Lessons from the PEPFAR Gender-Based Violence Initiative

One in three women worldwide has been beaten, coerced into sex, or otherwise abused at least once in her lifetime. And women who have experienced gender-based violence (GBV) can face up to three times greater risk for HIV compared to those who have not, according to UNAIDS. GBV is common, affecting both women and men. Children and key populations are also at high risk, and often don’t have access to the resources they need.

To address GBV as an underlying factor in the global HIV epidemic, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Gender and Adolescent Girls Technical Working Group launched the three-year, $55 million Gender-Based Violence Initiative (GBVI) in 2011 in three countries with high prevalence of both GBV and HIV: Democratic Republic of Congo (DRC), Mozambique, and Tanzania. The GBVI’s purpose was to demonstrate the feasibility of integrating GBV prevention and response into the existing PEPFAR platform and to understand the best approaches for achieving this integration in clinical and community settings.
On May 10, 2016, over 100 participants from PEPFAR, the three GBVI countries, and partner organizations convened at the Center for Strategic and International Studies to share lessons learned from the initiative. The meeting was organized by the Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project.

Jennifer Adams of the U.S. Agency for International Development emphasized the direct links between GBV and HIV and discussed how this linkage also affects men and boys: social expectations can encourage risky sexual behavior and violence against women. “I think we all know people who fall into the categories that we’re talking about today… Today is an opportunity to take that concern and commitment and use that with the information to think forward.”

Jen Casto of EnCompass LLC/AIDSFree, discussed the overall findings of the GBVI, which are summarized in AIDSFree’s collection, Lessons from the Gender-Based Violence Initiative. The GBVI reached over 1.3 million individuals with GBV services and interventions over the three-year initiative. The GBVI also created GBV and HIV service entry points across communities where no such access existed and demonstrated the need to engage a broad range of community stakeholders.

While the GBVI was implemented through different approaches in each country, its overall effect was to identify practical ways to address the issue through relevant tools, training packages, and guidelines and by defining roles among stakeholders. In DRC, the GBV catalyzed change in at least three ways, according to Elizabeth Rowley of PATH/AIDSFree. It demystified critical GBV and HIV linkages in practice and integrated GBV into HIV programs; institutionalized changes in service delivery; and leveraged the reach of other PEPFAR partners to expand the GBVI’s impact. As one implementing partner said, “One of the biggest contributions of the GBVI was to show that this work is possible—something can be done about GBV.

In Mozambique, the GBVI was implemented nationally using a multisectoral approach. In five provinces, partners also tested a one-stop model that enabled clients to access services from several sectors (police, nurses, psychosocial, medical) in one setting. The government has now integrated many GBVI activities into its infrastructure, and includes GBV within the health sector plan. A partner from Mozambique said, “There was nothing [to address violence] before the GBVI…we now have programs where GBV is integrated, we have messages that are delivered, and we have information. The impact is there. But there is still a lot to be done.

Tanzania also used a multisectoral approach, working with actors from government, regional, and community structures—and from the health, legal, police, and other sectors—in an initiative that resulted in a training scheme and two key policy documents. Susan Settergren of The Palladium Group reported that an evaluation of GBVI activities showed improvements in providers’ capacity to deliver GBV services. GBV-related service uptake in one region tripled—from 489 visits at control facilities to 1,427 visits at intervention facilities. Community surveys in this region showed a new understanding of GBV: less tolerance of violence, improved relationships, and greater responsiveness among community leaders. Though the GBVI has ended, Tanzania is carrying on with a national plan of action for women and children. The government is expanding GBV activities from the initial 4 regions to 15 regions. A Tanzanian local partner added the caveat that any scale-up needs to involve key populations, to make sure that they receive necessary services.

Janet Saul of CDC/PEPFAR closed the event by calling for the expansion of the GBVI’s impact. “Think about in your sphere of influence, how can you take these lessons and make sure they’re integrated into what you’re currently doing?” She urged participants to help create a generation free of both HIV and GBV. “It takes each and every one of us in this room to make a commitment.”

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