Aubrey Weber, Technical Officer, Science Facilitation, FHI 360
Robyn Dayton, Senior Technical Advisor, HIV Division, FHI 360

Each year, the 16 Days of Activism against Gender-Based Violence (GBV) campaign provides us with an opportunity to reflect on the work being done globally to prevent, respond to, and eliminate acts of GBV. We know that key populations—gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender people—experience a disproportionate burden of violence, much of which is gender-based, which increases their vulnerability to HIV and affects access to HIV services. Furthermore, robust evidence tells us that structural interventions to stop violence and protect the human rights of key populations are essential to an effective HIV response.

The USAID- and PEPFAR-supported EpiC project, and its predecessor project LINKAGES, have for years been working to meet the GBV-related needs of key populations to accelerate progress toward epidemic control and contribute to individuals’ quality of life. On this blog, we have been documenting the breadth and depth of this work since 2015. Among the stories we’ve told include our inaugural post, in which we prioritized research on GBV perpetrated against key populations. In 2017, we shared five ways that everyone who works with key populations can address gender-based and other forms of violence. The following year, we hosted a webinar that explored why addressing violence is a necessary component of high-quality HIV service delivery programs. And, in 2020, we stressed the importance of collaboration to address issues of service access, discrimination, and violence.

Now, we reflect on the ways GBV and the response to it have changed during the pandemic and consider how we’ve tailored our programs to address a growing need for services that arose in tandem with new barriers to GBV prevention and response. Here are three ways we are currently working to prevent and respond to GBV in the time of COVID-19.

Going virtual to address GBV at scale

As COVID-19 increased the need for GBV services and made fewer support services available, it was important to make a wider range of health care providers aware of and able to respond to the needs of GBV survivors. EpiC addressed this issue by developing a training on GBV identification and response designed to be delivered virtually and tailored to the context of COVID-19. The course, which is accompanied by relevant standard operating procedures that can be adapted for local use, was delivered to HIV program staff in more than 25 countries who then submitted videos of themselves performing the central skills—psychological first aid or LIVES (Listen. Inquire. Validated. Enhance Safety. Link to Support)—and were certified to go on and train others. In this way, we have improved access to GBV services in a range of settings, supporting survivors and helping providers address a central concern in the lives of their clients.

Keeping women and LGBT people safe as they deliver care

COVID-19 has not only increased violence against the clients served by HIV projects. Service providers, many of whom are women and LGBT people, also experience verbal, physical, and sexual abuse while doing their life-saving work. EpiC developed a virtual training to address implementer security that has, so far, been rolled out in 10 countries and is currently being adapted for use beyond USAID-funded projects. After attending the training, leadership at local implementing partners have worked with EpiC to develop and implement security plans that help protect  peer educators, outreach coordinators, and health care workers with whom they work. For example, in Kenya, the EpiC project worked with implementing partners to:

  1. Engage mental health counsellors to provide services to both staff and clients at the drop-in centers
  2. Secure identification passes to allow drop-in center staff to move freely in communities while conducting their duties during COVID-19 lockdowns
  3. Provide LIVES training to clinical staff and peer educators so that they could support both peers and peer educators who experience violence

Prioritizing mental health care for survivors of GBV in Liberia

COVID-19 has also shown us how important investments in mental health are for survivors of violence. In 2020, EpiC Liberia added two dedicated mental health clinicians to their GBV response team to provide extensive psychosocial support for female sex worker and MSM survivors of violence. When data from before and after the addition of mental health clinicians were compared, an eight-fold increase in overall GBV cases reported, from 168 to 1,350, was discovered. When it came to sexual violence, which carries the most direct risk of HIV infection, reporting increased from 4 to 228 cases. The unique support provided by the mental health clinicians was largely responsible for this increase. Their services were appreciated by survivors of GBV, who felt safe disclosing their experiences of violence and noted better mental health outcomes. Survivors also looked to them for help in accessing clinical care and returned to them for support if their HIV tests revealed positive results. Based on these successes, mental health care is being expanded so that more individuals can access these services in 2021 and beyond.

Looking ahead

While the COVID-19 pandemic has created huge disruptions and resulted in a sometimes overwhelming collective and individual grief, it has also been the catalyst for important change—investments in digital and scalable approaches to preventing and responding to GBV, more emphasis on caring for caregivers who also experience GBV, and a growing commitment to addressing mental health for both clients and providers. We take these lessons forward with a renewed sense of purpose to build on our past work to better address the challenges of today.

Photo Credit: Nancy Coste/FHI 360