Gender Integration in Zambia Prevention, Care & Treatment Partnership (ZPCT II) Josephine Musamba, Senior Gender Advisor, FHI 360 June 16, 2014

ZPCT II Overview USAID funded (PEPFAR) Supports 410 public + 30 private HFs 243 Staff (170 Male/73 Female) Objectives include: ‒ Support scaling up quality CT, PMTCT, ART, MC ‒ Laboratory and pharmaceutical support ‒ Capacity building of MOH ‒ Private-public partnerships ‒ Collaboration with partners.

Project Activities HIV prevention –Voluntary Medical Male Circumcision (VMMC) –Prevention of Mother-to-Child-Transmission (PMTCT) HIV Testing and Counseling (HTC)- Adult and children Treatment – Anti-Retroviral Therapy (ART), Post-Exposure Prophylaxis (PEP), & Emergency Contraceptives (EC), TB & Opportunistic infections Laboratory Support Capacity Building Infrastructure Improvement

Gender Issues - Cultural Identified through the 2010 gender assessment Culture & religion socializes the wife to submit to the husband’s sexual demands including unprotected sex even when husband is HIV positive. Married women generally lack power to negotiate safe sex, Family Planning method or number of children Some women internalize GBV as an expression of love Men perceive antenatal care as a women’s role Societal tolerance of a man’s multiple sexual partners

Gender Issues - CT/PMTCT/Clinical Care Belief that the first person tested and found positive is responsible for “bringing HIV into the family” Women fear repercussions of disclosing HIV status Men tend to get tested privately and do not disclose Less than 1% GBV survivors go to a doctor or medical personnel (2007 ZDHS) Low & late access to PEP & EC. Most clients report sexual assault cases after 72 hours In discordancy, both negative & positive HIV results for a woman usually result in gender based violence (GBV)

Specific Gender Activities Gender assessment Development of the gender strategy with specific gender indicators Developing of the GBV tool kit for community mobilization Engendering training manuals for CT, PMTCT and ART Mapping of GBV service providers to facilitate referral of GBV survivors Developing of the GBV screening checklist Training Health Care Workers and community volunteers in GBV Screening and referral, couple counseling, HIV/AIDS

Specific Gender Activities Couple counseling to prevent GBV, promote disclosure & adherence to PEP, ART, PMTCT & EC Promoting male involvement in PMTCT to enhance couple communication & adherence to PMTCT services Proactive screening for different types of GBV and referral for PEP, psychosocial counseling, Zambia police Victim Support Unit, GBV One Stop Centers and other services Provision of PEP, EC, Psychosocial Counseling and referral to YWCA, Zambia Police Victim Support Unit, GBV One Stop Centers and other services

Males Accessing HCT

Way Forward Facilitate stocking up of EC, sensitize communities to demand for it & orient frontline HCW on availing it the right clients in the GBV context Promote screening for GBV in outpatient settings Promote usage of protocols for management survivors of rape Work with traditional & religious counselors to integrate GBV prevention into traditional counseling & to address harmful male norms Target behavior change communication (BCC) materials specifically to men focused on family HIV prevention

Way Forward (continued) Conduct workplace sensitization programs on family HIV prevention Use male peers for outreach to men on PMTCT Take advantage of men coming in for MC to encourage couples counseling and testing Empower women with negotiation skills