PATH editor Laura Anderson brings us this interview with Elizabeth Rowley, a gender and gender-based violence (GBV) researcher who works with our HIV/AIDS and Tuberculosis Program at PATH.
What should PATH staff know about GBV?
There are different definitions of GBV. The definition from the US Agency for International Development is useful: Violence directed at an individual based on their sex, gender identity, or perceived adherence to socially defined norms of masculinity and femininity.
GBV is fueled in large part by inequitable gender norms. It can affect people at different points in their lives and ranges from intimate partner violence to sexual coercion and abuse to child marriage. Each of these can have physical, sexual, or emotional dimensions. GBV is perpetrated against men as well as women, but the vast majority of cases involve violence against women and girls.
GBV is widespread. The World Health Organization reports that about one in three women worldwide has experienced either physical or sexual intimate partner or non-partner sexual violence in her lifetime. Adolescents are at particular risk, in part because many girls and boys have not yet developed the knowledge, experience, or self-confidence to deal with GBV when confronted by it.
How is GBV connected with poor health?
We know that some women are at an increased risk for intimate partner violence during pregnancy, with adverse outcomes for both the mother and developing baby. Research indicates that maternal exposure to this type of violence is associated with poor child nutrition outcomes and morbidity. Research also links women’s empowerment, including the ability to have joint decision-making with their partners, to increased use of contraceptives. In many settings, women who suffer from violence have higher rates of unintended pregnancy compared with those who do not.
Women in violent relationships are at an increased risk of HIV infection because the same gender inequities that promote violence against women can also limit their say in condom use and the frequency of sex. Studies from various settings also point to increased sexual risk-taking among men who use violence in intimate partnerships, compared to those who do not, which may make them more likely to acquire HIV. It also affects HIV diagnosis and treatment, since many HIV-positive women fear that they will be beaten if their partners discover they have had an HIV test, or if they disclose their HIV status to their partners. This can complicate treatment adherence and makes it difficult to reach partners for testing.
How are PATH and our partners addressing GBV?
Finding solutions to a challenge as complex as GBV may seem daunting, but PATH is improving GBV prevention and response, both at health facilities and in communities, and is evaluating programmatic approaches to GBV prevention.
For example, in the Democratic Republic of the Congo, PATH integrates care for survivors of sexual violence into prevention of mother-to-child-transmission of HIV. This includes introduction of an HIV screening tool, training to help health care workers respond to the needs of clients who have experienced violence or may be at risk of violence, and the provision of equipment and supplies to facilitate medical care if needed.
In Kenya, PATH has developed a family-based approach to address GBV during adolescence. Through the APHIAplus Western project, the team has adapted a successful “peer families” approach, which focuses on improving family relationships and communication skills to address social norms linked to GBV.
These two very different approaches—one based in the health system, the other targeting family and community structures—are both important. PATH is also conducting an evaluation of a community empowerment program in Senegal to investigate whether informal education and community organizations in rural communities can contribute to a decrease in intimate partner violence.
This interview originally published in Spotlight, PATH’s internal newsletter.