This evidence brief provides a summary and presents the key findings from the EMPOWER Study, conducted in Johannesburg, South Africa, and Mwanza, Tanzania. The study asked: 

Is it feasible, acceptable and safe to integrate responses to gender-based violence and harmful norms into an HIV prevention programme offering pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW) aged 16-24 years? 

As part of the study, researchers developed a scalable intervention to address the heightened vulnerability of AGYW to HIV and violence consisting of:

• Provision of daily oral PrEP to HIV negative AGYW. 
• Integrated screening and linkage-to-care for AGYW who experienced gender-based violence (GBV) and stigma.
• Supportive interventions such as counselling, SMS visit reminders, and community and partner mobilisation.

The study compared this package of interventions with an enhanced support package, in which half the cohort was randomized to attend monthly empowerment clubs covering topics including: gender roles and social norms, power and control, sexual and reproductive health and empowerment. 

Findings

1. Lifetime experience of GBV is already high among adolescent girls and young women in South Africa and Tanzania, affecting around one third of women in both countries. 
2. Integrating GBV screening into HIV counselling and testing services is feasible and acceptable to AGYW. 
3. PrEP uptake was very high among the AGYW enrolled at baseline (100% in Mwanza, and 94% in Johannesburg).
4. It is possible to deliver PrEP to AGYW as part of a scalable combination HIV prevention programme that couches adherence support in an ‘empowerment’ framework. 

Given the multiple points of overlap between the epidemics of HIV and violence in this region, it makes sense from a programmatic and public health point of view to offer violence interventions alongside PrEP delivery. 

More from the EMPOWER study

• STRIVE learning lab: Results from the EMPOWER randomised trial