At sunrise in Dzaleka Refugee Camp, Chris Mahatchi laces up his shoes and steps out onto the dusty road. Around him, the camp is waking up, children heading to makeshift schools, vendors setting up their stalls, and life carrying on under the quiet shadow of one of Malawi’s biggest public health battles: HIV.

Like many others here, Chris lives with risk. But unlike before, he now walks with confidence. A simple decision to start taking PrEP has given him a sense of protection he never thought possible.

Across Malawi, a quiet revolution in HIV prevention is underway. Through the Consortium in Advancing Access to New HIV Prevention Biomedical Products (CAAPP), led globally by the Family Planning Association of India (FPAI), the Family Planning Association of Malawi (FPAM) is spearheading efforts to roll out Pre-Exposure Prophylaxis (PrEP) especially among communities at higher risk. The initiative is making its mark in districts like Dowa, reaching men who have sex with men, sex workers, transgender individuals, and people who use and inject drugs.

Josephy, a man who has sex with men, is among those benefiting from this initiative. He started taking PrEP in 2020.

“We face a higher risk of HIV,” he says. “PrEP helps prevent infection and gives me peace of mind. Taking pills daily can be hard, but Event-Driven PrEP gives us flexibility. It fits into our lives,’’ he explains.

Henry, a transgender sex worker, also speaks highly of PrEP’s impact. Before using it, he says condoms were the only form of protection and they were not always enough.

“Once I started taking PrEP, I felt safer and more in control,” he explains. “Now with injectable PrEP, one shot protects me for two months. No daily pills, no fear of forgetting. I can start protected sex the same day I get the shot. It has lifted a huge burden.”

Female sex workers are also taking charge of their health. Chisomo (not her real name) a female sex worker based in Dowa district began using PrEP after friends encouraged her to visit the clinic. “I have been taking PrEP for eight months now, and I have not experienced any side effects. I am still HIV negative,” she says.

Mercy Matiki (not her real name) says having heard that her husband is not faithful, she decided to be using PrEP. “Now I sleep with my husband peacefully, even if he may be unfaithful. I know I am protected,’’ she explains.

In Dzaleka Refugee Camp, Chris Mahatchi decided to use PrEP after realizing the high-risk environment around him. “I chose Event-Driven PrEP. and I have stayed negative ever since.”

Meanwhile, people who use and inject drugs also highlight how PrEP is giving them a new lease on life. Martin says, “When you are using drugs, you can end up doing things you normally would not do. PrEP gives protection during those risky moments.” he says.

James who also uses drugs also says PrEP offers him peace of mind.  “I felt lucky to be HIV-negative and wanted to stay that way. I moved from oral to injectable PrEP, though the supply was disrupted recently. Still, I have hope,’’ he narrates.

Unfortunately, the threat of funding cuts looms large. Some users worry that the recent USAID aid freeze could jeopardize access to the life-saving intervention. “We really hope other donors’ step in,” says James.

Vincent Sinda, CAAPP Project Coordinator at FPAM, confirms these fears. “The government had suspended the provision of PrEP after the aid freeze, and we rely on the public supply chain. However, currently the suspension has been lifted,’’ he says.

Despite these challenges, the commitment to PrEP remains strong. Washington Ozituosauka, Chief Prevention Officer at the Ministry of Health, affirms the Ministry of Health is geared to ensure that PrEP is available to those who need it. He further says clients that face any side effects should be reporting to the nearest health facility for assessment.

“Side effects are usually mild, short-lived, and tend to resolve on their own. However, we advise clients to visit the nearest health facility if they experience any side effects, so they can be properly assessed and receive the necessary care,’’ he says.

Across Malawi from the city to the villages PrEP is changing lives. It is more than just a pill or an injection. It is a promise. A promise of safety, of control, and of a better, healthier future.