Posted by: blog4globalhealth | 12/08/2011


Gender-based violence and a guide to assist with GBV and HIV prevention integration

Ahh… ahh…
Baby, I love you so much! ….

We repeated this refrain, clapping the beat as the person in the middle of the circle selected his or her replacement. This activity broke the ice – but what happened next was more serious. Facilitators paired us and asked us to describe an ideal “first time” (having sex). A question that provoked a wry smile and blush in me inspired tears from others. For many of the participants, their first sexual experience had been tainted by gender-based violence (GBV).

In 2006, I attended this workshop on GBV and HIV as a wide-eyed undergraduate intern researching community attitudes about GBV for the Treatment Action Campaign (TAC) in Khayelitsha, South Africa. TAC members had first-hand knowledge about the links between HIV and GBV; some of the people they knew – family members, friends, neighbors, or colleagues – had become infected with HIV when a gang broke into their shack and raped them, or when they had been abused by a teacher or family member or partner. They knew people who had been beaten and murdered because they disclosed their HIV status to their sexual partner.

As part of my research project, I asked people who lived or worked in Khayelitsha why GBV was so prevalent in their community. Their answers included responses I expected, such as substance abuse, consequences of apartheid, and old customs, but there were so many I hadn’t considered, like poor street lighting, limited extracurricular activities for teens, communication issues between police and lawyers, ignorance about HIV, and more.

Reviewing the interview transcripts and other data, there was no clear, primary cause for Khayelitsha’s high incidence of GBV. Individuals at risk for GBV live in a complex and dynamic environment. As such, targeting GBV through fragmented or siloed interventions will be unlikely to have a speedy, substantial, and sustainable impact on prevalence. To address what is clearly a very complex issue, a comprehensive approach is needed.

HIV programs address a wide spectrum of social and health care needs and at all levels of the social ecological framework. As such, they are a fertile soil for efforts to prevent and respond to GBV more comprehensively. TAC’s education and advocacy efforts helped increase reporting rates of sexual assault and pressured legal entities to hold perpetrators accountable for their actions, demonstrating the potential of integrating GBV prevention and response efforts into HIV programs.

TAC is just one example of an HIV program. There are many others that can incorporate GBV prevention and response, but knowing how best to do so requires direction.

This year, a new guide is available from the President’s Emergency Plan for AIDS Relief (PEPFAR) to help organizations incorporate prevention and awareness measures to begin to address GBV within their programs. The Program Guide for Integrating GBV Prevention and Response in PEPFAR Programs includes guiding principles for working with survivors of GBV, such as those I met in my workshop; guidelines for planning, launching, and evaluating GBV prevention efforts; and recommended actions and resources for addressing GBV within different HIV technical areas, such as testing & counseling or PMTCT.

In short, this guide serves as a tool for program managers to not only begin to address GBV within their programs, but also to plan for greater integration and coordination at a national level. Ideally, this guide will catalyze dialogue, action, and resource mobilization, building on PEPFAR programs and platforms for addressing GBV with national governments, implementing partners, and other key stakeholders.

The year I was in South Africa, TAC and other organizations had produced a bright orange t-shirt in honor of the 16 days of activism against GBV. On the back, it read: “Fed Up! of violence against women and children.” What was beautiful about that shirt was that you could not miss it. Looking out from the window of the minibus on my way to and from my internship, my heart would swell when I saw bright orange shirts moving – in increasing numbers – between the shanty houses. Khayelitsha’s orange shirts impressed on me the strength and speed with which an important idea can travel.

I’d like to think the principles laid out in this guide could take the same path: maybe tomorrow you see three organizations that have adopted its methods. And then there are eight more the next day. And then you will see 20 – a patch of orange, like a flower.

Imagine what could happen when everyone is wearing orange.

Daniel Cothran is a program officer for JSI.

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