A 2016 survey of around 200 men who have sex with men found 39% had experienced a human rights abuse in some form.
Around 12% reported being raped and 18% had been blackmailed.
Urban young people are more likely than rural young people to have knowledge of HIV prevention.20 Condom use is low among sexually active 15-to-19-year-olds, with only 25% of married females and 30% of sexually active unmarried females from this age group using any form of modern contraception.
More than18.7% of married women report an unmet need for contraception in Malawi.21 Young people often face obstacles to accessing contraceptives and health services, which increases their risk of acquiring HIV and other sexually transmitted diseases.22 Sexual violence is also an issue for young people.
Of those tested, 9% were under 15-years-old, 40% were between 15 and 24 and 52% were older than 25.42 HTC services are provided in two ways in Malawi, client initiated HTC, which is Voluntary Counselling and Testing (VCT), and provider initiated HTC, which encompasses a variety of methods including static sites; mobile testing units; home-based testing and national HTC events.43 The National HIV and AIDS Strategic Plan 2015-2020 has developed various prevention policies and strategies for reducing HIV incidence. Malawi has demonstrated an unprecedented commitment to preventing transmission from HIV-positive mothers to their infants in recent years.
Most of the perpetrators of sexual violence against women were spouses, boyfriends or romantic partners.11 Young people account for 50% of new HIV infections in Malawi, with HIV prevalence higher among some young populations, such as 15-17 year olds.12 In total, 3.6% of young women and 2.5% of young men (aged 15-24) are living with HIV in Malawi.13 Early sexual activity is high in Malawi with around 15% of young women and 18% of young men (aged 15-24) reporting having sex before the age of 15.14 Furthermore, girls aged 15-19 are 10 times more likely to be married than their male counterparts, with 45.9% of women having their first marriage before they turn 18 years old.15 With young people engaging in sex at an early age, addressing the sexual and reproductive health needs of this population is critical.Prevalence is also higher in urban areas than rural ones with marked differences observed in the northern and central regions of Malawi.7 The Malawian National AIDS Commission’s (NAC) 2013 Modes of Transmission (Mo T) study, the most recent available, found unprotected heterosexual sex between married/co-habiting partners accounts for 67% of all new HIV infections in Malawi while unprotected casual heterosexual sex accounts for 12%.8 Beyond this, there are several key populations that are increasingly vulnerable to HIV infection.HIV disproportionately affects women in comparison to men in Malawi.Around 23% of females and 13% of males aged 13-17 surveyed by UNICEF in 2013 reported experiencing sexual violence in the past 12 months.23 Men who have sex with men (sometimes referred to as MSM) have been identified as a key affected population within the Malawian HIV epidemic.Nearly one in five men who have sex with men live with HIV, a prevalence rate that remains two times higher than the rest of the adult male population in Malawi.24 Although HIV prevalence tends to be higher in older men, recent records from 2017 show that 11.8% of 18-19 year-old men who have sex with men are already infected.
KEY POINTS:• Malawi has one of the highest HIV prevalence in the world despite the impressive progress the country has made in controlling its HIV epidemic in recent years.• Young people are particularly at risk, due to early sexual activity and marriage, with 50% of new HIV infections affecting 15 to 17 years old in Malawi• Stigma remains a key barrier to progress, particularly among men who have sex with men and sex workers.• Malawi is on track to achieve the UNAIDS 90-90-90 target by 2020, with 90% of people with HIV knowing their status, 90% of these accessing ARVS and 90% of those on treatment being virally suppressed.