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However, of the people receiving HTC in 2014, only 31% were newly tested whereas 69% were repeat tests.41 The majority (66%) of people being tested were women.

Over the last decade, impressive efforts to reduce the HIV epidemic have been made at both national and local levels.A national assessment of the impact of HIV on the population, carried out by the Malawian Ministry of Health in 2015-2016, found HIV prevalence among adult women (aged 15-64) to be 12.8%, compared to 8.2% among Malawian adult men.9 This disparity is especially prominent among young people, with 3.2% of young women aged 15-24 living with HIV compared to 1.8% of their male counterparts.10 Sexual violence is also an issue with 22% of women and 15% of men experiencing sexual violence before the age of 18 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.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.Major achievements include the expansion of sites providing prevention of mother-to-child transmission (PMTCT) services.

For example, the proportion of female sex workers reporting using a condom with their most recent client was extremely high (85%).34 Sex workers in Malawi face high levels of discrimination and stigma when seeking HIV services further increasing their vulnerability to HIV, especially from police when seeking victim support services.35 An estimated 84,000 children (0-14 years) were living with HIV in 2015 of whom 49% (51,487) are receiving antiretroviral treatment.36 Malawi has shown immense progress in reducing child HIV infection rates.

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