasinga said meaningful progress will only be made if prevention strategies address poverty, gender inequality and access to services alongside education.
“If programmes do not reflect the realities girls live with every day, we will continue to see high HIV infection rates among adolescent girls and young women,” she said.
However, health authorities and civil society groups warn that recent disruptions in donor funding could threaten these gains.