Presentation on theme: "Why address gender-based violence in HIV response & what are effective strategies? Why address gender-based violence in HIV response & what are effective."— Presentation transcript:
Why address gender-based violence in HIV response & what are effective strategies? Why address gender-based violence in HIV response & what are effective strategies? Avni Amin World Health Organization Integrating strategies to address gender-based violence and engage men and boys to advance gender equality through National Strategic Plans on HIV and AIDS November 2011, Istanbul, Turkey
Part 1: Why address gender-based violence in the HIV response? Review data: How widespread is gender-based violence? How is gender-based violence linked to HIV ?
Definition: gender-based violence (GBV) GBV: violence involving men & women; derived from unequal power relationships between men and women; includes physical, sexual & psychological harm: acts of physical aggression emotional, psychological abuse & controlling behaviours coerced sex, sexual harassment, rape Violence against women (VAW): public or private act of gender- based violence that results, or likely to result in physical, sexual or psychological harm to women.
Different forms of GBV Sexual, physical, or emotional violence by an intimate partner (intimate partner violence or IPV) & non partners; Child sexual abuse Sexual violence in conflict situations Sexual harassment & abuse by authority figures (e.g teachers, police officers or employers etc), Forced prostitution and sexual trafficking Child marriage Violence perpetrated or condoned by the state. Homophobic violence Violence against women and men living with HIV
Key Message 1 Gender-based violence is a widespread public health & human rights problem worldwide.
Source: Preventing HIV by preventing violence: the global prevalence of intimate partner violence against women and its links with HIV infection. Devries K et al Paper presented at the Vienna AIDS Conference. Forthcoming publication on the Global Burden of Disease.
Prevalence of IPV: select countries Source: UN women, March 2011, Violence against women Prevalence Data: Surveys by country
Violence against vulnerable groups Prevalence of recent rape by clients among female sex workers (FSW) 32% in Mombasa, Kenya (2007) 31% in Karnataka, India (2005) 26% in Macau, China (2011) In Vancouver, Canada IDU survey 68% of women & 19% of men lifetime history of sexual violence Child sexual abuse 33% for women, and 13% for men In the USA in 2 studies: 68% young MSM : threats or violence from either family or partners 25% threats or violence by both family & partners Sources: Shannon K et al. A systematic review of gender-based violence and links to HIV infection among sex workers. Forthcoming 2012; Braistein P et al 2003); Spratt, Kai Technical Brief: Integrating Gender into Programs with Most-at-Risk Populations. Arlington, VA: USAID's AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1.
Key Message 2 Gender-based violence is rooted in or a manifestation of gender inequality in society: Traditional gender norms perpetuate violence against women.
Women’s agreement that wife-beating justified for at least 1 reason Source: Preliminary results, PAHO/CDC (forthcoming) “Violence against women in 12 countries from LAC”
Key Message 3 Gender-based violence is both a risk factor for, and a potential consequence of being identified as having HIV
Gender-based violence & HIV Across all settings women who have experienced IPV are 2X more likely to be at risk of HIV/STI infection compared to those with no IPV Source: Preventing HIV by preventing violence: the global prevalence of intimate partner violence against women and its links with HIV infection. Devries K et al Paper presented at the Vienna AIDS Conference. Forthcoming publication on the Global Burden of Disease.
Gender-based violence & HIV Longitudinal study, South Africa: HIV incidence in women with multiple episodes of intimate partner violence 9.6 per 100 person- years vs 5.2 per 100 person-years among those with one or none (aIRR =1.51); 12% of new HIV infections attributed to intimate partner violence. Tanzania: women seeking HIV counseling and testing who had experienced violence were 2X more likely to be HIV positive India, a study of 28,000 married women: those who experienced physical & sexual violence from intimate partners over 3 X more likely to be HIV-positive than those who had experienced no violence Studies from India, South Africa & the USA: men who perpetrate violence more likely to engage in high-risk sexual behaviours Sources: Jewkes et al Lancet, Maman et al, 2002; Silverman et al, 2008; Raj et al 2006, Dunkle et al 2007, Jewkes et al 2006, Silverman et al 2007
Gender-based violence & HIV Female Sex Workers, Thailand who experienced physical &/or sexual violence 31% more likely to report an STI symptom (2010) Sex workers, China: who experienced client violence - 32% more likely to report condom use failure compared to those who did not (2011). who experienced high compared to low levels of client violence (2008) - 2X as likely to report condom use failure. Source: Shannon K et al. Forthcoming 2012;
Pathways linking GBV & HIV Source: Jewkes et al. 2010
Part 2: Key strategies to address GBV in the context of HIV/AIDS programming?
Key Principles: Core values A human rights approach Promote gender equality Non-discrimination Meaningful participation Safety first & confidentiality
Key Principles: Sound programming Understand epidemiology of both HIV &GBV & links Strategies that foster participatory learning Use multiple entry points & approaches Recognize needs of the most marginalized Build competencies in understanding & responding to GBV Partnerships with range of stakeholders Rigorous monitoring & evaluation
Ecological framework for programming Couples & families Socio- economic conditions Laws & Policies Communities Countries Cultural & Social Gender Norms I ndividual Behaviour Choice in partner(s) Choice to have sex Partner reduction Condom use Drug use or non use
Address gender inequality as driver of GBV & HIV Individual Behaviour Choice in partner(s) Choice to have sex Partner reduction Condom use Drug use or non use Couples & families Socio- economic conditions Laws & Policies Communities Countries Cultural & Social Gender Norms Transforming harmful gender norms Soul City, Sexto Sentido Stepping Stones Empowering women: Microfinance, education, relationship skills, community mobilization IMAGE, Stepping Stones, Sex workers: Sonagachi Engaging men and boys Changing male norms & behaviours Program H, Yaari Dosti, One Man Can, Men As Partners Promoting GE laws& policies: Equal inheritance laws Laws against violence Training law enforcement National standards on post- rape care
Address GBV in HIV prevention, treatment & care Prevention: Behaviour Change Communication integrate: Violence & HIV risk messages Individual, Group, Peer Counselling: Combined risk-reduction & violence prevention: self-esteem, negotiation skills, partner communication, trauma counselling, HIV Testing & Counselling: Training HIV counsellors in identifying & appropriate response to GBV Safety planning, disclosure support PMTCT Couple Counselling & Testing Involving male partners Treatment Comprehensive Post-rape care including PEP Care & Support Peer & mediated disclosure support Key populations Sex Workers Substance abusers (IDU, drug & alcohol) MSM Survivors of GBV Women with prison history partners of substance abusers Adolescents
WHO Resources on GBV & HIV Links: alth/publications/violence/en/ Avni Amin