Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic

Abstract

Experiences of gender-based violence (GBV) are associated with increased vulnerability to HIV and difficulty accessing HIV services; at the same time, people living with HIV are at an increased risk of GBV. Key populations most affected by HIVgay and other men who have sex with men, female sex workers and transgender womenalso experience a disproportionate burden of GBV. In Puerto Plata, Dominican Republic, a local civil society organisation has led efforts to improve and integrate GBV and HIV services while making them welcoming to key population members and people living with HIV. According to interviews with service providers and service users and an analysis of service statistics, the intervention improved service quality and coordination, increased disclosures of violence and increased GBV response service uptake among the general population, key population members and people living with HIV. Findings also suggest that the intervention increased the uptake of HIV services, including HIV testing and post-exposure prophylaxis, and improved mental health among those receiving GBV response services. This case study of integrated GBV and HIV services describes a new model for simultaneously, synergistically and inclusively addressing two major epidemics negatively affecting health and well-being in affected communities today.

A Systematic Review of Gender-Based Violence Prevention and Response Interventions for HIV Key Populations: Female Sex Workers, Men Who Have Sex With Men, and People Who Inject Drugs

“…Examples of GBV prevention, response, and accountability through victim identification, care, and support were supported by promising practice reports across FSW (Bhattacharjee, Musyoki, et al, 2018; Dayton et al, 2020; Janssen et al, 2009; Longwill et al, 2012), MSM (Betron, 2009; Bhattacharjee, Musyoki, et al, 2018; Dayton et al, 2020; Wertheimer, 1990), and PWID (Foreman-Mackey et al, 2019; Janssen et al, 2009). These approaches included health system–based GBV screening and referral for MSM (Betron, 2009); peer educator delivered empowerment and support services (Bhattacharjee, Morales, et al, 2018; Bhattacharjee, Musyoki, et al, 2018; Huschke, 2019), rapid crisis response, counseling and access to care and justice for FSW (Euser et al, 2012; Longwill et al, 2012), and MSM (Wertheimer, 1990); and street-based safe spaces for PWID and PWID-FSW, which generated reductions in violence and an improved sense of safety (Foreman-Mackey et al, 2019; Janssen et al, 2009).…”

“…After removal of within-population duplicate results, the search total was 4,891 (2,079 FSW, 1,479 PWID, and 1,333 MSM). A total of 32 unique interventions met inclusion criteria and were included (21 FSW, seven PWID, and nine MSM, not mutually exclusive) ; one intervention targeted FSW and PWID (Janssen et al, 2009), two targeted FSW and MSM (Bhattacharjee, Musyoki, et al, 2018; Dayton et al, 2020), and one targeted all three key populations (Jaiyebo, 2018). These articles are included within each respective target population.…”

“…Several multisectoral interventions were implemented in India, all of which blended community mobilization and building of social capital with other features including legal empowerment and crisis response (Beattie et al, 2010; Table 1); unionization, peer education, access to legal action, rights-based advocacy, and structured protests (Gooptu & Bandyopadhyay, 2007; Misra et al, 2000); and a rapid-response crisis team for medical, legal, and psychosocial support (Javalkar et al, 2019) as well as violence advocacy and rights promotion (Euser et al, 2012). In the Dominican Republic, integrated GBV and HIV services including empowerment sessions and individual counseling were provided to FSW and other People Living With HIV (PLHIV), including MSM, by trained peer educators (Dayton et al, 2020). In Vancouver, Canada, a peer support intervention utilized a van to provide community-based harm reduction, trauma support, and emergency medical care (Janssen et al, 2009).…”

Gender violence perpetrated against trans women

“…Scientific evidence on gender-based violence perpetrated against trans women is presented in different forms and severities in different contexts (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) . It is essential to highlight that 78.8% of the murders of transgender and gender non-compliant people in the world occur in Latin America and the Caribbean, being derived from gender violence and transphobia that oppresses and makes abject the lives that affront the gender normativity (34) .…”

“…Gender violence gives the person, in general the woman, the distorted image of less control and power over themselves in relation to a dominant figure, most of the time, male. The latter believes that they can even control the lives they judge to be inferior, which, in the condition of trans women, causes more exposure to social and health problems, such as HIV and other morbidities (20)(21)25,27,29,32,35) . Gender violence perpetrated against trans women is supported by female behavior and the expression of this woman's identity, permeating the psychological, verbal, physical, economic, sexual, family and labor fields, with a worsening of the context of exclusion and stigma (36) .…”