Aubrey Weber, Research Utilization, FHI 360
Robyn Dayton, HIV Division, FHI 360
Josefina Rojas, CEPROSH, Dominican Republic
Sopha Nith, LINKAGES Cambodia
Dr. Sou Sanith, Battambang Provincial Health Department, Cambodia
Maurice Wangu, EpiC/FHI 360 Kenya
Today, the 16 Days of Activism Against Gender-Based Violence annual campaign begins. This global movement runs each year from International Day Against Violence Against Women on November 25th to International Human Rights Day on December 10th. It was launched in 1991 by the Center for Women’s Global Leadership to emphasize that gender-based violence (GBV) is a violation of human rights.
Since its inception, more than 6,000 organizations in approximately 187 countries have participated in 16 Days campaigns. The estimated reach is 300 million individuals and counting. But, 16 Days is much more than a hashtag used to talk the talk on Twitter, Facebook, and Instagram. 16 Days brings awareness to those who actually walk the walk. 16 Days mobilizes.
In the past year, the USAID- and PEPFAR-supported LINKAGES and EpiC projects have done quite a bit of walking the walk to end GBV among key populations most at risk of acquiring HIV – men who have sex with men, people who inject drugs, sex workers, and transgender people. Here are the highlights:
Violence Prevention & Response Series
In July, LINKAGES released a programmatic guide and training manuals to support the integration of violence prevention and response activities with HIV prevention, care, and treatment services in key population programs. The guide contains principles, step-by-step instruction, and sample templates and tools. The training manuals build the knowledge and skills of health care workers, peer educators and outreach workers (manual pending), and law enforcement officers to understand, assess, prevent, and appropriately respond to violence affecting the lives of key population individuals. The trainings are interactive and include ideas for adaptation.
Case Example: Puerto Plata, Dominican Republic
Many countries face the challenge of addressing both the GBV and HIV epidemics with limited resources. Recently, LINKAGES partnered with a Dominican civil society organization, the Center for the Promotion of Human Solidarity (CEPROSH), to address both epidemics in a way that meets the needs of all people, including key populations. In August, LINKAGES’ Dominican Republic team published a peer-reviewed paper, Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic, describing an assessment of the intervention. The process undertaken in Puerto Plata proved promising in its ability to reduce provider stigma, bring more individuals into both GBV and HIV care, and improve both HIV-related outcomes and overall well-being of survivors of violence. These results have galvanized further action by local stakeholders who feel confident that they have an effective approach to addressing GBV, which had seemed intractable, and HIV program implementers report new energy in their programming as they add services that are highly responsive to key population members’ needs.
Case Example: Battambang, Cambodia
In Cambodia, both LINKAGES and Enhancing Quality of Care Activity (EQHA) teams are supporting the Battambang Provincial Health Department in its efforts to improve access to comprehensive GBV response for all survivors of violence and to strengthen the links between GBV and HIV services. To achieve this goal, the Provincial Health Department coordinated a multi-sectoral Provincial Technical Working Group. It relies on existing government structures at provincial and sub-provincial level—such as the Consultative Committee for Women and Children, government hall, Department of Health, Women’s Affairs, Provincial Court, Social Affairs, Veterans and Youth Rehabilitation, Police Commissioner—in addition to civil society, and key population representatives (entertainment workers, men who have sex with men, transgender women, and people who inject drugs). The technical working group, in collaboration with LINKAGES and EQHA, developed a clear pathway for GBV response, trained health care workers to effectively identify and respond to GBV, and increased providers’ commitment to working with key population survivors across sectors. The provincial government leadership of this initiative has already generated national government stakeholders’ interest in scaling up this approach nationally. This is especially important because of recent changes in national PEP guidelines, also supported by LINKAGES, that allow for provision of PEP in the case of sexual as well as occupational exposure to HIV. The efforts in Battambang, while still new, have already resulted in more reporting and responding to cases of GBV and the successful initiation of PEP for survivors of sexual violence within the 72-hour period, indicating that the GBV response system is functional and timely.
Amplifying Best Practices in Kenya
In Kenya, where addressing structural barriers to HIV prevention and treatment is embraced by both key population groups and the national government, EpiC is supporting efforts for cross-organizational learning and improved monitoring. An event held November 19-21, 2019 in Nairobi brought together eight civil society organizations (CSOs) led by sex workers, men who have sex with men, and transgender people as well as the National AIDS and STI Control Programme. The CSOs shared their expertise and experiences in crisis response, law enforcement training, implementer safety, advocacy with power holders, employing paralegals to document cases of violence, and engaging media to reduce violence against key population members. They also discussed how to resolve ongoing challenges such as intimate partner violence and blackmail against key population members and were given the opportunity to describe what support is still needed from both EpiC and NASCOP. While a report detailing the learning from the workshop will be made available after the 16 days—to amplify the knowledge of those who are making these approaches work through creativity, perseverance, and trial and error—the event was a powerful and hopeful reminder of how much expertise already exists to counter problems, such as violence against key population members in criminalized environments, that can sometimes seem intractable. EpiC plans to focus ongoing efforts on supporting all CSOs in Kenya to use best practices and to monitor violence programming and its effects on HIV-related outcomes to support calls for sustained structural interventions within HIV programs.
Acting on GBV Study Findings
Sharing evidence on the incidence and consequences of GBV is important for galvanizing action during 16 Days and throughout the year. When the LINKAGES project—in collaboration with the United Nations Development Programme, key population regional and local networks, and local research institutions—undertook research on GBV among key populations in four countries in Latin America and the Caribbean, the process was designed not only to generate peer reviewed evidence but also to ensure that the findings informed HIV programming and advocacy. LINKAGES used the findings not only to inform the Violence Prevention and Response series described above, but also to raise awareness and call for action in platforms that had historically focused only on cisgender women, such as the Sexual Violence Research Initiative. Last month, LINKAGES staff presented study findings on the experiences of transgender women and men who have sex with men as part of a panel at SVRI on inclusion of sexual and gender minorities within GBV response. The findings are also being used by the lawyers of men who have sex with men from El Salvador who are seeking asylum, allowing them to document abuses by the state.