Empowering women and girls to tackle STIs and poverty Chi-Chi Undie 17 th IUSTI World Congress Marrakesh, Morocco May 9-12, 2016

Sustainable Development Goal 5: Gender Equality ‘Achieve gender equality and empower all women and girls’

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‘The Africa Regional SGBV Network’ (June 2012)

‘Africa Regional SGBV Network’ partner countries (PHASE 3: ) Kenya South Africa Swaziland Uganda Zambia South Africa Swaziland Kenya Ethiopia Uganda Zambia

WHO (2013) global estimates on prevalence of sexual and/or physical IPV, or non-partner sexual violence 35% of women globally 37% of women in the WHO Africa region

Relationship between SGBV and STIs One potentially increases the risk and impact of the other: – STI/HIV transmission risk increases during violent or forced-sex situations – particularly for young girls – Women who are beaten/dominated by their partners: much more likely to contract HIV than those in non-violent households – Fear of violence negatively affects care-seeking behavior – Female sexual violence survivors less likely to use condoms – Etc.

em·pow·er /əm ˈ pou(ə)r/ give (someone) the authority or power to do something. make (someone) stronger and more confident, especially in controlling their life and claiming their rights.

Key questions Can we really give women and girls authority and power that their societies have not yet given them? How much of a chance do even the strongest and most confident women and girls have against the whole world? Can women and girls truly combat that which their contexts have neither given them the authority nor the power to combat?

Zambia

After 72 hours n=72 Within 72 hours n=135 n=207 Not eligible Eligible ≥10 years n=104 ˂10 years n=31 (Data from Nov 1, 2012 to Oct 30, 2013) Did not receive PEP n=78 Received PEP n=26 PEP eligibility & provision

Why eligible survivors did not receive PEP Trained police officers were not at the station or not on duty –(53% of cases reported during evenings/weekends) Survivors’ relatives refused PEP

Swaziland

Indicator Baseline (n=247) Endline (n=143) ‘It is the man who decides when to have sex.’ DISAGREE 58%71%* ‘Women and girls have the right to refuse sex.’ AGREE 81%91%** ‘It’s a woman’s/girl’s responsibility to avoid getting raped.’ DISAGREE 35%45%* ‘Sexual violence should be kept secret.’ DISAGREE 83%97%** ‘Men and boys can do things to prevent violence against women and girls.’ AGREE 67%83%**

I would not agree to requests by a teacher to have sex Baseline: 47% Endline: 43% I would report requests by a teacher to have sex to other authority figures Baseline: 38% Endline: 40%

South Africa

‘Before this training, we didn’t know that when you get raped, you’re supposed to go to the hospital. We thought you should just go into your house and not tell anyone. This is what we do in Congo. This training has helped us a lot …. We are very grateful.’

‘I wish I knew what I know now about [the intervention]. If we were told this earlier, I would not be carrying this baby whose father I don’t even know. The day I got raped, I did not tell anybody [except] my relatives. I realized I was pregnant when i missed my period. My relatives warned me against telling anybody about it, but if I had known, I would have gone to the hospital immediately and gotten the drugs to prevent me from getting pregnant and any diseases, as we were taught.’

Kenya

Service Statistics Collated During 7-Month Screening Intervention Period (June-Dec 2012) Total # screened % reporting IPV % referred to GBVRC % presenting at GBVRC 12108% (n=95)77% (n=73)40% (n=29)

‘If I had someone who had asked me such questions, then I wouldn’t have suffered for that long like I did. I used to come here [hospital] all the time for treatment, but nobody ever asked me anything. I would come here for treatment after my husband had beaten me. I’d be treated and then I’d be told to go home. Sometimes, my husband used to box me in the head; and so, some women [have] injuries in the head, but they have no physical symptoms to show that.’

Gaps in hospital-based, post-rape care services for girls No protocols or service delivery charters Hardly any trained staff Mistimed administration of PEP

Empowering women and girls

Thank you

References Ajema, C. et al Health facility responsiveness to the needs of child survivors of sexual violence: Case study of Nyeri and Nakuru Counties, Kenya. LVCT Health: Nairobi, Kenya. American Foundation for AIDS Research Gender-Based Violence and HIV among Women: Assessing the Evidence. Issue Brief no.3. Campbell, T. and C. McPhail The Impact of rape on women’s sexual health risk behaviors.” Health Psychology, 23(1): IDS (n.d.) The link between violence against women and HIV and AIDS Proceedings of the 1 st Washington, DC Meeting of the Africa Regional SGBV Network BMC Proceedings 9(4). Speight, C.G. et al Piloting post-exposure prophylaxis in Kenya raises specific concerns for the management of childhood rape. Transactions of the Royal Society of Tropical Medicine and Hygiene. Undie, C. et al Is routine screening for intimate partner violence feasible in public health care settings in Kenya? Journal of Interpersonal Violence. World Health Organization. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization.