Written by Robyn Dayton, Gender Advisor, EpiC & LINKAGES, FHI 360

HIV programs for key populations—gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender people—provide myriad opportunities every day to integrate violence prevention and response services. As this infographic illustrates, key populations experience a disproportionate burden of violence, much of it gender-based, which increases their vulnerability to HIV infection and affects access to HIV prevention, care, and treatment services. The dedicated staff and volunteers at key-population-led and -serving organizations address violence throughout the year. And the 16 days of activism against gender-based violence (GBV) is an important time to reflect on the ways in which these activities, conducted under the USAID- and PEPFAR-supported LINKAGES and EpiC projects, have been meeting the GBV-related needs of key population members in order to accelerate progress toward epidemic control and contribute to beneficiaries’ overall well-being.  

Under LINKAGES and EpiC, efforts to address GBV are evidence-based and align with normative guidance. Through a partnership with the United Nations Development Program (UNDP) and regional and local key-population-led organizations in Latin America and the Caribbean we added to the evidence base by implementing rights-based participatory research on the experiences of GBV among key populations. This work has helped shine a spotlight on key population members’ daily experiences of GBV—particularly among transgender women and men who have sex with men, who had been left out of conversations on GBV for too long. The dissemination of this research has created opportunities to advocate for policy change and the allocation of more resources for addressing GBV in key population programs.

While there is a great deal to learn from and advocate for using such research, the main focus under LINKAGES and EpiC is implementing and advancing quality HIV programming. To that end, in collaboration with international key population networks—MPact Global Action, the Global Network of Sex Work Projects, the International Network of People who Use Drugs, and a Global Network of Trans Women and HIV—we developed guidance on comprehensive violence response in key population programs. The guidance is based on lessons learned by key-population-led and -serving organizations operating in more than 20 countries and is accompanied by trainings on violence prevention and response for health care workers and law enforcement officers. Implementing partners have also played an important role in creating guidance for specific areas of HIV programming. For example, EpiC supported the development of new tools for integrating intimate partner violence identification and response into PrEP services.

Implementing partners working with LINKAGES and EpiC have done their best not only to offer quality HIV/GBV integrated programming, but also to use the routine data emerging from the programs to continue to learn and improve. For example, in the Dominican Republic, the LINKAGES project partnered with a local community-based organization, CEPROSH, to improve the quality and integration of GBV and HIV services. Through review of data and corresponding tweaks to programming, CEPROSH was able to increase the uptake of both GBV and HIV services, improve beneficiaries’ opinion of HIV services, and improve beneficiaries’ quality of life. You can read about that experience in both the peer-reviewed literature and from the perspective of one of the peers implementing the project (English and Spanish).

Finally, as the projects’ work to protect beneficiaries has grown, so too has the understanding of the risks faced by implementers, especially when they themselves are members of key populations and particularly in situations of acute and widespread violence. As a result, LINKAGES collaborated with Frontline AIDS to convene community advocates and key population-led and -serving organizations from across East and Southern Africa to develop a Safety and Security toolkit to protect implementers from GBV and other security risks. To complement and expand this effort, LINKAGES also developed data security guidance, including a self-assessment tool.  

The link between violence and HIV is irrefutable, so observance of the 16 days of activism against GBV is also a reminder of an essential element of comprehensive HIV programs for key populations. Within both LINKAGES and EpiC, we appreciate the opportunity to acknowledge the role that violence prevention and response play in epidemic control during the 16 days and every day, through our programming and by sharing the lessons learned and tools these programs generate.

Photo: Jessica Scranton/FHI 360