A Brief Introduction: Violence and PEPFAR

Violence is a barrier of adherence to PrEP. Gender, GBV, and the Clinical Cascade Prevention Testing Care and Treatment Initiate on PrEP Initiate on & complete PEP Initiate on ART Access HTS Sustain on ART 95% 95% Barriers to PEP adherence for survivors of sexual violence include psychological and emotional stress and rape stigma as a result of the assault. Survivors may also delay in accessing PEP after an assault due to fear of reprisal attacks from perpetrators. Violence is a barrier of adherence to PrEP. Women who experience violence are less likely adhere to treatment and achieve viral suppression. Violence is also associated with reduced ART adherence among adolescents, transgender women, and drug users. Harmful gender norms often inhibit men’s health-seeking behaviors. Violence is associated with reduced linkage to HIV care services and initiation on ART. 95% Integrating gender into all PEPFAR programs is essential to meeting PEPFAR’s 95-95-95 goals. Integrating gender means identifying and responding to the unique needs of women, men, girls, boys, LGBTI individuals, and individuals of other gender identities – of all ages and abilities – so they are equally able to access and utilize HIV prevention, care, and treatment services; protect themselves and practice healthy behaviors; exercise their rights; and live lives free from violence, stigma, and discrimination. Violence and harmful gender norms inhibit one’s ability to access testing services and disclose their status. Many people report fear of violence and/or abandonment if their partner learns their status. *Slide credit: Emily Reitenauer; USAID

Framework of Violence Prevention & Response Finding those who need services Routine & Clinical Enquiry Providing post violence care services Minimum Package Violence prevention Community Mobilization Linking with HIV Services

PEPFAR GEND_GBV Indicator Measures Post-Violence Service Provision Indicator description: Number of people receiving post-gender based violence (GBV) clinical care based on the minimum package The minimum package for post-violence care is not the same as the requirements to ask patients about violence PEPFAR has an obligation to patient-centered care and principles of do-no-harm Even if sites do not have targets/ report on GEND_GBV, they can still sensitively identify violence cases and refer to needed services Providing post violence care services Minimum Package

Violence Prevention Programming Addresses Multiple Layers Examples of programming that seek to prevent violence: SASA! IMpower Program from No Means No Worldwide Families Matter! Program Sinovuyo Violence prevention Community Mobilization

What are Clinical and Routine Enquiry for violence? Clinical & Routine Enquiry for Violence What are Clinical and Routine Enquiry for violence? When a clinician asks only clients she/he suspects is experiencing violence or fears violence Clinical Enquiry for Violence Routine Enquiry for Violence Clinical enquiry for violence is generally recommended over screening and routine enquiry UNLESS there are certain populations that may be at a higher risk of experiencing violence. Routine enquiry for violence is only recommended in certain settings for populations that may be at a higher risk of experiencing violence, including: ANC/PMTCT Care and Treatment HTS When a clinician asks all clients who present for specific services about experiencing violence or fears violence There are two ways to ask about violence within PEPFAR: Routine enquiry is only recommended in certain settings for populations that may be at a higher risk of experiencing IPV, including: HTS as HIV (+) persons are at an increased risk of experiencing violence; violence may also affect disclosure of HIV status or jeopardize the safety of women who disclose ANC/PMTCT because of the dual vulnerability of pregnancy; HIV (+) persons are also at an increased risk of experiencing violence There are certain requirements that must be in place for a site to conduct clinical enquiry or routine enquiry. *Slide credit: Emily Reitenauer; USAID

Healthcare Facilities are a Natural Point for Identifying Survivors of Violence Health care providers interact with individuals (women, men, KP, AGYW) who are experiencing violence and have an unmet need for services. Survivors may be able to overcome fear or shame of disclosure with a trusted health care provider. Health care interactions are an opportunity if appropriate approach is taken.