“I’ve Got Your Back”: Addressing Gender-Based Violence to Help End the HIV Epidemic

 

During this week commemorating World AIDS Day, I am thinking about the millions of women, men, girls and boys worldwide who have experienced gender-based violence (GBV), and especially sexual violence.

Sexual violence – a global human rights violation and public health emergency of vast proportions – affects one in three girls and one in seven boys.[1] An estimated one in three women worldwide has been beaten, coerced into sex, or otherwise abused in her lifetime. Such instances happen in developed and developing countries, in emergency settings and during peacetime: in our homes, our relatives’ houses, our lower schools and college campuses, our religious institutions, and our communities at large.

So why think about sexual violence during World AIDS Day week – a week when people worldwide unite in the fight against HIV, share stories, and commemorate those we have lost to HIV/AIDS?

A growing body of evidence has established a strong association between sexual violence and increased vulnerability to HIV infection.[2] Even if someone is not infected with HIV as a result of an act of sexual violence, research indicates that s/he becomes more likely to contract infectious and chronic diseases later in life.[3] Children and adolescents are often at greater risk for HIV transmission than adults because sexual violence against them is frequently associated with multiple episodes, and is more likely to result in mucosal trauma.[4] Various studies have also established linkages between experiences of sexual violence during childhood and future engagement in sexual risk-taking behaviors, such as having multiple partners, using condoms inconsistently, drug and alcohol abuse, and engagement in intergenerational and transactional sex.[5]

Yet far too often – and with a parallel to the damaging environment surrounding the HIV epidemic – sexual violence is surrounded by a culture of stigma, discrimination, secrecy, shame, and silence.

Combating violence, including sexual violence, is a growing US Government priority area. Said President Barack Obama, speaking about the epidemic of college sexual assault: “Perhaps most important, we need to keep saying to anyone out there who has ever been assaulted: you are not alone. We have your back. I’ve got your back.”[6]

Over the last three years, PEPFAR has invested more than $215 million in GBV-related programming, making PEPFAR one of the largest investors worldwide in GBV initiatives. Unique programs such as the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative seek to reduce new HIV infections in adolescent girls and young women in 10 sub-Saharan African countries, with support from the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare. DREAMS invests in a number of special initiatives to address the intersection between gender and HIV and combat the structural drivers that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, and sexual violence. Today, on December 1, the DREAMS partnership announced an additional $105 million in investments to help accelerate and advance global efforts to reduce new HIV infections among adolescent girls and young women.

JSI is increasingly active in working to address GBV. Our efforts range from supporting an improved policy environment to combat the violence epidemic at the national level; to building capacity for violence prevention programs at the community level; to working with local groups to promote leadership and dialogue around issues of GBV; to developing guidance targeting health managers and social welfare services so they can offer short and long-term treatment, care and support for the youngest survivors/victims.

Under the Support to the HIV/AIDS Response in Zambia (SHARe) project and SHARe II), JSI spearheaded several innovative interventions for integrating HIV and GBV work, including training and mentoring instructors from three police training academies to teach and coordinate the HIV-related aspects of integrated HIV/AIDS, gender and human rights of the police training curricula. Under both SHARe and SHARe II, JSI supported the Ministry of Gender, working with other stakeholders, to enact the Anti-Gender-based Violence Act; provided technical assistance to simplify the law for public dissemination; and collaborated to ensure extensive dissemination. The SHARe II Gender, Sexuality and HIV/AIDS intervention, implemented in workplaces and defined outreach communities, supported focused discussions on the local drivers of the HIV/AIDS epidemic including sexual violence against women and girls.

Through the USAID-funded AIDS Support and Technical Assistance Resources Sector (AIDSTAR-One) Project, the Project led the development of The Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs to enable country teams to better address the medical/forensic needs of those who have experienced sexual violence. Developed with experienced clinicians, behavioral scientists, and social workers from eight countries and over 14 different organizations/agencies (including USAID, Together for Girls and UNICEF), this resource provides implementation guidance for providers to address and respond to the unique needs and rights of children and adolescents who have experienced sexual violence. Currently, under AIDSFree, JSI is developing a Companion Toolkit to provide guidance on better linking these health services with the critical legal/justice, psycho-social, safety and protection, and other social support services young survivors/victims’ need to heal.

These meaningful investments and global initiatives addressing GBV are cause for celebration – and a call to action. Despite the complex challenges surrounding GBV (and sexual violence in particular), we can and must reduce instances of GBV and improve the availability of support services for survivors/victims around the world.

[1] Together for Girls. 2015. Available online at: http://www.togetherforgirls.org/issue/

[2] 1. Baral, S. B. et al. 2012. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infectious Disease, 12, 538-549; 2. Dunkle, K. et al. 2004. Gender-based Violence, Relationship Power, and the Risk of HIV Infection in Women Attending Antenatal Clinics in South Africa. The Lancet 363 (9419): 1415-1421; 3. Jewkes, R. K. et al. 2010. Intimate partner violence, relation-ship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. Lancet, 376, 41–48; 4. Machtinger, E. L. 2012. Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS & Behavior, 16, 2091–2100.

[3] Jewkes R. et al 2002. Sexual violence. In: Krug EG et al., eds. World report on violence and health, pp. 149–181. Geneva, World Health Organization; Jewkes, R. K. et al. 2010. Intimate partner violence, relation-ship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. Lancet, 376, 41–48.

[4] Day, Kim, and Jennifer Pierce-Weeks. 2013. The Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs. Arlington, VA: USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR One, Task Order 1.

[5] Lalor, K., and McElvaney, R. 2010. Child sexual abuse, links to later sexual exploitation/

high-risk sexual behavior, and prevention/treatment programs. Trauma Abuse, 11, 159–177; Richter et al. 2014. Reported Physical and Sexual Abuse in Childhood and Adult HIV Risk Behaviour in Three African Countries: Findings from Project Accept (HPTN-043). AIDS Behav. 2014 February ; 18(2): 381–389.

[6] President Barack Obama, January 22, 2014

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