LVCT Health

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Sep 2018

GBV/HIV integration: from discussion to action

“As players in the HIV sector we have been talking about the integration of HIV and violence services for quite too long, but we now need to move from conversations to action.” Remarked Dr. Wanjiru Mukoma during the #GBVHIVintegration satellite session at the NASCOP organised HIV conference.

This conference brought together over one hundred stakeholders drawn from the community, civil society, learning institutions, national and county governments to share the progress, gaps and way forward in the integration of GBV and HIV services. The one hour session was made up of sharing of experiences from technical experts, beneficiary of integration and #GBVHIVintegration county implementers.

“There are many studies and reports that show the linkage of violence to HIV. A KNBS study done in 2014 reported that, 38% Women aged 15-49 years had experienced violence. A 2012 LVCT Health study also showed that 47% of women attending VCT reported at least one form of violence by their intimate partner. Additionally, there have been numerous reports of violence in the media, while many others go unreported.” Said Dr. Lina Digolo – Head of Research and strategic information department at LVCT Health.

Dr. Digolo asserted that there was a direct pathway that showed violence led to HIV, especially to women and children. Those who faced violence at a young age were at risk of getting HIV infection. Research also showed that the same populations that are at high risk of HIV infection continue to face violence. While men are also affected, the burden is mainly on women and children.

“Violence is a direct barrier to offering HIV prevention services, this was a key finding in our PrEP demonstration study, which showed some women were facing challenges in PrEP uptake due to fear of disclosure and in some cases secrecy in PrEP uptake led to physical violence.”

She concluded by stating that violence was a silent driver of HIV and needed to be integrated into HIV services. She proposed the formation of a community of practice to discuss the GBV-HIV integration.

Robert Muiruri, a bodaboda rider and beneficiary of a GBV/HIV integration program, shared his experience of how they managed to go to churches, chief baraza’s and were able to reach men. This resulting to reduced GBV cases.

“I was one of the victims of GBV, before we got trained I was always in conflict with my wife, since most of my clients were women. After we were trained on how to avoid violence, we started communicating and I am happy that I now have 2 boys as a result of a good relationship with my wife.” Said an enthusiastic Muiruri, who is also a pastor.

Robert, said that including men in ending GBV was important and bodaboda riders, (who are mostly men) can be used to end GBV other than being used during political campaigns.

Dr. Lilian Otiso – Director of Services at LVCT Health, shared some lessons learnt in integrating GBV and HIV.

“We started by informing our service providers that there was GBV and they needed to document it. After documenting the cases of GBV within our HIV services, we developed a package of service and trained our care givers on how to handle GBV cases. Due to the work load on the counsellors that could easily lead to burn-out. We got dedicated staff who support and offer mentorship to the counsellors to document GBV cases.” Said Lilian

As a leader in Partner Notification Services (PNS) in reaching people at risk of HIV infection, LVCT Health has also come across cases of GBV which have proved challenging at times.

“As we implement PNS we have discovered that it can lead to violence, especially on disclosure and when following up contacts. Hence we try to avoid any cases that may lead to violence, when a client indicates that there is risk of violence we stop at that. Our counsellors have also faced threats from partners of PNS index clients, through phone calls and physical violence.”

Dr. Carol Ngunu the Deputy Director for Preventive and Promotive Health in the Nairobi City County shared their experience in scaling up of GBV/HIV integration services in Nairobi County,

“A service provision assessment in 2013 revealed that two thirds of women coming for ANC services in Nairobi were reporting cases of GBV. To address this, we trained 210 health care providers and 50 CHV in GBV reporting over the last 2 years, most of these service providers work in comprehensive care centres and the training helped them to handle, screen and refer GBV cases. We also have a County technical working group that brings together all the stakeholders; medical, children services, police and judicial officers for a unified agenda of ending violence and improving access of services to GBV survivors.” Said Carol

Nairobi is one of the counties which has effectively integrated GBV/HIV services, through the social workers within the public health facilities and has achieved a 66% reporting from 15% in 2 years.

Dr. Ngunu advised the counties to own their problems, quantify them and leverage on existing resources from different partners. She encouraged them to build capacity of health care workers, get community buy-in and involve men in addressing the challenges faced in GBV cases.

The session concluded with a confirmation that it was time for action, participants were encouraged to start the process of integrating and to reach out to all the stakeholders within the county to harness the available resources.

By Alfred Itunga

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