There is growing consensus that HIV prevention programs must not only address the biomedical and behavioral factors involved in transmission, but also the underlying social and structural drivers that increase vulnerability. Social, political, and economic inequities fuel women's and girls' vulnerability to HIV and GBV. Likewise, stigma and discrimination, including against MARPs such as MSM, sex workers, transgender people, and people who inject drugs, make it impossible to prevent or treat HIV through biomedical and behavioral approaches alone. While the evidence base for both HIV structural prevention and GBV prevention are limited, strategies to empower women and girls, engage men and boys, and challenge harmful social norms show promise for addressing the underlying drivers of HIV and GBV, simultaneously reducing the risk and vulnerabilities to both.
Download the 
Gender-based Violence Guide Prevention Chapter (PDF, 301 KB) or click on the arrows below to view the interactive recommended actions and resources for prevention.
Addressing GBV within prevention programs can have a direct impact on reaching PEPFAR prevention targets, specifically:
- Working with countries to track and reassess their HIV epidemic in order to fashion an evidence-based prevention response based on best available and most recent data
- Emphasizing HIV prevention strategies that have been proven effective at achieving intended outcomes and targeting interventions to MARPs with high incidence rates
- Increasing emphasis on supporting and evaluating innovative and promising HIV prevention methods
- Expanding integration of HIV prevention programs with family planning and reproductive health services, so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing GBV
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Combination HIV prevention strategies can simultaneously contribute to GBV prevention, dismantling the structural drivers of both.
| Actions to Address Gender-based Violence |
Community-based actions
- Include GBV in HIV prevention curricula and peer education programs and provide information about and access to GBV support services
- Mobilize communities on GBV and HIV, specifically, the links between the two and how harmful gender norms, beliefs, and practices contribute to both
- Support life skills education for boys and girls through both in- and out-of-school programs
Health facility-based actions
- Raise awareness among all cadres of health care workers about GBV as a risk factor for HIV infection
- Train and support health care providers to screen for violence where counseling and referral services exist
- Link GBV and HIV prevention and awareness programs with voluntary medical adult male circumcision services
- Support GBV survivors in negotiating risk reduction behaviors such as condom use
- Ensure timely access to post-exposure prophylaxis
- Ensure access to female condoms
Structural actions:
- Ensure protective laws and policies are in place and enforced to prevent GBV
- Challenge harmful gender norms, roles, and behaviors, and reduce acceptance of GBV
- Support girls’ and women’s access to education because increased educational attainment has been linked to increased protection from HIV infection and violence
- Promote women’s and girls’ economic security through livelihood programs and ensure their property and inheritance rights
- Support research on female-initiated methods of HIV prevention
- Ensure policies are in place that promote linkages between GBV and HIV, and support programs that address harmful gender norms, beliefs, and practices that contribute to GBV and HIV.
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Gender-related Barriers to HIV Prevention Methods: A Review of Post-exposure Prophylaxis Policies for Sexual Assault: Recommendations for increasing access (PDF, 912 KB)
Handbook for Legislation on Violence against Women 
Implementing Stepping Stones: A Practical and Strategic Guide for Implementers, Planners, and Policy Makers: Tools for promoting community awareness and life-skills education (PDF, 2.16 MB)
Preventing Intimate Partner and Sexual Violence Against Women: Evidence-based promising practices in violence prevention (PDF, 1MB)
Project H: Working with Young Men to Promote Health and Gender Equity
The SASA! Activist Kit for Preventing Violence Against Women and HIV: Comprehensive set of tools for community-based action
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (PDF, 1.58MB) |
| Actions to Address Gender-based Violence |
Community-based actions
- Ensure that information on GBV is addressed within HIV programs consistent with the context of the country’s HIV epidemic, including the most vulnerable populations.
Health facility-based actions
- Establish strong referral and coordination mechanisms between HIV and GBV services as well as services designed specifically for MARPs (e.g., methadone replacement therapy, outreach to sex workers)
- Address bias and discrimination among provider attitudes toward MARPs
- Train health care workers and counselors on high-risk populations’ increased vulnerabilities to violence
- Address the impact of GBV on negotiating risk reduction strategies
- Ensure access to male and female condoms to all populations
- Create linkages with substance abuse prevention services and programs that are friendly towards MARPs and have staff trained in GBV screening.
Structural actions:
- Ensure that information on GBV is addressed within HIV programs consistent with the context of the country’s HIV epidemic, including the most vulnerable populations.
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Blueprint for the Provision of Comprehensive Care to Gay Men and Other Men Who Have Sex with Men in Latin America and the Caribbean
Comprehensive HIV Prevention for People Who Inject Drugs, Revised Guidance (PDF, 138KB)
Developing Services for Female Drug Users: Training module
Gender Identity, Violence, and HIV among MSM and TG: A Literature Review and a Call for Screening: Screening tool (PDF, 120KB)
Identifying Violence Against Most-at-Risk Populations: A Focus on MSM and Transgenders. Training Manual for Health Providers
(PDF, 799KB)
IGWG Gender, Sexuality, and HIV Training Module (PDF, 3.2MB)
Sex Work, Violence and HIV: A Guide for Programmes with Sex Workers
Technical Guidance on Combination HIV Prevention: Men Who Have Sex with Men (PDF, 210KB)
Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users
UNAIDS Action Framework: Universal Access for Men Who Have Sex with Men and Transgender People (PDF, 325KB)
Understanding Drug Related Stigma: Tools for Better Practice and Social Change |
HIV prevention programs for youth are an ideal vehicle for integrating primary prevention programs for GBV as there is consensus that such efforts should focus on younger age groups.
| Actions to Address Gender-based Violence |
Community-based actions
- Train and sensitize child- and youth-serving program staff and volunteers on GBV and the particular risk factors that children and young people face, for example, sexual violence including forced sex and coercion
- Ensure that services and programs are tailored to the distinct needs of girls, boys, young women, and young men, acknowledging that programming is not necessarily the same for each group
- Establish linkages between prevention programs and age-appropriate services for young GBV survivors
- Include information on GBV in school-based programs to prevent HIV
- Include HIV and GBV prevention information in comprehensive sexuality education for young people.
Health facility-based actions:
- Ensure access to youth-friendly sexual and reproductive health services that include GBV screening
- Ensure gender-sensitive access to post-exposure prophylaxis for young people
Structural actions:
- Support efforts to prevent all forms of violence and abuse, especially child maltreatment and child sexual abuse.
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Adolescents: Missing from Programs for the World’s Orphans and Vulnerable Children: Overview of needs of vulnerable adolescents with examples of programs that work
Elimination of All Forms of Discrimination and Violence against the Girl Child, Report of the Expert Group Meeting: Includes overview of the issues and recommendations for policy change, programming, and nongovernmental organizations and civil society (PDF, 392KB)
Gender Matters: A Manual on Addressing Gender-based Violence Affecting Young People (PDF, 1.37MB)
Gender-related Barriers to HIV Prevention Methods: A Review of Post-exposure Prophylaxis Policies for Sexual Assault: Recommendations and key components for a gender-sensitive post-exposure prophylaxis policy for sexual assault (PDF, 912KB)
Preventing Intimate Partner and Sexual Violence Against Women: Includes age-specific promising practices for the primary prevention of violence (PDF, 1MB)
Project H: Working with Young Men to Promote Health and Gender Equity
Women, Girls, Boys, and Men: Different Needs – Equal Opportunities: Gender Handbook in Humanitarian Situations: Includes a series of questions on what to look for or ask so that programs are designed and implemented with sensitivity to the different needs of women, girls, boys, and men (PDF, 3.13MB) |
GBV is a significant barrier to women's use of HTC services, in turn hampering treatment scale-up and prevention efforts (WHO 2006). Violence and fear of violence are often cited as barriers to HIV testing and disclosing a positive test result (Hale and Vazquez 2011). In addition to physical violence, women cite fear of abandonment, loss of economic support, rejection, and accusations of infidelity as reasons for not seeking out HTC services or returning for test results. Experience with violence and women's low status within the family can negatively influence knowledge of where and how to get tested; the level of autonomy and decision making individual family members have about accessing health care; and access to resources, such as money for transportation, that impede utilization of services (Ali 2007).
A 2006 WHO expert meeting identified four thematic areas for addressing GBV within HTC:
- A barrier to accessing services
- Safe disclosure of test results
- Ability to negotiate risk reduction behaviors
- Access to post-test support and care (WHO 2006).
Download the Gender-based Violence Guide HIV Testing and Counseling Chapter (PDF, 299 KB) or click on the arrows below to view the interactive recommended actions and resources for HTC.
Addressing GBV within HTC programs can have a direct impact on advancing PEPFAR's HTC strategies and reaching HTC targets, specifically:
- Addressing GBV within testing and counseling programs can improve uptake of services, increasing the number of individuals who know their HIV status and 1) seek treatment, and 2) have the information, tools, and support to prevent further infection.
- Expanding integration of HIV prevention, care and support, and treatment services with family planning and reproductive health services so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection.
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing GBV.
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| Actions to Address Gender-based Violence |
Readiness
- Assess and identify if and how GBV influences women’s and men’s access to HTC services
- Assess community and policy environment to determine readiness to respond to GBV in HTC programs
- Establish linkages with police and law enforcement agencies.
Training:
- Ensure adequate training in GBV screening and referral for all HTC providers
- Provide additional training as needed for issues on links between GBV and HTC.
HTC services:
- Ensure services are financially, geographically, and linguistically accessible to women and MARPs
- Raise awareness about GBV within “male-friendly” services (i.e., mobile/outreach, evening/weekend hours)
- Utilize a family-centered approach that supports HTC for couples/partners and children
- Provide adequate and appropriate space for HTC services that allows for safety and privacy
- Ensure the “4 Cs” are adhered to: consent, confidentiality, counseling, and correct test results
- Ensure that HTC services are not implementing mandatory testing or unlawful disclosure
- Consider integrating screening and counseling for GBV as part of HTC services where training and support are available; ensure counselors are equipped to deal with GBV if suspected
- Ensure provision of quality services (see section: Addressing GBV in HTC Quality Assurance Approaches).
Ensuring safe disclosure:
- Train and support HTC providers to identify women who fear violence as a result of testing or disclosure and counsel them on how to address these fears
- Offer alternative models for disclosure including counselor-assisted disclosure
- Provide couples/partner HTC to relieve burden on women for disclosing to male partners
Linkages and referrals:
- Establish referral networks and coordination mechanisms within the community and for GBV services
- Link clients proactively with GBV services as needed
- Refer women and marginalized populations to peer groups to provide ongoing psychosocial support
- Build support systems for GBV survivors where services do not exist
- Increase access to HTC by integrating HTC within GBV services.
Risk-reduction:
- Address violence as a barrier to negotiating risk reduction strategies and support survivors in developing strategies to protect themselves when negotiating safer sexual relationships.
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A Manual for Integrating the Programmes and Services of HIV and Violence against Women: Recommendations for integrating GBV services within voluntary counseling and testing programs (PDF, 1.35MB)
A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and resources to establish and strengthen GBV services within existing public health facilities, improve linkages with other sectors, and engage local communities (PDF, 3.11MB)
Guidance on Couples HIV Testing and Counseling (Forthcoming)
Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities: Information on strategic scale-up of provider-initiated testing and counseling, including minimum information for obtaining informed consent (PDF, 2.65MB)
Guidelines for Medico-legal Care for Victims of Sexual Violence (PDF, 887KB)
Improving the Health Sector Response to Gender Based Violence: Checklist for conducting a situational analysis and step-by-step guidance for planning and implementing GBV services 
Opening Up the HIV/AIDS Epidemic: Guidance on Encouraging Beneficial Disclosure, Ethical Partner Counselling & Appropriate Use of HIV Case-reporting (PDF, 216KB)
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (PDF, 1.58MB) |
| Actions to Address Gender-based Violence |
Increase availability of CHTC services:
- Train providers to deliver CHTC in all HTC settings
- Educate clients and patients about the benefits of CHTC services, including GBV prevention
Ensure quality CHTC service provision:
- Ensure that neither member of the couple (or polygamous family) has been coerced to attend CHTC; train HTC providers to identify signs that either partner has been coerced to attend CHTC or potential violence within the couple; these partners should be met with individually before proceeding with CHTC; for couples where coercion or violence may be present, HTC providers may wish to recommend individual HTC or delay CHTC to a later time
- Offer the entire HTC service together, including learning their test results together if couples presenting for CHTC have discussed this decision jointly; separating couples could suggest secrecy or distrust, and may put HTC providers in a compromising position if they learn something about one partner that the client is not willing to share with the other
- Confirm that both partners are ready to receive and to disclose their results together before the HTC provider reveals test results to the couple
- Offer both partners the opportunity to return to the HTC site (or refer to appropriate site) for additional counseling and support, either as individuals or as a couple
- Provide appropriate linkages and support for serodiscordant couples
- Provide additional follow-up to women in serodiscordant couples with special attention to HIV-positive women who are at increased risk for violence due to their HIV status
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AIDS Information Centre Uganda: Model program for addressing GBV within the context of couples counseling
Couples HIV Counseling and Testing Intervention and Training Curriculum
Important note: this resource is currently under revision
Guidance on Couples HIV Testing and Counseling (Forthcoming)
See additional resources listed previously for HTC |
| Actions to Address Gender-based Violence |
Training and sensitization:
HTC and other HIV treatment, care and support, and prevention services should provide and facilitate training on:
- The links between HIV and GBV
- Incidence of and risk factors associated with GBV
- Special considerations for working with GBV survivors
- Risk factors for GBV specifically related to HTC
Implementation of linkage programs:
HTC sites should implement, monitor, and evaluate approaches to ensure linkages and successful enrollment of clients, which might include (but is not limited to):
- Integrating GBV screening, care, and support into HTC services
- Integrating or co-locating HTC services with other follow-up services, including GBV services
- Integrating additional services at the HTC site, such as point-of-care CD4 testing
- Escorting clients to appropriate follow-up services
- Establishing partnerships between HTC sites and follow-up services (both clinic- and community-based)
- Improving HTC provider understanding of and engagement with GBV referral sites through visitation, contact points, and comprehensive referral lists
- Providing additional GBV counseling or social support services at the HTC site or within the community
- Providing transportation, child care assistance, nutritional support, or other incentives for providers, clients, or patients
- Sending SMS (short messaging service) text reminders, making phone calls, or conducting home visits (with informed consent) to follow-up on referrals that were given at HTC
- Training providers to create an enabling environment for all clients and patients within HTC services, particularly for women, MARPs, and other vulnerable populations who may be deterred from following through on referrals due to stigma and discrimination
- Establishing M&E systems that track linkages
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A Manual for Integrating the Programmes and Services of HIV and Violence against Women: Recommendations for integrating GBV services within voluntary counseling and testing programs (PDF, 1.35MB)
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide: Practical tools to help plan, deliver, and evaluate trainings appropriate for a broad range of community-based organizations and entities addressing GBV (PDF, 1.58MB)
Also see the resources in sections of this guide pertaining to:
- Prevention
- Adult Treatment
- Guidelines for GBV Programming: MARPs and M&E
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| Actions to Address Gender-based Violence |
Establish systems for HIV testing quality assurance to ensure correct test results are given by HTC providers and to monitor outcomes for clients, including GBV, related to their decision to get tested or disclosure of test results. These might include:
Proficiency panel testing
Utilization of pre-printed laboratory logbooks
Engaging laboratory staff in supportive supervision of HTC providers
Ensuring test kits and supplies are of sufficient stock, and are in-date
Follow up visits or surveys for clients.
Establish systems for HIV counseling quality assurance to ensure HTC providers provide adequate and client-centered counseling that addresses their risk factors and needs, including risk of GBV, fear of disclosure, etc. These might include:
- Provision of monthly or quarterly supportive supervision meetings with HTC providers from multiple sites to discuss challenging issues
- Provider self-reflection tools
- Client exit interviews
- Refresher trainings on key issues.
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Couples HIV Counseling and Testing Intervention and Training Curriculum: Provides key steps and tools for ensuring the quality of HTC services
Important note: this resource is currently under revision
Facilitative Supervision Handbook: Tools for supervisors to provide ongoing support when introducing new services
Also see the resources in sections of this guide pertaining to:
- Guidelines for GBV Programming: M&E
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| Actions to Address Gender-based Violence |
- Utilize HIV rapid testing technology in all HTC settings, whenever possible, to reduce the need for HTC clients or patients to return to the site at a later time to access their test results. HIV rapid testing technology facilitates same-hour results, reducing loss to follow-up, and it can be provided by lay counselors with appropriate training and supervision. This is of importance to GBV survivors where violence or the fear of violence can prevent them from accessing services.
- Ensure sufficient stock of in-date test kits at all HTC sites through accountability and quality supply chain management.
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No resources to display. |
| Actions to Address Gender-based Violence |
- Mark available HTC services with appropriate signboards or lettering to increase access to these services
- Involve women, men, PLHIV, and other affected communities in the formulation, implementation, and monitoring of HTC communications campaigns
- Vet all messages and images used in HTC communications campaigns in order to reinforce gender equality and positive norms and to avoid reinforcing negative stereotypes or harmful gender norms
- Include information about patient rights, including the right to privacy and confidentiality, the availability of no- or low-cost services, and linkages to both HIV and GBV support services in public information campaigns.
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Addressing Gender-based Violence through USAID’s Health Programs: A Guide for Health Sector Program Officers: Recommendations for communications on social and behavioral change (PDF, 1.45MB)
Also see the resources in sections of this guide pertaining to:
- Guiding Principles: Meaningful Engagement of PLHIV
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While PMTCT services can be highly effective in preventing vertical transmission of HIV, coverage levels have remained low. GBV, including during pregnancy, can pose a barrier to women getting tested, disclosing their status to partners, adhering to treatment regimens, and seeking antenatal care. Addressing GBV within PMTCT programs can facilitate uptake of strategies to prevent vertical transmission and provides opportunities to support HIV-positive women in exercising all of their pregnancy options, promote and support men's participation in maternal health, reduce maternal and child mortality related to violence, and help women achieve their reproductive aspirations. Primary prevention strategies also offer numerous opportunities to address and integrate GBV services, for example, through pregnancy prevention services.
Download the Download the Gender-based Violence Guide PMTCT Chapter (PDF, 326 KB) or click on the arrows below to view the interactive recommended actions and resources for PMTCT.
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Addressing GBV within PMTCT programs can have a direct impact on advancing PEPFAR's PMTCT strategies and reaching PMTCT targets, specifically:
- Increasing investment in PMTCT to meet 80 percent coverage levels in HTC of pregnant women and 85 percent coverage levels of antiretroviral prophylaxis for women who test positive
- Expanding integration of HIV prevention, care and support, and treatment services with family planning and reproductive health services, so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing GBV.
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Pregnancy-related care offers an entry point for both HIV and GBV interventions and creates opportunities to engage male partners and promote violence prevention strategies. However, GBV and unequal status within the family and community can pose barriers to accessing health services, including emergency obstetric care.
| Actions to Address Gender-based Violence |
- Readiness: Follow steps for establishing readiness to respond to GBV within clinical settings, including adopting appropriate policies and protocols; ensuring safety, privacy, informed consent, and confidentiality; training staff; equipping facilities; and establishing referral networks and coordination mechanisms.
- Pregnancy-related violence, stigma, and discrimination: Train and support staff in screening for violence and identifying harmful consequences including psychological and physical trauma that can lead to obstetric complications.
- Vulnerability to human rights abuses: Enact policies and enforcement mechanisms to prevent coercion, forced termination of pregnancies, or forced sterilization of women living with HIV, and address punitive laws and policies related to vertical transmission.
- HTC: Train providers on the linkages between GBV and HIV, specifically how violence or the fear of violence can prevent women from assenting to HTC or returning for results, the importance of confidentiality; potential negative outcomes of disclosure, and incidence of anxiety, depression, and stress when learning about HIV status during pregnancy.
- Risk reduction: Address violence as a barrier to negotiating risk reduction strategies and support survivors in developing strategies to protect themselves when negotiating safer sexual relationships; consider ongoing risk of infection as part of HTC even if tested negative.
- Pregnancy options: Sensitize providers to respect and support pregnancy intentions of women living with HIV, provide support and linkages to safe pregnancy and motherhood services, and provide information on access to safe abortion services where legal.
- Ensure access to safe delivery services: Violence or fear of violence may cause women to avoid hospitals due to fear of involuntary disclosure.
- Safe abortion and postabortion care: Complications of abortion are of particular concern for women living with HIV given their potentially higher rates of morbidity due to unsafe abortion, and there is evidence to suggest that there are status, vulnerability, and stigma-related barriers that may compel women living with HIV to undergo unsafe abortions. Access should include accurate information on the legal status of abortion and health exceptions for seeking abortion.
- Male involvement: Provide information and counseling to couples and men on violence prevention strategies and implement programs with men and boys that change harmful gender norms.
- Support for follow-on care: Increase access to follow-on care for GBV survivors, including antenatal care and PMTCT services.
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A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and resources to establish and strengthen GBV services within existing public health facilities, improve linkages with other sectors, and engage local communities (PDF, 3.11 MB)
Family Planning–Integrated HIV Services: A Framework for Integrating Family Planning and Antiretroviral Therapy Services (PDF, 678 KB)
HIV & AIDS - Stigma and Violence Reduction Intervention Manual: Tools for implementing community-owned processes in development programs (PDF, 5.2 MB)
Improving the Health Sector Response to Gender-Based Violence
Linkages and Integration of Sexual and Reproductive Health, Rights, and HIV: The Alliance Approach
Men As Partners: A Program for Supplementing the Training of Life Skills Educators
mothers2mothers: Preventing Mother-to-Child HIV Transmission in Africa Using New Paradigms in Health Care Delivery: Model program using mentor mothers to promote treatment adherence
Technical Brief: Integrating Prevention of Mother-to-Child Transmission of HIV Interventions with Maternal, Newborn, and Child Health Services
The One Man Can Action Kit: Tools for engaging men to address GBV
The Pregnancy Intentions of HIV-positive Women: Forwarding the Research Agenda: Important background reading for understanding barriers to access and stigma and discrimination (PDF, 2.55MB)
Twubakane GBV/PMTCT Readiness Assessment: Questionnaires and focus group discussion guides designed for introducing GBV services within health care settings
Also see the resources in sections of this guide pertaining to:
- Guidelines for GBV Programming
- HTC including Couples Counseling
- Adult Treatment
- Prevention
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Women living with HIV are particularly vulnerable to violence, stigma, and discrimination associated with both HIV and pregnancy.
| Actions to Address Gender-based Violence |
- Readiness: Follow steps for establishing readiness to respond to GBV within clinical settings, including adopting appropriate policies and protocols; ensuring safety, privacy, informed consent, and confidentiality; training staff; equipping facilities; and establishing referral networks and coordination mechanisms.
- Confidentiality: Pay special attention to confidentiality as access to drugs for prenatal transmission may lead to unintended disclosure.
- Stigma and discrimination: Women living with HIV choosing to continue pregnancy may face hostility and accusation from providers. Establish and enforce mechanisms to prevent coercion and educate women about their rights, as fear of forced or coerced sterilization or termination may pose a barrier for accessing ART; establish PMTCT and postnatal support groups for women living with HIV; reduce economic barriers to accessing ART; and promote and support family and community engagement to support women living with HIV including pregnant women.
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HIV & AIDS - Stigma and Violence Reduction Intervention Manual: Tools for implementing community-owned processes in development programs (PDF, 5.2MB)
mothers2mothers: Preventing Mother-to-Child HIV Transmission in Africa Using New Paradigms in Health Care Delivery: Model program using mentor mothers to promote treatment adherence
Twubakane GBV/PMTCT Readiness Assessment: Questionnaires and focus group discussion guides designed for introducing GBV services within health care settings
Also see the resources in sections of this guide pertaining to:
- Guiding Principles for Working with Survivors of GBV
- Adult Treatment
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Women’s choices related to infant feeding may inadvertently reveal their HIV status or subject them to stigma, for example opting to use formula versus breastfeeding. Pressure to breastfeed or fear of stigma, discrimination, and violence can also interfere with women’s feeding choices.
| Actions to Address Gender-based Violence |
- Confidentiality: Ensure mechanisms are in place to protect confidentiality as choices regarding infant feeding may have implications for disclosure within the family and community.
- Support women’s feeding choices: Promote family and community support to challenge negative perceptions based on infant feeding choices. Combine infant feeding support with referrals and support related to postpartum health, family planning, and ART adherence.
- ART: Provide support for access to antiretroviral prophylaxis during breastfeeding and ongoing access to ART for women living with HIV.
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No Resources to Display |
Wrap around services, such as income-generating activities, can help address risk factors for GBV and provide needed support, such as legal services and support groups for survivors.
| Actions to Address Gender-based Violence |
- Readiness assessments: Support social care organizations in conducting readiness and needs assessments for addressing GBV including knowledge, attitudes, and practices; institutional policies; training; staffing; and linkages with GBV organizations and networks.
- Training and sensitization: Provide training for social care organizations on the linkages between HIV and GBV, the role of communities in addressing and preventing GBV, incidence and risk factors associated with GBV, and special considerations for working with survivors.
- Establish linkages with existing GBV services and networks: Develop mutually reinforcing partnerships and referral networks among HIV-service and GBV organizations and promote bidirectional integration of HIV and GBV prevention and response efforts.
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A Manual for Integrating the Programmes and Services of HIV and Violence against Women: Tools for identifying opportunities for linkages between GBV and HIV services (PDF, 1.35 MB)
A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and resources to establish and strengthen GBV services within existing public health facilities, improve linkages with other sectors, and engage local communities (PDF, 3.11 MB)
Family Planning–Integrated HIV Services: A Framework for Integrating Family Planning and Antiretroviral Therapy Services (PDF, 678 KB)
IMAGE Study Publication List 2005-2009: Model program for integrating microfinance and GBV interventions
Improving the Health Sector Response to Gender Based Violence: Tools for mapping available services
Linkages and Integration of Sexual and Reproductive Health, Rights, and HIV: The Alliance Approach |
Linking HIV services can contribute to increased access to services, for example, by making multiple services available in a single setting. Linkages may create opportunities for efficiencies such as through joint training, support groups for staff and clients, and information sharing.
| Actions to Address Gender-based Violence |
- Readiness assessments: Support HIV programs and organizations in conducting readiness and needs assessments for addressing GBV including knowledge, attitudes, and practices; institutional policies; training; staffing; and linkages with GBV organizations and networks.
- Training and sensitization: Provide training on the linkages between HIV and GBV, incidence and risk factors associated with GBV, and special considerations for working with GBV survivors.
- Establish linkages with existing GBV services and networks: Develop mutually reinforcing partnerships and referral networks among HIV-service and GBV organizations and promote bidirectional integration of HIV and GBV prevention and response efforts.
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A Manual for Integrating the Programmes and Services of HIV and Violence against Women (PDF, 1.35 MB)
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (PDF, 1.58 MB) |
| Actions to Address Gender-based Violence |
- Train counselors to identify risk factors for violence within the family
- Use opportunities for partner involvement to provide information about violence prevention strategies
- Encourage support for PLHIV within the family.
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* See previous resources for PMTCT |
Addressing GBV within the context of adult treatment programs can help break down barriers to accessing ART that hamper treatment scale-up efforts toward universal access. GBV can pose multiple barriers along the spectrum of services related to adult treatment including access to HTC, PMTCT, and ART, as well as ART adherence, leading to worse patient outcomes and potential development of HIV drug resistance (Herstad 2010; Ali 2007).
Download the Gender-based Violence Guide Adult Treatment Chapter (PDF, 333 KB) or click on the arrows below to view the interactive recommended actions and resources for adult treatment.
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Addressing GBV within adult treatment programs can have a direct impact on advancing PEPFAR's adult treatment strategies and reaching treatment targets, specifically:
- Directly supporting more than 4 million people on treatment, more than doubling the number of patients directly supported by PEPFAR in its first five years
- Scaling up treatment with a particular focus on serving the sickest individuals, pregnant women, and those with HIV/tuberculosis coinfection; increasing support for country-level treatment capacity by strengthening health systems and expanding the number of trained health workers
- Working with countries and international organizations to develop a shared global response to the burden of treatment costs in the developing world, and assisting countries in achieving their defined treatment targets
- Expanding integration of HIV prevention, care and support, and treatment services with family planning and reproductive health services, so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing GBV
- Increasing the proportion of HIV-infected infants and children who receive treatment commensurate to their representation in a country's overall epidemic, helping countries to meet national coverage levels of 65 percent for early infant diagnosis, and doubling the number of at-risk babies born HIV-free.
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Addressing HIV with governments, policymakers, and leaders offers an entry point for raising awareness about and commitment to ending GBV.
| Actions to Address Gender-based Violence |
- Promote adoption of and adherence to international laws and policies against gender-based discrimination and violence
- Strengthen national laws and policies related to gender equality and GBV
- Address both statutory and customary laws that discriminate based on sex or sexual orientation
- Ensure enforcement and accountability
- Promote community participation, specifically of PLHIV and women, in decision making and coordinating bodies
- Include GBV in national action plans, targets, and indicators related to HIV, treatment, and GBV.
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Combating Gender-based Violence: A Key to Achieving the MDGs: Advocacy guide
Good Practices in Legislation on Violence Against Women, Report of the Expert Group Meeting (PDF, 473 KB)
and
Handbook for Legislation on Violence against Women: Companion guides
International Guidelines on HIV/AIDS and Human Rights: Details the responsibilities of states for protecting human rights within the context of HIV (PDF, 910 KB)
Preventing Intimate Partner and Sexual Violence Against Women: Guide for policymakers and program planners (PDF, 1.1 MB)
UN Trust Fund to End Violence Against Women: Provides programmatic examples of local and national initiatives for raising awareness, legal literacy, training, prevention, and research
Virtual Knowledge Centre to End Violence against Women and Girls: Module on legislation |
| Actions to Address Gender-based Violence |
- Include training on gender-sensitive communications and service provision and GBV within core and supplementary curricula
- Ensure gender awareness and GBV training are provided on an ongoing basis with opportunities for reflection
- Create mechanisms to support health care workers to handle incidents of GBV appropriately, including adequate and ongoing training, established guidelines and protocols, and supervision
- Include gender sensitivity and GBV within curricula guidelines for all health care workers.
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Communication Skills in Working with Survivors of Gender-based Violence
Community Treatment Literacy: Recognizing Gender Issues in Adhering to HIV Treatment, Workshop Manual: Designed for PLHIV networks to raise awareness about how stigma, discrimination, gender inequality, and GBV create barriers to treatment adherence and how to develop strategies to promote adherence (PDF, 941 KB)
IGWG Gender, Sexuality, and HIV Training Module (PDF, 3.19 MB)
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (PDF, 1.58 MB) |
| Actions to Address Gender-based Violence |
Readiness:
Follow steps for establishing readiness to respond to GBV within clinical settings, including adopting appropriate policies and protocols; ensuring safety, privacy, informed consent, and confidentiality; training staff; equipping facilities; and establishing referral networks and coordination mechanisms.
Implications of rapid scale-up:
Program planners should plan for additional needs resulting from rapid scale-up of treatment access including support services, ongoing training for counselors, and emergency services and supplies for GBV survivors. |
A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and resources to establish and strengthen GBV services within existing public health facilities, improve linkages with other sectors, and engage local communities (PDF, 3.11 MB)
Improving the Health Sector Response to Gender Based Violence: Management checklist
Violence Against Women: The Health Sector Responds (PDF, 120 KB) |
| Actions to Address Gender-based Violence |
- Ensure diagnostic tests are geographically, financially, and linguistically accessible
- Ensure laboratory services maintain privacy and confidentiality protocols.
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The Gender-based Violence Information Management System: Sample information sharing protocol |
| Actions to Address Gender-based Violence |
- Sensitize and train adherence counselors and support group leaders on GBV including barriers to accessing treatment on a consistent basis
- Include messages challenging harmful gender norms and stereotypes within HIV communications
- Address stigma, discrimination, and violence related to HIV and access to services
- PLHIV, women, and affected communities should be involved in the formulation, implementation, and monitoring of public information campaigns
- All messages and images should be carefully vetted to avoid reinforcing negative stereotypes or harmful gender norms
- Public information campaigns should include information about patient rights including the right to privacy and confidentiality, the availability of no- or low-cost services, and linkages to both HIV and GBV support services.
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Community Treatment Literacy: Recognizing Gender Issues in Adhering to HIV Treatment, Workshop Manual (PDF, 949 KB)
Implementing Stepping Stones: A Practical and Strategic Guide for Implementers, Planners, and Policy Makers (PDF, 2.16 MB)
Men As Partners: A Program for Supplementing the Training of Life Skills Educators
Mobilising Communities to Prevent Domestic Violence: A Resource Guide for Organisations in East and Southern Africa
Project H: Working with Young Men to Promote Health and Gender Equity
Soul City Series: Television and radio program and related tools for addressing HIV, sexuality, and violence |
Linking HIV services can contribute to increased access to services, for example, by making multiple services available in a single setting. Linkages may create opportunities for efficiencies such as through joint training, support groups for staff and clients, and information sharing.
| Actions to Address Gender-based Violence |
Risk reduction:
- Address violence as a barrier to negotiating risk reduction strategies and support survivors in developing strategies to protect themselves when negotiating safer sexual relationships
- HTC must consider ongoing risk of infection even if tested negative
- Address the special needs of serodiscordant couples
- Provide access to female initiated methods of prevention.
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A Manual for Integrating the Programmes and Services of HIV and Violence against Women (PDF, 1.35 MB)
Also see the resources in sections of this guide pertaining to:
- Prevention
- HTC
- Care and Support
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| Actions to Address Gender-based Violence |
- Ensure all cadres of health care workers are sensitized to GBV, understand the role of the health sector in addressing GBV, and have the skills to work with survivors
- Provide training and support on GBV on an ongoing basis
- Address provider knowledge, attitudes, and practices, particularly regarding harmful social norms that may reinforce and perpetuate GBV
- Ensure post-exposure prophylaxis policies for sexual assault address who can provide services.
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Communication Skills in Working with Survivors of Gender-based Violence
Gender-related Barriers to HIV Prevention Methods: A Review of Post-exposure Prophylaxis Policies for Sexual Assault: Recommendations and key components for a gender-sensitive post-exposure prophylaxis policy for sexual assault (PDF, 911 KB)
IGWG Gender, Sexuality, and HIV Training Module (PDF, 3.19 MB)
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (PDF, 1.58 MB) |
PLHIV are more likely than those not infected to experience GBV (WHO and UNAIDS 2010). Violence or fear of violence can prevent PLHIV from seeking or accessing care and support services consistently. Several studies among women living with HIV reveal large gaps between the number of women living with HIV and the portion of those women receiving treatment, care, and support (Lindsey 2003). HIV care and support services and networks provide a ready-made infrastructure for screening PLHIV for violence, providing a minimum response to GBV survivors, linking them to other basic health care services, and providing referrals. Linkages to organizations and programs that address GBV can be mutually beneficial: strengthening health surveillance and referral networks, creating efficiencies around shared strategies such as economic self-sufficiency, mobilizing a comprehensive community-based response, and increasing successful programmatic outcomes and sustained results.
Download the Gender-based Violence Guide Care and Support Chapter (PDF, 280 KB) or click on the arrows below to view the interactive recommended actions and resources for Care and Support
Addressing GBV within care and support programs can have a direct impact on advancing PEPFAR's care and support strategies and reaching care and support targets, specifically:
- Expanding integration of HIV prevention, care and support, and treatment services with family planning and reproductive health services, so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection and have access to women-initiated prevention technologies such as female condoms and microbicides (once the latter are approved)
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing gender-based violence.
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Like HIV, GBV requires a comprehensive, multidimensional, multisector response. Social care, such as income-generating activities, can help address risk factors for GBV and provide needed support, such as legal services and support groups for GBV survivors.
| Actions to Address Gender-based Violence |
Readiness assessments:
Support social care organizations to conduct readiness and needs assessments for addressing GBV; to review institutional policies, training, and staffing; and to create linkages with GBV organizations and networks.
Training and sensitization:
Provide and facilitate training for social care organizations on the linkages between HIV and GBV, the role of communities in responding to and preventing GBV, prevalence and risk factors associated with GBV, and special considerations for working with GBV survivors.
Establish linkages with existing GBV services and networks:
Develop mutually reinforcing partnerships and referral networks among HIV-service and GBV organizations and promote bidirectional integration of HIV and GBV prevention and response efforts.
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HIV & AIDS - Stigma and Violence Reduction Intervention Manual: Guide for community-based organizations to facilitate community-led and -owned processes that address stigma and GBV in HIV prevention efforts (PDF, 5.2 MB)
Implementing Stepping Stones: A Practical and Strategic Guide for Implementers, Planners, and Policy Makers: Tools for engaging communities on gender and HIV (PDF, 2.16)
Project H: Working with Young Men to Promote Health and Gender Equity 
The SASA! Activist Kit for Preventing Violence Against Women and HIV: Comprehensive set of tools for community-based action
Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: Includes practical tools to help plan, deliver, and evaluate trainings appropriate for a broad range of community-based organizations and entities involved in addressing GBV (PDF, 1.58 MB)
Violence Against Women: The Health Sector Responds: Provides an overview of PAHO's integrated strategy for addressing GBV, not only within the clinical setting, but also within policy, the health sector, and the community (PDF, 120 KB) |
Service delivery networks can be entry points for screening clients for GBV and providing basic GBV services and referrals. Addressing GBV within HIV care and support services can help mitigate barriers that GBV survivors face in gaining access to priority services, such as ART, diagnosis and treatment of STIs, PMTCT, healthy pregnancy services, and prevention and treatment of opportunistic infections. Services and supplies should be made available at no or low cost, and financial assistance for related support (e.g., transportation, nutrition) should be made available.
| Actions to Address Gender-based Violence |
Situational analysis:
Assess provider knowledge, attitudes, and practices; review policies and protocols with respect to client safety, privacy, and confidentiality; review existing local or national data on GBV prevalence; review relevant laws and policies including obligations of health providers; and identify existing services (including basic health; sexual and reproductive health; mental health; and social, legal, financial, and family services).
Staff training and sensitization:
Ensure all facility staff, including program managers, health providers, counselors, and administrative staff, are sensitized routinely to GBV, trained on GBV organizational policies and protocols, integrate GBV into core and supplemental training programs, and provide GBV training to others on a consistent, regular basis.
Organizational policies and protocols:
Ensure client safety, privacy, and confidentiality including with respect to managing client information, and establish accountability and enforcement mechanisms.
Infrastructure and supplies:
Ensure facilities allow for client safety and privacy (e.g., private screening rooms) and procure emergency supplies; information, education, and communication materials; rapid test kits; and male and female condoms.
Public sector coordination:
Establish and maintain linkages with public sector responders (e.g., police, and public health providers); support training on and sensitization to GBV, human rights, gender power relations, and legal obligations.
Related services:
Map existing services (including health, social, legal, and financial) and establish referral pathways and protocols.
GBV screening:
Where referral services are available, adopt protocols to screen clients for GBV including how to identify risk factors, ask clients about violence, and validate their experience.
Care for GBV survivors:
Where referral services are available, adopt protocols for care of GBV survivors, including emergency services and safety planning. |
A Manual for Integrating the Programmes and Services of HIV and Violence against Women (PDF, 1.35 MB)
A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and resources to establish and strengthen GBV services within existing public health facilities, improve linkages with other sectors, and engage local communities (PDF, 3.11 MB)
Addressing Gender-based Violence through USAID's Health Programs: A Guide for Health Sector Program Officers: Intended to help integrate GBV activities into health sector portfolios during project design, implementation, and evaluation (PDF, 1.45 MB)
Guidelines for Medico-legal Care for Victims of Sexual Violence: Developed to improve professional health services for all victims (men, women, and children) of sexual violence (PDF, 887 KB)
Improving the Health Sector Response to Gender Based Violence
Twubakane GBV/PMTCT Readiness Assessment: Questionnaires and focus group discussion guides designed for introducing GBV services within health care settings |
Psychological reactions to GBV are similar to, but distinct from, those experienced by people infected and affected by HIV, such as anger, denial, and depression (UNFPA 2004). Just as community attitudes, such as HIV stigma and discrimination, can influence PLHIV’s sense of self, harmful gender norms can fuel and reinforce GBV survivors’ feelings of shame, isolation, and self-blame.
| Actions to Address Gender-based Violence |
- Include mental health services in referral networks for PLHIV and GBV services
- Train and sensitize community-based support workers to provide counseling and support
- Employ community-based strategies to address the role of survivors’ family and friends in overcoming the trauma of GBV (UNFPA 2004)
- Ensure children and youth receive age-appropriate trauma counseling
- Facilitate access to quality counseling by trained workers, such as counselors, nurses, social workers, psychologists, or psychiatrists
- Develop support groups specifically designed for GBV survivors and their families.
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Communication Skills in Working with Survivors of Gender-based Violence
IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings: Information on providing psychosocial support to survivors of GBV (PDF, 830 KB) |
| Actions to Address Gender-based Violence |
- Train and sensitize providers on increased risk of violence for PLHIV, particularly women living with HIV
- Train and sensitize providers on GBV, especially on the sexual and reproductive health rights of PLHIV and increased risk to GBV survivors of pressure and coercion regarding pregnancy and childbearing within health care settings
- Train and sensitize providers on barriers that GBV can pose for treatment access and adherence; ensure services are available and at no or low cost, and that financial support is available for related expenses such as food and transportation.
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Community Treatment Literacy: Recognizing Gender Issues in Adhering to HIV Treatment, Workshop Manual (PDF, 941 KB)
IGWG Gender, Sexuality, and HIV Training Module (PDF, 3.19 MB)
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GBV against orphans and vulnerable children (OVC) can take the form of physical and emotional violence, sexual abuse, forced and early marriage, forced labor and child trafficking, and inequitable access to household resources, including nutrition, schooling, and health care. GBV against children can occur in multiple settings: in the home, in school, in institutional settings, in the community, and in situations where children are living outside of family care. Perpetrators include family members, neighbors, caretakers, teachers, employers, service providers, and others. Children without adequate adult protection and care are highly vulnerable to all forms of maltreatment including sexual violence.
GBV against children is increasingly pervasive. An evaluation of GBV programs in sub-Saharan Africa showed that children constitute a significant portion of GBV survivors seeking services but that they are underserved by adult-oriented services (Keesbury and Askew 2010). Although sexual violence tends to increase with age and to affect girls more than boys, it is known to occur against children of both sexes and at all ages, including infancy.
Numerous studies illustrate young women's particular vulnerability to sexual violence; for example, one study showed that the younger women are at the age of first sex, the more likely it is to have been forced (Moreno 2005). In another study, young women living with HIV were 10 times more likely to report partner violence than their counterparts. Economic vulnerabilities for OVC are especially acute. Girls may be pressured to leave school in order to take on household responsibilities or paid work, and they are more likely than boys to exchange sex for food or money or be forced into prostitution (Plan UK and Plan International 2007). Likewise, boys may be pressured to leave school to take on paid work and be turned out of their house in order to relieve the economic burden (real or perceived). The consequences are numerous and far reaching.
Download the Download the Gender-based Violence Guide Orphans & Vulnerable Children Chapter (PDF, 280 KB) or click on the arrows below to view the interactive recommended actions and resources for OVC.
Addressing GBV within OVC programs can have a direct impact on advancing PEPFAR's OVC strategies and reaching OVC targets, specifically:
- Strengthening the ability of families and communities to provide supportive services, such as food, nutrition, education, and livelihood and vocational training to OVC
- Expanding PEPFAR's commitment to cross-cutting integration of gender equality in its programs and policies, with a focus on addressing and reducing GBV.
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The best protection for a child against maltreatment is a safe, stable and caring family.
Safe communities help to ensure that children and their families thrive; community groups often step in to help struggling families.
Safe communities help to ensure that children and their families thrive; community groups often step in to help struggling families.
| Actions to Address Gender-based Violence |
- Review or enact gender-sensitive child protection policies within all institutions and organizations that serve children and adolescents
- Train all service providers about gender inequality and equip them to recognize and address gender disparities in access to and provision of services to OVC
- Ensure health services are child-friendly, gender-sensitive, and confidential, and that providers are trained and equipped to identify and respond to GBV
- Provide access to sexual and reproductive health care
- Support girls’ education and address barriers to access
- Ensure equal access to birth registration
- Provide legal services for girls and young women related to property and inheritance rights.
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Advocating for Sexual Abuse Free Classrooms (PDF, 893 KB)
Child Protection Policies and Procedures Toolkit (PDF, 90 KB) |
Strong government child protection systems are necessary along with champions for children who lack adequate adult protection at home.
| Actions to Address Gender-based Violence |
- Integrate gender equality principles into national plans, laws, and policies related to children
- Enact and enforce legal protections against all forms of violence against children including early and forced marriage, harmful practices such as female genital cutting, child labor, and trafficking in persons
- Protect and promote inheritance rights for children, particularly girls and young women
- Ensure customary laws protect children, particularly girls and young women.
Resources for communities:
- Ensure resources are allocated for violence prevention programs
- Invest in programs to get and keep girls and young women in school and ensure schools and the trip to school are safe for children, especially girls and young women.
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Child Protection System Mapping and Assessment Toolkit: Users' guide, comprehensive toolkit, and core toolkit
Council of Europe Policy Guidelines on Integrated National Strategies for the Protection of Children from Violence (PDF, 637 KB)
Report of the Independent Expert for the United Nations Study on Violence Against Children: Recommendations for states (PDF, 168 KB)
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