Analysis of Services to Address Gender-based Violence in Three Countries

"Breaking the links between HIV infection and GBV requires targeted interventions to foster changes in individual and community norms that perpetuate violence against women and other vulnerable groups..."

Because gender-based violence (GBV) is widely recognised as both a cause and a consequence of HIV infection, the President's Emergency Plan for AIDS Relief (PEPFAR) has identified reducing GBV as one of its five high-priority gender strategies. As part of this effort, the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1) conducted case studies in three countries where GBV services were available: Vietnam, Ecuador, and Swaziland. The case studies and this accompanying findings report aim to identify and share promising programmatic approaches and disseminate key elements of success for replication and scale-up.

Findings - with an emphasis on communication aspects - include:

1. All three countries have recently enacted policy frameworks for GBV, yet the policy environment for institutionalising and scaling up services beyond a few sites remains limited; comprehensively addressing GBV is not yet a priority.
   • Vietnam - The government passed the 2007 Law on Domestic Violence Prevention and Control, which includes, among other provisions, expansion of access to family-based counselling. In 2010, the Ministry of Health (MOH) developed guidance for Vietnamese hospitals; the MOH requires project training materials and screening tools be used countrywide.
   • Ecuador - There has been a law against violence toward women and the family since 1995, but knowledge of the law is limited, and few women report violence to the authorities or seek judicial redress. In 2007, the National Plan for the Eradication of Gender Violence against Children, Adolescents and Women was enacted. It provides for access to legal protections and services, prevention through mass media campaigns, modules on GBV in school curricula, specialised courts to deal with GBV, support services such as shelters and hotlines, and institutional capacity building for government and non-governmental organisation (NGO) staff. Additional protection is promised in Article 66 of Ecuador’s new constitution (2008).
   • Swaziland - A new constitution was adopted in 2006 that provides for equal rights of women and men, but issues of marriage, child custody, property rights, and inheritance laws remain largely covered by traditional law and custom, which reflect strongly patriarchal norms and practices. A positive development is the 2010 National Gender Policy, which is expected to guide the attainment of gender equality provided by the constitution. Also, the government acknowledges the need to mainstream gender equality in all key policy documents.
2. The sustainability and scale-up of GBV services requires collaboration between the government and civil society.
   • GBV services are extremely limited in Vietnam. The services highlighted in this case study, supported since 2010 by the Hanoi Department of Health, are available in only two hospitals and in a limited number of communes in the vicinity of the hospitals. All medical and nursing staff in emergency rooms, obstetrics and gynecology, surgery departments, and most outpatient clinics receive basic training about GBV. When a GBV case is identified, emergency treatment is provided if necessary and a referral is made to the counseling centre in the hospital. Staff from the hospitals and the two counselling centres visit communities monthly to provide communication sessions to members of mass organisations, like the Farmers' Union and the Students' Union, or interested community members on topics related to gender equality and GBV. These teams also support survivors' clubs but do not work extensively with youth, the schools, or HIV programmes in the community.
   • Centro Ecuatoriano para la Promoción y Acción de la Mujer (CEPAM) is one of the few organisations in Ecuador that provides comprehensive services for GBV survivors. Counsellors, all women who are GBV survivors, undergo an intensive process of psychological support and training to become community educators and advocates for women's rights, particularly related to GBV. "CEPAM's collaboration with government has resulted in improved quality of GBV services such as improved understanding within the justice system of the multifaceted needs of women experiencing violence."
   • Swaziland Action Group Against Abuse (SWAGAA) is the only organisation in Swaziland whose primary work is to address GBV. Services include prevention education (school and community programmes), a toll-free hotline providing phone support and counselling, face-to-face counselling for adults and children, case management, legal services, economic self-sufficiency initiatives, a male involvement programme, advocacy, community awareness campaigns, and referrals to a network of service providers. The links between HIV and GBV are made explicit throughout SWAGAA's programmes.
3. HIV testing and counselling (HTC) services are not routinely provided across all sites - e.g., in the low-prevalence countries Vietnam and Ecuador, most health care providers are not familiar with HIV or may assume that female GBV survivors who are not from high-risk populations cannot be at risk for HIV.
4. Funding for GBV programmes is insufficient and precarious - In the case of the community-based rights counsellors in Ecuador, for example, when the donor-funded project that built their capacity and initiated activities came to an end, the counsellors stopped meeting with multi-sectoral GBV networks to coordinate their detection and referral efforts.
5. Programmes need to work with men and boys. In all three countries, violence against women is seen by many as a "natural" part of life, and this perspective is a major barrier to efforts to address GBV. In Swaziland, SWAGAA's "Men for Change" project is introduced to communities by engaging the chief, the chief's inner council, and other influential males who are part of the traditional community power structure. Trained facilitators organise male dialogues as opportunities for men to come together to discuss a wide range of topics relating to gender norms. The focus of the project is to engage men as positive partners in ending GBV, rather than simply as perpetrators. That said, perpetrators receive one-on-one anger management counselling; when the client is repentant and the couple wants to remain together, couples counselling and communication skills building is provided.

A number of recommendations are provided. Communication-centred ones include: ensure that GBV survivors and people living with HIV (PLHIV) are credibly engaged in policy discussions and programme planning and implementation; develop GBV advocates within civil society, including GBV survivors and PLHIV, and within all levels of government; and create awareness of the links between gender equality and social and political development: "Ultimately, community ownership of efforts to reduce GBV will depend on the leverage that informed and energized communities can use to ensure long-term resources from government or the private sector."