As the 16 Days of Activism Against Gender Violence come to an end this week, it is important to highlight the often-overlooked intersection between gender-based violence (GBV) and its impact on HIV risk and access to HIV prevention and treatment for most-at-risk populations (MARPs). Gender inequities that cause GBV, including both physical and sexual violence, are key drivers of the HIV epidemic. While this is often well-recognized and addressed in generalized HIV epidemics, efforts to integrate GBV prevention and response into programs for MARPs are less apparent.
Around the world, GBV is experienced at high rates by persons who use drugs and their sexual partners, persons who engage in sex work (SWs), and men who have sex with men (MSM). Substance abuse is associated with both recent and lifetime experience of GBV. Research reveals that recent violence more than doubles the risk of illicit drug use in women and that sex partners of people who use drugs are at a particularly high risk of GBV. Such evidence has substantial implications for HIV prevention efforts targeting people who use drugs. The environments that drive initiation into sex work, and the contexts where it is managed and sold, produce a variety of risks including coercion, physical injury, forced sex, infections and substance abuse.
While GBV programs primarily focus on women and girls as beneficiaries, GBV is also targeted toward MSM. Such GBV is experienced both early in life, often as child sexual abuse, and later as punishment for breaking social norms around masculinity or in an effort to prove masculinity. Among MSM, GBV is associated with HIV and other sexually transmitted infections, substance use and mental health problems.
The President's Emergency Plan for AIDS Relief (PEPFAR) recognizes the need to plan, implement and evaluate strategies to prevent and respond to GBV within programs for people who use drugs, SWs and MSM. The recently released Gender-Based Violence and HIV: A Program Guide for Integrating Gender-Based Violence Prevention and Response in PEPFAR Programs offers specific guidance and resources for integrating GBV within programs for MARPs.
PEPFAR just completed the second round of our Gender Challenge Fund, which was focused entirely on countries with concentrated HIV epidemics. Three proposals were selected in this round, with over $1.5 million in additional funding. All three will address GBV among MARPs in one way or another. In Central America, the U.S. and national government agencies will collaborate on programs to reduce GBV among MSM and SWs. In the Central Asia Republics, PEPFAR teams will work with partners to raise awareness and strengthen GBV prevention for SWs, female persons who inject drugs and their sex partners. In India, projects will improve access to HIV testing, care and treatment services and address GBV for high-risk women within the context of a concentrated HIV epidemic.
Finally, we have also focused on the technical side, supporting countries to implement efficient and effective programs for MARPS. Over the past six months, PEPFAR has hosted a series of regional trainings on HIV and drug use, including for the Eastern Europe/Central Asia and South/Southeast Asia regions, with a cross-cutting focus on gender, including GBV. The meetings brought together representatives from U.S. and national governments, civil society, and multilateral agencies to share country experiences, develop collaborative relationships, and disseminate PEPFAR's 2010 Comprehensive Guidance on HIV Prevention for People Who Inject Drugs. This guidance supports the implementation of evidence-based interventions for PWID, including services that meet the specific and comprehensive needs of both male and female PWID. Participants gained an understanding of gender issues relevant to concentrated epidemics, and civil society shared promising practices for responding to GBV in programs for people who use drugs, SWs and MSM.
While more programs, policies and science are still needed to address GBV in MARPs, momentum is building to fill existing gaps. By capitalizing on PEPFAR's existing platforms, proven interventions for HIV prevention among MARPs, and the range of partners supporting this work, we can continue to make progress that will bring us closer to the goal of an AIDS-free generation.
Daniela Ligiero serves in the State Department's Office of the Global AIDS Coordinator, Sasha Mital at the Centers for Disease Control (CDC) Division of Global HIV/AIDS, and Diana Prieto at the U.S. Agency for International Development (USAID) Office of HIV/AIDS. They are co-chairs of the PEPFAR Gender Technical Working Group.