The urgent need for violence response systems within HIV programming

Written by Tisha Wheeler, Senior Technical Advisor for Key Populations, U.S. Agency for International Development (USAID)

Never before have HIV prevention, care, and treatment programs for key populations been available in so many countries. Key population access to HIV services globally is expanding at a rate we can see changing monthly. However, structural barriers that key populations face persist, and violence, stigma, and discrimination continue to pose significant roadblocks to achieving meaningful progress toward an AIDS-free generation.

The wide-ranging manifestations of violence that key populations (transgender people, men who have sex with men, sex workers, and people who inject drugs) routinely face are often socially sanctioned and institutionally perpetuated. As criminalized and discriminated groups, key populations experience violence that is exacerbated by the lack of recourse available for addressing these abuses, compared to those offered to the general population. This lack of support and violence manifests in the family, among police, partners, landlords, in schools serving the children of key populations, and in many other facets of life. The violence and resultant trauma faced by key populations lead to a lack of stable housing and schooling for their children, a lack of agency in sexual negotiation, riskier sexual behavior, lower service uptake, and eventual increase in HIV incidence among key populations. It is obvious to conclude that HIV programming for key populations will continue to be incomplete and ineffective without basic violence response mechanisms at the community level.

bithia

Bithia, a sex worker and a peer navigator of CHAMP Cameroon

For many of the key population individuals in HIV programs, addressing violence is of greater importance than HIV. If prompted, a member of the key population community will speak with deep emotion and fluency about the far-ranging violence that they and their friends face. If you ask that same person to speak about HIV testing services, it is unlikely that you will hear the same level of urgency in their voice despite their knowledge about HIV diagnosis and treatment. I recently had the opportunity to sit down with Bithia,* a sex worker, and a peer navigator of CHAMP Cameroon, about her lived realities dealing with violence and the steps she has taken to advocate for change in her community:

“There are three main types of violence, number one is police. Two, the clients and people around in the bar, and yes three, health facilities that don’t receive us well. They all see who we are and they don’t like us. They see we are dressed half naked, they know what we do. I have started to work with my friends, the other sex workers who are around where I work. We started a group called Glamour Girls. We talk about issues of violence and we find ways to help each other. We have been able to meet in the drop-in clinic, but we don’t have money for anything. Still, change is possible. We just need to plan and work together.”

In order for HIV programs to be effective, they need to be designed to address these realities. In the past five years, the international donor community has made significant strides to work toward this. Recognizing the importance of key population programs both to control the HIV epidemic, and to address the human rights of key populations who face violence and discrimination, PEPFAR has funded the largest scale-up of key population programming by any single donor through the LINKAGES project. The Global Fund, Robert Carr Civil Society Networks Fund, Elton John Foundation, and USAID have been recognized for their dedication to funding comprehensive HIV programming. Moving forward, the vision is that governments will build upon this momentum to further scale up key population programming beyond the levels we might have imagined just five years ago and that they will do this hand in hand with local key population civil society groups, who should drive the programming on the ground to best meet their needs.

We know that inadequate funding for global HIV programming will always be a persistent challenge. However, even in the face of resource constraints, we must reframe the conversation to focus on how to prioritize funding to address stigma, discrimination, and violence in key population programs and institutionalize those approaches in national program planning. For example, the Kenya national program under the leadership of Dr. Martin Sirengo has included violence as an indicator in its national key population HIV dashboard, and PEPFAR has included a budget line item for violence programming in their HIV expenditures. More countries need to follow this example.

To support national programs, PEPFAR also needs to go further to invest in policy change, to bring new funding opportunities, and to work on creating country budgets for key population programs that include violence. By taking these important steps, we can gain a better understanding of how to scale up violence response work through key-population-led approaches and create the changes needed to fast-track the end of the epidemic.


*The author and the LINKAGES project would like to thank Bithia and the staff at CHAMP Cameroon for their contributions to this post.

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