The National Strategy on Gender Equity and Equality, released by the White House in October 2021, is the first whole-of-government approach outlining a comprehensive agenda to advance gender equity and equality in domestic and foreign policy. USAID is committed to addressing the unique needs of women, men, girls, boys, and LGBTQIA+ individuals – of all ages and abilities – so they are able to utilize HIV prevention and treatment services; protect themselves and practice healthy behaviors; exercise their rights; and live free from violence, stigma, and discrimination.
USAID prohibits sexual misconduct, including harassment, exploitation or abuse of any kind among staff or implementing partners. USAID’s Action Alliance For Preventing Sexual Misconduct (AAPSM) is working to prevent and address sexual exploitation and abuse in USAID programs, and also prevent and address workplace sexual misconduct, including among implementing parnters. USAID’s Child Safeguarding Policy and Award Requirements for Implementing Partners are designed to prevent and prohibit all forms of child abuse, exploitation, and neglect in USAID-funded awards. USAID’s PEPFAR-funded programs have a duty to: 1) ensure that programs and services do no harm; 2) put in place measures to enhance the safety and security of clients; and 3) provide response services for survivors of violence.
Barriers and Solutions to Addressing Gender Inequality and Gender-Based Violence
Addressing violence and inequality throughout PEPFAR programs, across the HIV clinical cascade and HIV prevention, is essential to advancing human rights and reaching sustained HIV epidemic control. USAID’s approach is grounded in World Health Organization (WHO) clinical and policy guidelines, including the provision of first-line support to survivors of violence.
Graphic 1: Barriers to Epidemic Control
Evidence-based HIV Prevention Approaches
- Harmful gender norms and inequitable attitudes about gender put individuals at risk for HIV and serve as a barrier to uptake of HIV prevention, testing, and care and treatment services.
Initiate on PrEP
- Violence is a barrier to PrEP initiation and adherence. Qualitative evidence suggests that violence can also occur as a result of PrEP use.
Access HTS (95%)
- Violence and harmful gender norms inhibit one’s ability to access HTS and disclose their status. Many people report fear of violence and/or abandonment if their partner learns their status.
Care and Treatment
Initiate on ART (95%)
- Harmful gender norms often inhibit men’s health-seeking behaviors. Violence is associated with reduced linkage to HIV care services and initiation on ART.
Continue on ART & viral suppression (95%)
- Women who experience violence are less likely to adhere to treatment and achieve viral suppression. Violence is also associated with reduced ART adherence among adolescents, transgender women, and drug users.
Graphic 2: USAID’s Solutions: Addressing Violence and Inequality Across the HIV Cascade
Evidence-based HIV Prevention Approaches
- HIV prevention interventions must integrate GBV prevention and link to the clinical cascade. Initiate on PrEP
- Integrated GBV case identification and first line support and referrals to GBV services help increase PrEP adherence.
Access HTS (95%)
- GBV case identification and first-line support is a minimum standard of safe and ethical index testing services and supports treatment initiation or uptake of prevention services.
Care and Treatment
Initiate on ART (95%) & Continue on ART & viral suppression (95%)
- Integrated GBV case identification and first- line support should become standard in HIV treatment, with survivors provided with or referred to GBV clinical care.
- Increasing the reach and improving the quality of GBV services is critical to support retention and adherence to HIV treatment.
USAID’s Strategic Vision for Advancing Gender Equality and Preventing and Responding to Gender-Based Violence in HIV Services
USAID’s Office of HIV/AIDS strategy to address gender inequality and gender-based violence (GBV), including violence against children, is rooted in USAID and PEPFAR priorities, and emphasizes the seamless integration of interventions to address GBV and promote gender equality across HIV prevention programming and the clinical cascade.
Graphic 3: Country Operational Planning 2021: Aligning Vision to Action
Routine data analysis & response
- Grow → Quality → Sustain
- Grow the program
- Grow the program by increasing its reach in order to…
- Support quality & innovation
- ...Retain at-risk individuals, PLHIV, and GBV survivors in innovative and high quality services, and…
- Sustain our investments
- ...Sustain USAID’s investments by strengthening partnerships, supporting the health and social service workforce, and reducing structural inequalities.
Incidents of GBV and violence against children have sharply increased during the COVID-19 pandemic, forming a “shadow pandemic” that threatens efforts to achieve and sustain HIV epidemic control. USAID is committed to scaling up GBV prevention, case identification, and response efforts across all areas of PEPFAR programming to support survivors’ ability to access HIV and GBV response services. USAID has provided training on GBV first-line support (LIVES) and violence against children prevention and response to its staff and implementing partners to advance these efforts.
Graphic 4: How to GROW the program
Increase identification, reach, and retention across the HIV prevention and clinical cascades.
- GBV Prevention and Gender Transformative Approaches
- GBV Case Identification, First-line Support, & Linkages between Community and Facility Services
- GBV Clinical Care in HIV Treatment Services and ‘One-Stop’ or Specialized Sites
- Engage Boys and Men across the HIV Prevention and Treatment Clinical Cascade and Structural Interventions
USAID emphasizes quality for all of its HIV/GBV services and encourages innovation to identify gender sensitive and community-specific approaches to prevent and respond to GBV and advance efforts to achieve HIV epidemic control. This has been especially important during the COVID-19 pandemic, as USAID has identified and implemented adaptations to its clinical GBV-response service delivery to respond to the unique needs of survivors during COVID-19 lockdowns, travel restrictions, and school closures. These adaptations have included expanding the use of virtual counseling and hotlines, transportation assistance to help survivors reach services, and decentralized services using mobile outreach to deliver care and support to survivors.
Graphic 5: How to SUPPORT service quality and promote innovation
Innovation and Adaptation of Services
- COVID-19 adaptations
- Rural response systems to reach GBV survivors
- Engaging boys and men
- Trauma-informed care for
- PLHIV and GBV survivors
Program Monitoring for Performance and Quality
- Site- and IP-specific performance monitoring
- Ensure minimum standards are met to ensure quality care
- GBV Quality Assurance and Program Monitoring Tools
- Custom program indicators and analytics
Sustainability is a key priority for USAID’s integrated HIV/GBV programming. USAID works with national governments, local partners, and indigenous and civil society organizations to enhance the sustainability of PEPFAR’s GBV interventions to facilitate lasting and gender transformative change that improves the lives, health, and safety of survivors of violence and people living with HIV.
Graphic 6: How to SUSTAIN USAID’s investments
Complementary and Integrated Policies and Strategies
- Integrate GBV prevention and response into HIV clinical services and policies.
- Expand partnerships to advance gender equality and prevent and respond to GBV.
Sustaining Technical Capacity
- Sustain technical capacity to deliver high quality, innovative services and support the health and social service workforce.
- Support community-led monitoring and engagement for program quality and accountability.
What Does Success Look Like?
USAID’s strategy to address gender inequality and GBV includes growing the program, supporting quality and promoting innovation, and sustaining USAID’s investments as a key component to achieving HIV epidemic control. Essential to this strategy is ensuring that all clinical partners are able to identify and respond to cases of violence. There are multiple means of measuring the success USAID’s HIV/GBV programming, which includes but is not limited to:
- Quarter to quarter growth in key program indicators
- Use of innovative and flexible strategies to reach and retain clients
- Accessible, acceptable, and appropriate HIV and GBV services
- Locally-led partnerships and solutions
- Improvements in measures of gender equality
For more information about USAID’s PEPFAR-funded gender-based violence prevention, case identification, and response efforts, please see USAID’s Advancing Gender Equality and Preventing and Responding to Gender-Based Violence.