Intersections between HIV/ AIDS and Violence Against Women: Research to Develop Pilot Projects in Barbados and Dominica Caroline Allen for The Inter-American Commission of Women/ Organisation of American States (CIM/ OAS)

Aims of the research  Aimed to identify: –Possible intersections between HIV and VAW in the Caribbean –Services provided to address HIV and VAW in Barbados and Dominica, with a view to developing services to address the intersections.

Methodology  The research was conducted via: –review of Caribbean epidemiology and research literature on HIV and VAW –interviews with key stakeholders in the two countries. Note: This was empirical research, not heavily theoretically grounded

What does the Caribbean research say about HIV and VAW? 1. Profile of HIV and VAW (epidemiology) 2. Gender-based norms of sexual-economic exchange 3. Violence and poor communication in intimate relationships and in the family unit 4. Violence against women living with HIV 5. Sex work and violence

Epidemiology: VAW as risk factor for HIV?  No Caribbean studies have directly measured the association between VAW and HIV. Studies in Africa have.  Proxy links? –VAW as risk factor for STI (Haiti and DR) –Early intercourse (child abuse?) a risk factor for STI in pregnant women (T&T) –Child abuse as risk factor for non-use of condoms in women (Jamaica) –Child abuse as risk factor for early intercourse (9- country study)

Sexual-economic exchange  Gender-based economic inequality  Norm that men should provide financially for their partner  At odds with the economic reality that some cannot or do not  Association with tension in sexual relationships  Men defend their control over women through violence when they do not have economic control

Sexual-economic exchange  Some women take risks in choice of partner for access to resources  Children and adolescents vulnerable to abuse  Older male partners often favoured Qualitative studies by Bailey, Barrow, Kempadoo, Le Franc and others.

Violence in intimate relationships and the family unit  “ Adversarial” intimate relationships  Trend towards “hyper-masculine behaviour”: violence valorised  Communication difficulties with partners and children  Poor couple communication shown to predict non-use of condoms (Jamaica)  Acceptance of physical punishment of children  Evidence that child abuse affects the risk-taking behaviour of females more than males (Caribbean Youth Health Survey in 9 countries)

Violence against women living with HIV  Caribbean studies have not focussed on gender dimensions of living with HIV  Women in CRN+ study: –12% physically abused by someone they knew –2% physically abused by a stranger –15% rejected by friends –23% rejected by member of family But no significant gender differences  Need studies of whether sexual risk taking by women living with HIV is linked to violence

Poverty as “structural violence” against women living with HIV?  CRN+ study in Antigua and Barbuda, Grenada and T&T  Condom use at last sex by PLHIV related to income  Women had lower incomes

Sex work and violence  High HIV prevalence among sex workers: 22 to 46%. Were only the most vulnerable surveyed?  Risk factor studies have not measured violence  Qualitative research highlights violence by police and immigration officers as well as clients and pimps  Migration creates vulnerability to violence and lack of access to HIV prevention services  Women usually travel to do sex work voluntarily (they are not “trafficked”) (Kempadoo)

Lit Review: Conclusions  “Proxy” evidence of links between HIV and VAW  HIV and VAW may be linked via gender- based inequalities

Lit Review: Conclusions  Need more/ better research on: –Violence as a risk factor for HIV (VAW → HIV) –Violence against women living with HIV (HIV→VAW)

Interviews with stakeholders in Barbados Service availability and views on integration of HIV and VAW services

Interviews with stakeholders in Barbados  Semi-structured interviews with key stakeholders with a professional and personal interest in HIV and/ or VAW  20 interviews with people representing 15 agencies (including 3 UN agencies)  17/20 interviewees were female

Findings  High awareness of potential links, and support for addressing them  Limited work to address the links  Most organisations focused predominantly either on HIV or VAW  Some UN agencies focus on both and links between them  This presentation will only focus on national agencies (lack of time)

Organisations focusing on HIV  National HIV/ AIDS Commission in the Ministry of Youth, Family and Sports  Coordinating body with multisectoral mandate –NHAC has not yet focused on violence issue, though VAW may be discussed during community outreach –National HIV policy includes section on gender-based approaches. VAW and gender norms are mentioned.

Organisations focusing on HIV  HIV/ AIDS Programme at Ministry of Health –Responsible for health service delivery –Collaborate with police in cases of rape and sex abuse –During counseling and testing, counselors often explore history of violence, but not done systematically (no protocol) –Sex Worker Project provides VCT, STI testing, condoms and lubricants, referrals to other sources of support

Organisations focusing on HIV  Comfort, Assist, Reach Out, Educate (CARE) –NGO representing PLHIV –Support groups discuss violence and condom negotiation skills –Conducts stigma and discrimination training for Ministry of Labour

Organisations focusing on HIV  United Gays and Lesbians Against AIDS of Barbados (UGLAAB) –Advocates against discrimination on the basis of sexuality and HIV –Condom distribution, support groups and education for people from marginalised communities

Organisations focusing on VAW  Bureau of Gender Affairs –Addresses both VAW and HIV, but largely as separate issues –Community outreach for gender sensitisation –Survey on prevalence and demographic characteristics of domestic violence

Organisations focusing on VAW  Business and Professional Women’s Club –Crisis Centre is a project of a club –Includes hotline and a safe house with space for up to 22 survivors of VAW. Not a long-term residence. –Working on establishing a rape protocol for agencies involved in dealing with rape. Recommendation that VCT and PEP be available to survivors even if they do not make a police report

Organisations focusing on VAW  National Organisation of Women –Umbrella for 15 women’s organisations –Conducts seminars and events to promote awareness on VAW and HIV (usually separately) –Discussion sessions with children on ways to manage conflict and avoid violence

Organisations focusing on VAW  Victim Support Unit of the RBPF –Provides counseling and support for victims of crime –Trained volunteer counselors throughout the country. Coordinator at Central Police Station. –Police doctor refers to MoH clinic for VCT and PEP against HIV

Organisations focusing on VAW  Note: Services Alliance for Violent Encounters (SAVE) had not been formed when the research was conducted

Discussion 1. Agency links –Providers doing a number of things that can help address links, but are not guided by protocols –Suggestion: protocols for screening and referral systems to link VAW and HIV services –Services could be integrated in health care, education, VCT, antenatal care –Lack of services to which to refer. For VAW, rely on NGOs and volunteers.

Discussion 2. Norms and vulnerability –A number of agencies are seeking to address norms re. HIV and VAW –Are they reaching the right people/ the most vulnerable? –Sometimes to reach the most vulnerable you need to work “under the radar” (e.g. with sex workers) –Can we reach vulnerable women in domestic settings?

Discussion 3. Economic issues –Initiatives scarcely address sexual-economic exchange or gender-based economic inequalities –Lack of resources for VAW

Caribbean regional responses to HIV and VAW  Declaration of San Salvador on Gender, Violence and HIV (CIM/ OAS, 2007) –Agreed by consensus by CARICOM as part of governments of the Americas  Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women signed by Caribbean governments (Convention of Belem do Para)  CARICOM model legislation on domestic violence  PANCAP initiatives, including Law, Ethics and Human Rights