Addressing Stigma and Gender-Based Violence to Improve HIV Service Delivery to Key Populations: Findings From a Rapid Assessment

"In Guyana, there is concern that KPs [key populations] are not being adequately reached with [HIV prevention and treatment] services and that insufficient frameworks, policies, and regulations are contributing to the marginalization of those at greater risk of HIV infection."

From Advancing Partners & Communities (APC) Project, implemented by JSI Research Training Institute in partnership with FHI360 and The International Center for Research on Women (ICRW), this rapid assessment was conducted in Guyana to gather information on the programmatic and capacity needs of the non-governmental organisations (NGOs) supported through APC "to implement services for key populations as well as the structural challenges faced by these NGOs." Interviews and focus group discussions (FGDs) with staff from fifteen NGOs and nine key stakeholders from the Government of Guyana (GOG) and development agencies were conducted in 2014 to find new structural and programmatic directions and capacity strengthening needs to inform the development of a training course and ongoing technical assistance for capacity building to integrate stigma and discrimination (S&D) and GBV prevention and response activities and expand services of local organisations. The 90-minute interviews were transcribed and analysed for key themes and findings

Because adult prevalence of HIV in Guyana in 2014 was low (1.4%) but as high as 19.4% among men who have sex with men (MSM) and 16.6% among female sex workers (FSWs), KPs, including as well transgender (TG) individuals, sex workers (SWs), and women, were the focus of concern in trying to reach KPs with services. S&D includes shaming, despite programmatic efforts at stigma reduction due to high staff turnover,  particularly among police and health care workers. Homophobia and the illegal status of same-sex sexual behaviour reduce willingness to engage with police over intimate partner violence. SWs are less willing to seek prevention, care, and treatment services or police help due to S&D, and Transgender (TG) individuals can face extreme violence.

The Ministry of Health requires posting of a non-discrimination policy at health centres and now requires that anonymous suggestion boxes be placed in health facility waiting areas so clients can report bad experiences or abuse. A disincentive is the placement near reception desks. Work in secondary schools on stigma through sessions on HIV, sexuality, and violence in the classroom setting or through after-school sports-based programmes has revealed that students prefer to talk with social workers, not teachers, in the sessions. Workplace training has yielded mixed results and limited employment of people living with HIV (PLHIV). Women who suffer GBV are hesitant to leave their husbands, often for reasons of economic dependence.

Structural direction recommendations include:

• Rigorous training in professional schools - doctors, nurses, social workers, police, and teachers - on S&D pertaining to HIV and KPs. Trainings on harmful gender norms that perpetuate GBV should be integrated into the curriculum of professional training programmes.
• Training of police officers for appropriate and effective GBV response and violence prevention, including ending police abuse.
• Expanding shelter and economic empowerment opportunities for survivors of violence so that they can exit abuse relationships.

New programmatic directions include:

• Shift norms among the general population through, for example: "support in developing media campaigns and edutainment initiatives to foster community and national dialogue and change" and work "specifically with men for violence prevention, stigma reduction, and the promotion of healthy masculinities."
• "Expand educational sessions with youth in schools...to promote sexual health and reduce harmful gender norms and stigmatizing attitudes."
• "Expand and enrich support groups for KPs..." through support group sessions to help clients overcome internalised stigma and engage in health-protective behaviour.
• "Empower survivors of violence to facilitate exiting a relationship." 

Capacity-strengthening needs of NGOs include:

• "Training in basics of GBV (including IPV, non-partner sexual assault, and hate-based violence and harassment)
• A GBV screening tool and training on how to use it
• Refresher training on stigma, with a focus on KPs
• Support to monitor and evaluate their efforts to reduce stigma and GBV
• Support to expand and develop new edutainment strategies to reach the general population"