Engaging Male Partners of Adolescent Girls and Young Women in HIV Services in Malawi: Findings from DREAMS Implementation Science Research

National estimates mask geographic variations, with Project SOAR finding that HIV prevalence among AGYW aged 17-23 is 6.3 percent and HIV incidence from 2010-2013 is 9.7 per 1,000 in Machinga and Balaka districts. Power differentials in AGYW's sexual relationships with male partners contribute to their vulnerability to HIV, reducing their ability to negotiate condom use. Men are often reluctant to access HIV prevention, care, and treatment services, including HIV testing services (HTS), antiretroviral therapy (ART), and voluntary medical male circumcision (VMMC). Engaging male partners of AGYW is crucial in reducing HIV incidence among AGYW. Project SOAR, in collaboration with the Center for Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in two districts implementing DREAMS programming, Zomba and Machinga. The study aimed to identify and locate the types of men who have sexual relationships with AGYW, understand the challenges to and facilitators of accessing HIV services among AGYW's male partners, and identify strategies to reach and engage male partners of AGYW in HIV services. Community mapping exercises with AGYW and opinion leaders identified a wide variety of locations where AGYW meet their male partners, including initiation ceremonies for boys, rest houses/lodges, markets/trading centers, bars, and construction company offices. Focus group discussions with men aged 18 and older in relationships with AGYW revealed that men identify HIV service barriers as fear of testing positive, stigma, long waiting times, lack of privacy and confidentiality, and the use of female healthcare workers to provide certain services. Men want health communication messages and services that meet their needs and answer their questions, are delivered by male providers, and are provided at home and other venues they frequent. The study found that men are reluctant to access HIV services due to fear of testing positive, which they associate with death and relationship dissolution. Stigma is also a significant barrier, with men fearing internalized and externalized stigma. Men also noted drawbacks to accessing VMMC services due to lack of privacy and the use of female providers. Emphasizing men's health and well-being and engaging their peers and partners in health promotion messages facilitates their HIV service use. Strategies to reach and engage male partners of AGYW in HIV services include providing health communication messages and services that meet their needs, using male providers, and providing services at home and other venues they frequent.