Gender-based violence (GBV) is a key driver of HIV transmission and a major barrier to positive health outcomes for women around the world.
While gender-based violence (GBV) is more than just a health problem, health systems offer a powerful platform for ending this epidemic. When health practitioners from communities and clinics speak out about GBV and treat survivors with compassion and respect, community norms begin to shift. When survivors receive compassionate care and psychosocial support, they are better able to protect themselves and their families, and to challenge family norms of violence.
PSI is a driving force in this kind of change, by ensuring that all our staff – from outreach workers, to community HIV testers, to nurses and doctors – recognize the signs of GBV. They respond appropriately and compassionately, and support GBV survivors to seek and receive the services they need. Increasingly, PSI network members are working to bring these services closer to survivors, by making them available in the community to survivors of sexual assault.
Making a Difference
Our networks leverage existing programs to offer services for survivors of GBV:
Integrating post-rape care into reproductive health clinics
PSI/Zimbabwe, with support from the United Kingdom’s Department for International Development (DfID), has integrated GBV services and messaging into its existing reproductive health and HIV programs. PSI/Zimbabwe has already championed integrated service delivery through its New Start social franchise. Their service delivery sites (including mobile and static sites) provide HIV testing and counseling, contraceptive services, TB screening and treatment, as well as cervical cancer screening. These services are provided all together so that patients receive efficient and streamlined care. In February 2013, PSI/Zimbabwe added GBV to the mix by integrating post-rape care and essential referrals into eight of its service delivery sites. Services include initial screening for survivors of sexual violence, access to post exposure prophylaxis to prevent HIV infection, and emergency contraception within 72 hours of the assault. The program also provides referrals for ongoing psychosocial support, legal services and forensic exams.
In its first 18 months, PSI/Zimbabwe saw about 1,500 survivors for sexual violence services and is working in collaboration with Family Support Trust and the Adult Rape Clinic to provide seamless and sustained clinical and psychosocial support. These services are promoted through a mass media campaign that both informs survivors of where to access services, as well as challenges the gender norms that drive sexual violence and leave many survivors without the social support they need to recover from their experiences.
Peer-based program for female sex workers
PSI/Tanzania is integrating GBV messaging and services into its Shosti program for female sex workers. Shosti, or ‘friend’ in Swahili, is a peer-based program that sends trained female sex workers (FSW) out to brothels, bars, streets and neighborhoods where FSW gather, to provide information about HIV prevention and condoms. Shosti also has two female sex-worker-only drop-in centers where sex workers can access HIV testing and counseling, contraceptive services and a safe space to gather and learn among peers. PSI/Tanzania is working with the Ministry of Health and the police force to ensure that clinical services for the management of sexual violence are also provided at the drop-in centers, and that safe and effective referrals can be made to the police and other social support in the community. PSI/Tanzania is also designing a series of communication materials for Shosti peer educators to use when talking to female sex workers. These materials discuss GBV, promote the services available and help sex workers develop strategies to remain safe in their work environments.
Empowering healthcare workers to take a survivor-centered approach
In 2013, PSI/Papua New Guinea (PSI/PNG) partnered with Médecins Sans Frontières (MSF) to launch an initiative to provide screening, treatment, and referral services for survivors of GBV. PSI/PNG developed and implemented a facilitator manual for improving the health sector’s response to GBV, empowering healthcare workers to take a ‘survivor-centered’ approach to addressing the needs of clients in a variety of contexts and settings. PSI/PNG also launched a four-day marital relations workshop for women and men to learn (separately) about the relationship between human rights, gender and GBV, sexual health, HIV and other STIs. The workshop teaches participants communication skills, planning and budgeting, and the risks associated with extramarital relationships and alcohol abuse. The aim is to build skills and understanding in order to strengthen their relationships and reduce arguments that could lead to intimate partner violence and marital rape.
- USAID Central Asia Flagship Activity Project Year 3 Results
This resource lists results from year 3 of the USAID Central Asia Flagship Activity.
- “Stigma And Discrimination-Free Zones”: An Innovative Approach to Engaging the Private and Public Sectors in Creating More Inclusive Environments for Key Populations in Central America (TUPED509)
Central America's HIV epidemic is concentrated in key populations (KPs). Despite existing HIV laws and policies that respond to KP's specific needs, there is evidence of widespread discriminatory attitudes and practices towards these populations, and stigma and discrimination continue to be important barriers to accessing HIV services and care. In 2016, under the USAID Combination Prevention Program for HIV in Central America, PASMO designed an intervention entitled “stigma and discrimination-free zones” as part of a broader initiative known as Generation Zero, contributing to the goal of “getting to zero discrimination.”
- An Integrated Approach of Addressing GBV and HIV for AGYWs. The Case of DREAMS Project in Malawi (WEPED564)
Half of the 100,000 new HIV infections in Malawi occur among young people (15-24 years). Through the DREAMS initiative, PSI Malawi offer integrated health services including GBV to Adolescent Girls and Young Women (AGYW) in Machinga district. Health services on offer to AGYW's through mobile outreach clinics are STI screening, HIV testing and first-line support to survivors of GBV. Program data was used to understand the effectiveness of integrating GBV and HIV service for AGYW.
- Quantifying the Levels of Violence Towards Men Who Have Sex with Men (MSM) in Three Cities of Honduras (WEPED382)
In Honduras, a social context of traditional values, homophobia and machismo create an environment that makes MSM vulnerable. There has been no recent quantification of violence towards them. The Pan American Social Marketing Organization conducted a population-based study to assess the USAID Combination Prevention Program for HIV and quantify the proportion of this population experiencing violence.
- Mapping Population Sizes and Hotspot Locations for Female Sex Workers Improved Targeting for HIV Prevention Interventions in Ethiopia (TUPEE702)
HIV prevalence among female sex workers (FSWs) in Ethiopia is approximately 23%. To address risk of HIV in this population, the MULU/MARPs combination HIV prevention project was launched in 2012 across 168 Ethiopian towns/cities. Implementation was challenged by insufficient data on FSW locations and sizes. A rapid size estimation approach was developed to aid program implementation.