Gender-Based Violence and HIV/AIDS: Emerging Lessons from the PEPFAR Initiative in Tanzania

"In April [2012], I traveled to Tanzania to examine how the GBV initiative is being implemented. I found that, although still early in implementation and facing many challenges, the GBV initiative has the potential to yield important lessons about synergies in reducing GBV and HIV, with clear implications for U.S. global health investments."

In this Global Health Policy Center report, the President’s Emergency Plan for AIDS Relief (PEPFAR) gender-based violence (GBV) initiative is analysed as to its effectiveness and potential in Tanzania. Because country studies show a four-fold higher risk of HIV and sexually transmitted infections (STIs) among women in countries with elevated levels of GBV, this United States (US) government-sponsored initiative in Tanzania, Democratic Republic of Congo (DRC), and Mozambique works to strengthen GBV and HIV programmes.

In Tanzania, the initiative seeks to provide comprehensive services for survivors of GBV, strengthen community-based responses and referral networks, and work with men on changing attitudes and behaviours. In the process of organisation of implementers, EngenderHealth was designated to coordinate information sharing on emerging best practices, including a visitor exchange with Raising Voices of Uganda to study their SASA! approach. Pathfinder was designated to provide clinical technical and logistical support including an in-service training curriculum for health workers.

Implementing partner programmes include:

• Tutunzane: A home-based care provider programme with GBV training to sensitise communities
• The CHAMPION Project (Channelling Men's Involvement in the National Response to HIV and AIDS): A programme promoting dialogue about men's roles, including GBV training using both the Men as Partner's (MAP) curriculum and SASA! approach, as well as community outreach (CAT) teams.
• Pamoja Tuwalee: an orphan and vulnerable children (OVC) programme, including community sensitisation on GBV and clinical referrals for GBV survivors.

As stated by the author in her abstract: "Important questions remain about whether the GBV initiative will get traction beyond the short life of its PEPFAR funding and whether the initiative will serve as a vehicle for a more sustainable response.

To demonstrate success, the report says that the GBV initiative will have to show:

•     That the national government has made GBV a national policy priority;
• That integrating GBV into HIV platforms produces constructive outcomes in prevention and access to services at the clinical level, and in the development of support structures and referral networks at the community level;
• That these programs are sustainable over the longer term, by becoming part and parcel of public sector health services and training;
• That high level leadership is sustained at the country level and in Washington, including that bipartisan support in the U.S. can be maintained and expanded."