|

OCTOBER 2011

This publication was produced by the AIDS Support and Technical Assistance Resources (AIDSTAR-One) Project, Sector 1, Task 

Order 1, USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.

______________________________________________________________________________________

GENDER-BASED VIOLENCE AND 

HIV

A PROGRAM GUIDE FOR INTEGRATING GENDERBASED VIOLENCE PREVENTION AND RESPONSE IN 

PEPFAR PROGRAMS 

The authors' views expressed in this publication do not necessarily reflect the views of the U.S. Agency for 

International Development or the United States Government.

GENDER-BASED VIOLENCE 

AND HIV

A PROGRAM GUIDE FOR INTEGRATING GENDERBASED VIOLENCE PREVENTION AND RESPONSE IN 

PEPFAR PROGRAMS
AIDS Support and Technical Assistance Resources Project

AIDS Support and Technical Assistance Resources, Sector I, Task Order 1 (AIDSTAR-One) is funded by the 

U.S. Agency for International Development under contract no. GHH-I-00–07–00059–00, funded January 31, 

2008. AIDSTAR-One is implemented by John Snow, Inc., in collaboration with Broad Reach Healthcare, 

Encompass, LLC, International Center for Research on Women, MAP International, Mothers 2 Mothers, 

Social and Scientific Systems, Inc., University of Alabama at Birmingham, the White Ribbon Alliance for Safe 

Motherhood, and World Education. The project provides technical assistance services to the Office of 

HIV/AIDS and USG country teams in knowledge management, technical leadership, program sustainability, 

strategic planning, and program implementation support.

Recommended Citation 

Khan, Alia. 2011. Gender-based Violence and HIV: A Program Guide for Integrating Gender-based Violence Prevention 

and Response in PEPFAR Programs. Arlington, VA: USAID’s AIDS Support and Technical Assistance 

Resources, AIDSTAR-One, Task Order 1.

Acknowledgments

Many thanks to the members of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Gender 

Technical Working Group for its leadership in conceptualizing and overseeing the development of this guide. 

Thanks also to the following individuals for their participation in the Technical Advisory Group consultations 

to develop this guide and for their thoughtful review and contributions: Avni Amin (World Health 

Organization [WHO]), Ginna Anderson (International Community of Women Living with HIV), Doris 

Bartel (CARE), Claudia Briones (UN Women), Manuel Contreras (International Center for Research on 

Women [ICRW]), Mary Ellen Duke (U.S. Agency for International Development [USAID]), Mary Ellsberg 

(ICRW), Diane Gardsbane (EnCompass LLC), Jill Gay (independent consultant), Jessie Gleckel (U.S. Health 

and Human Services Centers for Disease Control and Prevention [CDC]), Alessandra C. Guedes (Pan 

American Health Organization/WHO), Andrea Halverson (USAID), Daniela Ligiero (Office of the U.S. 

Global AIDS Coordinator), Ronnie Lovich (Save the Children), Lyn Messner (EnCompass LLC), Sasha Mital 

(CDC), Claudia Garcia Morena (WHO), Kellie Moss (Kaiser Family Foundation), Patricia Poppe (Johns 

Hopkins University Center for Communication Programs), Diana Prieto (USAID), Samira Sami (CDC), Kai 

Spratt (USAID), and Pamela Wyville-Staples (USAID). Thanks to the following PEPFAR Technical Working 

Groups for reviewing relevant sections of the guide: HIV Testing and Counseling, Prevention of Mother-toChild Transmission, Orphans and Vulnerable Children, Most at-Risk Populations, and Adult Treatment; and 

to the AIDSTAR-One Gender Team for their support in the development and publication of this guide. 

AIDSTAR-One 

John Snow, Inc.

1616 Fort Myer Drive, 11th Floor

Arlington, VA 22209 USA

Phone: 703-528-7474

Fax: 703-528-7480

E-mail: info@aidstar-one.com

Internet: aidstar-one.com
iii

CONTENTS

Acronyms............................................................................................................................................................................. v

Introduction ........................................................................................................................................................................ 7

Why Link Gender-based Violence and HIV Programs?....................................................................................... 7

The Case for Integrating Gender-based Violence Services................................................................................ 8

About this Guide .......................................................................................................................................................... 9

Limitations of the Guide ........................................................................................................................................... 10

How to Use the Guide.............................................................................................................................................. 11

Methodology................................................................................................................................................................ 12

Guiding Principles for Working with Survivors of Gender-based Violence...................................................... 13

Guidelines for Gender-based Violence Programming ............................................................................................ 19

Prevention ......................................................................................................................................................................... 29

HIV Testing and Counseling.......................................................................................................................................... 33

Prevention of Mother-to-Child Transmission........................................................................................................... 39

Adult Treatment.............................................................................................................................................................. 45

Care and Support ............................................................................................................................................................ 51

Orphans and Vulnerable Children............................................................................................................................... 55

References......................................................................................................................................................................... 59

Recommended Resources............................................................................................................................................. 61
iv
v 

ACRONYMS

ACORD Agency for Cooperation and Research in Development 

ART antiretroviral therapy 

CDC Centers for Disease Control and Prevention 

CHTC couples HIV testing and counseling 

FHI Family Health International (now known as FHI 360) 

GBV gender-based violence 

GNP+ Global Network for People Living with HIV 

HTC HIV testing and counseling 

IASC Inter-Agency Standing Committee 

ICRW International Center for Research on Women 

IGWG Inter-Agency Gender Working Group 

IHAA International HIV/AIDS Alliance 

IPPF International Planned Parenthood Federation 

IRC International Rescue Committee 

M&E monitoring and evaluation 

MARP most-at-risk population 

MSM men who have sex with men

OHA Office of HIV/AIDS 

OVC orphans and vulnerable children 

PAHO Pan American Health Organization 

PEPFAR U.S. President’s Emergency Plan for AIDS Relief

PLHIV people living with HIV 

PMTCT prevention of mother-to-child transmission 

RHRC Reproductive Health for Refugees Consortium 

STI sexually transmitted infection

UNAIDS Joint U.N. Programme on HIV/AIDS 

UNDAW U.N. Division for the Advancement of Women

UNFPA U.N. Population Fund 

UNHCR U.N. Refugee Agency
vi

UNICEF U.N. Children’s Fund 

UN Women U.N. Entity for Gender Equality and the Empowerment of Women 

USAID U.S. Agency for International Development 

WHO World Health Organization 
7 

INTRODUCTION 

While there is mounting evidence that gender-based violence (GBV) is both a cause and 

consequence of HIV infection, programs and services designed to address these pandemics are 

largely fragmented. This guide offers a starting point for U.S. President’s Emergency Plan for AIDS 

Relief (PEPFAR) program managers to integrate a basic response to GBV within existing HIV 

programs and to establish linkages with other efforts that are addressing GBV. 

WHY LINK GENDERBASED VIOLENCE AND 

HIV PROGRAMS?

Violence or the fear of violence can pose 

formidable barriers to HIV prevention, care, 

and treatment, limiting individuals’ ability to 

learn their status and adopt and maintain 

protective measures ranging from negotiating 

safer sex to getting and staying on treatment to

remaining in school (Gardsbane 2010; World 

Health Organization [WHO] and the Joint U.N. 

Programme on HIV/AIDS [UNAIDS] 2010). 

Similarly, violence can impede access to basic 

health information and services, including HIV 

treatment, care, and support. Conversely, a 

positive test result can lead to stigma, 

discrimination, isolation, and violence in the 

home and community, magnifying the 

vulnerabilities that women, girls, orphans and 

vulnerable children (OVC), and other at-risk 

populations already face in pursuing healthy, 

satisfying, and productive lives (Hale and 

Vazquez 2011). Research studies from India, 

Kenya, Rwanda, South Africa, Tanzania, the 

United Kingdom, the United States, and 

Vietnam demonstrate that women who are 

HIV-positive are more at risk of violence than 

women who are HIV-negative, and that 

violence is a major contributing factor to HIV 

infection (Program on International Health and 

Human Rights and Harvard School of Public 

Health 2009). 

Defining Gender-Based Violence

In the broadest terms, “gender-based 

violence” is violence that is directed at an 

individual based on his or her biological sex, 

gender identity, or his or her perceived 

adherence to socially defined norms of 

masculinity and femininity. It includes physical, 

sexual, and psychological abuse; threats; 

coercion; arbitrary deprivation of liberty; and 

economic deprivation, whether occurring in 

public or private life. 

GBV takes on many forms and can occur 

throughout the lifecycle, from the prenatal 

phase through childhood and adolescence, the 

reproductive years, and old age (Moreno 

2005). Types of GBV include female 

infanticide; harmful traditional practices such 

as early and forced marriage, “honor” killings, 

and female genital cutting; child sexual abuse 

and slavery; trafficking in persons; sexual 

coercion and abuse; neglect; domestic violence; 

and elder abuse. 

Women and girls are the most at risk and most 

affected by GBV. Consequently, the terms 

“violence against women” and “gender-based 

violence” are often used interchangeably.

However, boys and men can also experience 

GBV, as can sexual and gender minorities, 

such as men who have sex with men and

transgender persons. Regardless of the target, 

GBV is rooted in structural inequalities 

between men and women and is characterized 

by the use and abuse of physical, emotional, or 

financial power and control. 
8 

Like HIV, GBV has implications for almost every aspect of health and development from access to 

and use of health services to educational attainment, economic empowerment, and full enjoyment of 

human rights. The similarities between these two mutually reinforcing pandemics do not end there. 

Women, girls, and other at-risk populations’ distinct vulnerability to HIV and GBV are rooted in 

structural inequalities—i.e., unequal power relationships based on biological sex, gender identity, and 

sexual orientation—that are codified via cultural beliefs and societal norms and are reinforced in 

political and economic systems. 

Linking GBV and HIV efforts is both a necessary and a potentially powerful strategy for eliminating 

the structural drivers of each and achieving lasting results in the fight against HIV. Both require a 

comprehensive response: one that simultaneously addresses the biomedical, behavioral, and social 

risk factors and implications for affected populations. Both require well-coordinated, multi-sectoral 

efforts that address the multiple dimensions in which violence and HIV infection can affect peoples’ 

lives, including their health, education, social interactions, economic opportunities, safety, legal 

protections, and human rights. And both must be addressed on a continuous basis throughout the 

lifecycle to ensure lasting results. 

THE CASE FOR INTEGRATING GENDER-BASED 

VIOLENCE SERVICES

Integrated health services provided within the context of well-coordinated referral networks and 

social services is a recognized strategy for meeting the unique health needs of women and children 

(Ferdinand 2009; Global Health Initiative n.d.; Women Won’t Wait 2010). While health services and 

programs may be fragmented, individual health and social needs are comprehensive, including 

multiple types of care (e.g., primary care, family planning and sexual and reproductive health, 

antenatal and maternal health care, child health) and social services (e.g., education, livelihood 

programs, legal assistance). Strengthening linkages and integration between and among services can 

increase access, which is a fundamental priority for individuals who already face barriers due to 

poverty, low social status, lack of education, stigma, discrimination, and GBV (Keesbury and Askew 

2010; Morel-Seytoux et al. 2010).

Emerging evidence regarding integrated programs has found that access to comprehensive services, 

whether through one-stop centers, co-location of services, or functional referral systems, among 

other strategies, can produce better outcomes for GBV survivors (Keesbury and Askew 2010). 

Training programs for different cadres of health care workers, police, and community leaders have 

been shown to increase individuals’ comfort level with respect to addressing GBV, paving the way 

for victim-centered services, community-based violence prevention efforts, increased utilization of 

HIV testing and counseling (HTC) services, and better adherence to antiretroviral therapy (ART): all 

essential elements for achieving lasting success in the fight against HIV (Keesbury et al. 2011).

Research studies and program evaluations also point to challenges to integration, largely related to 

the pressure on already overburdened health systems (Keesbury et al. 2011). Health care worker 

shortages, burnout, poor infrastructure, lack of emergency equipment and supplies, long wait times, 

and inadequate geographic coverage must be addressed not only within the context of HIV 

prevention, care, and support, but in broader attempts to integrate services (Keesbury and Askew 

2010; Keesbury et al. 2011). In addition, discriminatory norms, laws, and policies, for example, 

relating to HIV status, property rights, and high-risk behaviors, both statutory and customary, create 

an enabling environment for violence and pose barriers to receiving comprehensive, compassionate 

care that fully respects individuals’ dignity and rights (Spratt 2010). However, though challenges 
9 

exist, this should not be construed as an argument against integration. Rather, they identify clear 

priorities for ensuring that health and development efforts are gender sensitive, promote universal 

access to needed services, and respect and promote human rights. 

ABOUT THIS GUIDE

The authorizing legislation for PEPFAR specifies that PEPFAR will support five high priority areas, 

including reducing GBV and coercion, challenging negative male norms, and expanding women’s 

legal rights and protections (Lantos and Hyde 2008). This legislation includes both programmatic 

and budgetary reporting requirements on gender-sensitive activities as well as inclusion of gender 

equality in partnership frameworks. Accordingly, PEPFAR’s five-year strategy aims to link HIV 

services to broader delivery mechanisms that improve health outcomes for women and children, 

including by expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a renewed focus on addressing and reducing GBV (Office of the U.S. 

Global AIDS Coordinator 2009). Likewise, a focus on women, girls, and gender equality, including 

the prevention of and response to GBV, is a key priority of the U.S. Global Health Initiative (Global 

Health Initiative n.d.). 

This guide is designed to help PEPFAR program managers address and respond to GBV within 

HIV prevention, care, and treatment programs. It serves as a starting point for HIV programs and 

services to contribute to a comprehensive response to GBV including through direct services for 

GBV survivors, community mobilization to address the root causes of violence, capacity building 

for service providers, and policy change and leadership to create an enabling environment for 

preventing, addressing, and ultimately ending GBV. In addition to mobilizing a comprehensive 

response to GBV, the issues, strategies, and actions presented are intended to reflect consensusbased recommendations from public health experts, women’s groups, reference agencies such as 

WHO and the Centers for Disease Control and Prevention (CDC), academic researchers, 

development partners, and others. These include using an evidence- and rights-based, gendersensitive approach; fostering strong, functional linkages and integration within and between services 

and programs; mobilizing communities to address harmful gender norms that contribute to violence; 

coordinating across sectors; and monitoring and evaluating outcomes and impact to provide holistic 

services that address the legal, health, education, economic, and other needs of survivors, their 

families, and communities (see Figure 1). 

While there is increasing political momentum to end GBV, including through greater integration and 

linkages with HIV programs, this guide was written with the understanding that HIV programs may 

already be operating on limited budgets and within resource-constrained settings. This is not a 

rationale for omitting or minimizing a response to GBV, but rather is an acknowledgment of the 

fact that program planners and implementers will continue to have to do more within existing 

budgets and rely on greater integration, coordination, and efficiencies within and across 

development efforts. Therefore, this guide is not intended to be prescriptive, and it does not assume 

that all programs can adopt all strategies and tactics presented here. 

Instead, it aims to assist HIV program managers and implementers to first see and understand the 

relationship between HIV and GBV. Next, it identifies opportunities for establishing linkages, for 

example, by conducting sensitivity trainings on the relationship between GBV and HIV or 

establishing relationships with women’s groups that are already working on GBV. Finally, it includes 

information on integrating basic GBV response and prevention services into existing HIV programs, 
10

Figure 1. Comprehensive, multi-sectoral response to GBV

for example, training HTC and adherence counselors to offer GBV screening, counseling, and 

referrals.

In short, this guide serves as a tool for program managers to not only begin to address GBV within 

their programs, but also to plan for greater integration and coordination within country teams when 

designing workplans and budgets. Ideally, this guide will catalyze dialogue, action, and resource 

mobilization, building on PEPFAR programs and platforms for addressing GBV with national 

governments, implementing partners, and other key stakeholders. 

LIMITATIONS OF THE GUIDE

This guide represents a starting point for HIV programmers and planners who may have limited 

exposure to or experience with GBV and integrated programs. As such, it does not address the twoway integration of HIV services into existing GBV programs, although it should, at minimum, serve 

as a basis for dialogue with GBV service providers. Nor does the guide provide comprehensive, 

detailed technical information for implementing GBV services and programs; rather, it refers to 

existing resources that have been developed by GBV experts. Finally, this guide does not address 

GBV within the context of conflict, post-conflict, emergencies, disasters, and humanitarian 

situations. 
11

HOW TO USE THE GUIDE

The guide is divided into two parts that highlight key considerations, opportunities, and strategies 

for addressing GBV within existing HIV programs (see Figure 2). 

Figure 2. Steps for using the guide

1. The first part offers recommended practices for planning and implementing GBV programs. 

These are cross-cutting principles and actions that should be applied to any and all programs and 

services, regardless of technical area, sector, or approach (e.g., direct services, community 

mobilization, policy advocacy). 

a. Guiding principles for working with GBV survivors. This section outlines the guiding principles 

that should be adopted before a GBV response is integrated into HIV programs and that 

should be monitored while programs are being implemented. These principles are meant to 

protect the rights, privacy, and dignity of those at risk for GBV as well as GBV survivors to 

prevent further harm within service-based program settings.

b. Guidelines for GBV programming. This section provides an overview of the basic steps for 

planning, launching, and evaluating efforts to address GBV, including consulting with 

stakeholders, conducting a situational analysis, developing workplans, establishing a 

monitoring and evaluation (M&E) plan, and budgeting.

2. The second part presents issues, opportunities, and actions for addressing GBV within each 

PEPFAR technical area through the lens of PEPFAR priorities (e.g., integrating GBV within 

HTC clinical services and addressing GBV in treatment adherence programs). Each technical 

section can be used as a stand-alone guide; however, they are best used together in order to take 

advantage of the full range of opportunities to address GBV and to achieve the goal of greater 
12

linkages between HIV prevention, treatment, care, and support. The technical areas included in 

this guide are as follows: 

• Prevention

• HTC

• Prevention of mother-to-child transmission (PMTCT)

• Adult treatment

• Care and support

• OVC

Recommended Resources: Throughout the guide, recommended resources are identified to direct 

users to detailed technical information for implementing the integration strategies. They include 

practical tools for program planners and implementers (e.g., checklists for program managers; 

sample client intake and consent forms; training curricula and resources; and questionnaires for 

conducting situational analyses). To the extent possible, the resources selected were specifically 

developed for use in low and middle income settings and have applicability across countries. The 

resources included in this guide are illustrative; their selection does not constitute an exhaustive list 

of available expertise. Full reference information for all of the recommended resources is listed at 

the end of the guide. 

METHODOLOGY

This guide is based on an extensive review of existing English language literature for mobilizing a 

comprehensive response to GBV within the context of HIV. Keywords used in the search include 

“gender based violence,” “gender and HIV/AIDS,” “women and AIDS,” “violence against 

women,” and “sexual violence against women.” To the extent possible, articles and recommended 

resources selected for inclusion in this guide were developed or can be adapted for low- and middleincome settings. The literature reviewed includes original research, program evaluations, clinical and 

professional guidelines, resource manuals, and training materials produced by technical experts and 

normative agencies such as WHO and CDC. Also included are materials produced by civil society 

advocates and implementers working to address GBV, gender equality, human rights, development, 

HIV, and the health needs and rights of marginalized populations. The guide underwent multiple 

reviews by GBV experts, U.S. Government headquarters and field staff and PEPFAR Technical 

Working Groups. 
13

GUIDING PRINCIPLES FOR 

WORKING WITH SURVIVORS 

OF GENDER-BASED 

VIOLENCE

All programs seeking to address GBV must first and foremost protect the dignity, rights, and wellbeing of those at risk for, and survivors of, GBV. The following section outlines four fundamental 

principles for integrating a GBV response into existing programs and specific actions for putting 

these principles into practice. These principles are as follows:

• Do no harm 

• Privacy, confidentiality, and informed consent 

• Meaningful engagement of people living with HIV (PLHIV), in particular women living with 

HIV and GBV survivors 

• Accountability and M&E. 
14

Do No Harm

Service Provision

Adherence to ethical codes of conduct is particularly relevant when working with GBV survivors, namely: 

• Autonomy. The right of GBV survivors to make decisions on their own behalf. All steps taken in providing 

services are based on the informed consent of the survivor.

• Beneficence. The duty or obligation to act in the best interests of the survivor.

• Non-malfeasance. The duty or obligation to avoid harm to the survivor.

• Justice or fairness. Providing universal access to services without judgment or negative repercussions for the 

client (WHO 2003).

Actions The principle of “do no harm” translates into awareness of the needs and wishes of the 

client, displaying sensitivity and compassion, and maintaining objectivity (WHO 2003). This 

should be reinforced through:

• Organizational policies to address violence and sexual harassment

• Codes of conduct

• Sensitization of staff on issues of power and control within the context of gender 

inequality and in health service settings

• Ongoing training and support for communicating with GBV survivors, for example, 

guidance on how to ask about violence and validate survivors’ experiences 

• Hiring staff or trained volunteers from the same backgrounds as GBV survivors 

• Safety planning for GBV survivors and their families. 

Recommended 

Resources

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

Communication Skills in Working with Survivors of Gender-based Violence: Training 

manual (Family Health International [FHI], Reproductive Health for Refugees Consortium

[RHRC], and International Rescue Committee [IRC] 2004) 

Improving the Health Sector Response to Gender Based Violence: Includes a 

management checklist and tools for developing key policies and protocols, improving 

danger assessments, and providing safety plans (Bott, Guezmes, and Claramunt 2004)
15

Do No Harm

Program Design

Program planners and implementers must be fully aware of the local context in which programs and services are 

delivered to avoid further harm to GBV survivors or putting individuals at increased risk of violence and to protect 

the safety of everyone involved. Programs, services, and messages must be developed in partnership with those 

they are meant to serve and reviewed by primary stakeholders to avoid reinforcing harmful social norms and 

ensure cultural sensitivity.

Actions • Coordinate activities and messages to minimize duplication and gaps in response

• Commit to evaluation, openness to scrutiny, and external review

• Develop cultural and gender sensitivity and competence

• Stay updated on the evidence base regarding effective practices and the value of 

participatory approaches

• Involve GBV survivors in decisions on accessibility, type and quality of services, and 

communications materials (Inter-Agency Standing Committee [IASC] 2007).

Recommended 

Resources

A Manual for Integrating the Programmes and Services of HIV and Violence against 

Women: Stakeholder mapping tool (Ferdinand 2009)

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

HIV & AIDS - Stigma and Violence Reduction Intervention Manual: Tools for 

implementing community-owned processes in development programs (Duvvury, Prasad, 

and Kishore 2006)

Improving the Health Sector Response to Gender Based Violence: Rapid situational 

analysis tool; management checklist (Bott, Guezmes, and Claramunt 2004)

Virtual Knowledge Centre to End Violence against Women and Girls: Module on 

programming essentials (U.N. Entity for Gender Equality and the Empowerment of 

Women [UN Women] n.d.-a)
16

Do No Harm

Special Populations

Children and adolescents. Children and adolescents need age-specific services for post-rape care, reproductive 

health, and HIV care and support that must include protocols and counseling that are developmentally appropriate. 

Child and adolescent GBV survivors should be linked to child protective services where they exist.

Most-at-risk populations (MARPs). Sex workers, people who inject drugs, men who have sex with men 

(MSM), and transgender people are among the most vulnerable to GBV and may face stigma, discrimination, and 

violence perpetrated by the very personnel, such as health care workers and law enforcement officials, that are 

charged with protecting their health and rights (Betron and Gonzalez-Figueroa 2009; Burns 2009; Sex Workers’ 

Rights Advocacy Network 2009). Stigma and discrimination against MARPs must be proactively addressed in HIV 

programs so that these populations can access appropriate services.

Actions • Conduct ongoing training with all staff on the rights of MARPs and special needs of each 

group

• “Do more than train”; challenge stakeholders on issues of stigma and discrimination

• Establish safe virtual and physical spaces for specific MARP groups to seek information and

referrals for care and support

• Address gender barriers in accessing post-exposure prophylaxis.

Recommended 

Resources

Comprehensive HIV Prevention for People Who Inject Drugs, Revised Guidance

(PEPFAR 2010)

Developing Services for Female Drug Users: Training module (Eurasian Harm Reduction 

Network [EHRN] n.d.)

Gender-related Barriers to HIV Prevention Methods: A Review of Post-exposure 

Prophylaxis Policies for Sexual Assault: Recommendations and key components for a 

gender-sensitive post-exposure prophylaxis policy for sexual assault (Herstad 2009)

Identifying Violence Against Most-at-Risk Populations: A Focus on MSM and 

Transgenders. Training Manual for Health Providers (Egremy, Betron, and Eckman 

2009)

OVCSupport.net: Web portal (AIDSTAR-Two n.d.)

Protecting Children Affected by HIV Against Abuse, Exploitation, Violence and 

Neglect (Long 2011)

Sex Work, Violence and HIV: A Guide for Programmes with Sex Workers (International 

HIV/AIDS Alliance [IHAA] 2008)

Technical Guidance on Combination HIV Prevention: Men Who Have Sex with Men

(PEPFAR 2011)

Understanding Drug Related Stigma: Tools for Better Practice and Social Change

(Harm Reduction Coalition n.d.)
17

Privacy, Confidentiality, and Informed Consent

Privacy and confidentiality are essential for GBV survivors’ safety in any health care setting given that providers 

can put the survivor’s safety at risk if they share sensitive information with partners, family members, or friends 

without consent. A breach of confidentiality about pregnancy, rape, contraception, HIV status, or a history of 

sexual abuse can put GBV survivors at risk of additional emotional, physical, or sexual violence. Moreover, those 

who have already experienced violence need privacy in order to disclose those experiences to providers without 

fear of retaliation from a perpetrator. To protect confidentiality and privacy, health programs need adequate 

infrastructure and patient flow, as well as clear policies outlining when and where providers are allowed to

discuss sensitive information (Bott, Guezmes, and Claramunt 2004).

Actions • Establish clear policies and protocols for privacy and confidentiality 

• Designate a private consultation space

• Provide ongoing training for staff on protecting survivors’ privacy and confidentiality

• Create opportunities to talk with survivors without partners, children, family, or friends 

present

• Ensure privacy of medical information, including storage of information and policies 

regarding sharing information

• Train providers on obtaining informed consent, including ensuring that GBV survivors are 

informed of their options and their rights

• Ensure printed materials are accessible for both literate and illiterate clients, are 

provided in local language(s), and that interpreters are available as needed. 

Recommended 

Resource

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

Improving the Health Sector Response to Gender Based Violence: Management 

checklist and tools for ensuring privacy and strengthening confidentiality (Bott, Guezmes, 

and Claramunt 2004)

Meaningful Engagement of PLHIV, Particularly Women Living with HIV and GBV 

Survivors

The critical role of PLHIV in all aspects of the response is well established, as is community ownership and 

women’s participation (UNAIDS 1999). Involving PLHIV, specifically women living with HIV, in program planning, 

implementation, and evaluation is paramount regardless of the type of GBV response being provided, be it direct 

services, community mobilization, or policy advocacy. Participatory processes can facilitate access to and

acceptance and uptake of services and can help confront stigma and discrimination. It allows programs to build on 

direct experience and tailor services to individuals and the contexts in which they are offered.

Actions • Provide training and ongoing support to empower individuals to participate in 

organizational and community processes

• Create opportunities for participation, such as volunteering as counselors, advocates, and 

health promoters

• Train and sensitize staff on greater involvement of PLHIV principle

• Plan for ongoing follow-up and communication with PLHIV. 

Recommended 

Resource

Greater Involvement of People with AIDS (GIPA) Good Practice Guide (IHAA and the 

Global Network for People Living with HIV [GNP+] 2010)
18

Ensure Ongoing Quality Improvement and Assurance

As new programs and services are tested and launched, quality improvement and assurance mechanisms are 

essential for ensuring that interventions are technically sound, implemented correctly, and meet the needs of the 

people they are meant to serve, especially PLHIV, GBV survivors, communities, and other relevant stakeholders. 

Quality assurance mechanisms for GBV services can include guidelines and protocols as well as data collection 

tools also used for M&E. As with all GBV services, care should be taken to ensure the rights and safety of GBV 

survivors and confidentiality when gathering client information and feedback used for quality assurance.

Actions • Develop mechanisms to monitor violence as a result of HIV-related interventions

• Roll-out of guidelines and policies (e.g., HIV testing and counseling, PMTCT) should 

include plans for monitoring adverse outcomes

• Allocate sufficient resources for M&E activities

• Include mechanisms for client and provider feedback 

• Train staff involved in collecting data on how to obtain informed consent from clients

• Ensure confidentiality and anonymity of data during collection, storage, and dissemination

• Ensure participation of all stakeholders in M&E planning and activities

• Communicate results, including to clients and providers. 

Recommended 

Resources 

A Manual for Integrating the Programmes and Services of HIV and Violence against 

Women: Guide for designing an exit survey for HIV and violence against women related 

needs at testing and counseling sites (Ferdinand 2009)

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

Improving the Health Sector Response to Gender Based Violence: Data collection 

tools (provider knowledge, attitudes, and practice); clinic observation tools; client exit 

questionnaire; protocol for collecting qualitative information; random record review 

protocol; management checklist (Bott, Guezmes, and Claramunt 2004)

Researching Violence Against Women, A Practical Guide for Researchers and 

Activists: Tools for collecting and analyzing data (Ellsberg and Heise 2005)
19

GUIDELINES FOR GENDERBASED VIOLENCE 

PROGRAMMING

Programming guides on GBV almost universally recommend a comprehensive, rights-based, multisectoral approach that simultaneously addresses survivors’ immediate and long-term needs and 

rights, the role of communities in preventing and responding to violence, and the legal and policy 

environment in which violence occurs. Further, ensuring a relevant, effective, and sustainable 

response requires systematic planning to ensure local relevance and appropriateness, achieve 

community commitment and support, and make the best use of existing resources and expertise. 

The following steps are intended to assist program planners in achieving these objectives:

• Conduct a situational analysis 

• Employ a rights-based, gender-sensitive approach

• Plan for and support community participation 

• Pay special attention to the needs of young people 

• Identify MARPs

• Develop a workplan

• Establish an M&E framework and plan

• Budget. 
20

Conduct a Situational Analysis

A situational analysis is a fundamental step for understanding the extent to and context in which GBV takes place, 

including its drivers, and the relationship between GBV and HIV infection and their impact on individuals, their 

families, and communities. New programs and services must be developed with an understanding of existing 

services and gaps across multiple sectors, including the health, legal, education, and social sectors.

Actions Macro level:

• Identify data collection mechanisms such as demographic health surveys and 

administrative statistics maintained by police, hospitals, and judicial and social service 

agencies

• Collect and analyze epidemiological data on the prevalence of GBV, HIV, and other 

sexually transmitted infections (STIs)

• Review and assess national, provincial, and local plans, laws, policies, and budgetary 

allocations related to the prevention of and response to GBV, including property and 

inheritance rights and access to sexual and reproductive health services. 

Sectoral level:

• Assess sectoral responses (e.g., health, education, justice, social) to GBV such as 

inclusion in sectoral plans and the presence of coordinating mechanisms.

Community level:

• Identify customary laws, traditional practices, and norms and responses that may increase 

vulnerability to HIV and GBV

• Map existing services and programs and the level of coordination between them.

Institutional level:

• Conduct readiness and capacity assessments for integrating a response to GBV within 

existing programs.

Individual level:

• Assess risk perception for HIV infection and STIs, awareness of and sensitization to GBV; 

attitudes regarding gender roles and norms; and the use of and need for relevant 

services.

Recommended 

Resources

A Manual for Integrating the Programmes and Services of HIV and Violence against 

Women: Tools for conducting a situational analysis and evaluation of the legal framework

(Ferdinand 2009)

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

Improving the Health Sector Response to Gender Based Violence: Rapid situational 

analysis tool (Bott, Guezmes, and Claramunt 2004)

Preventing Intimate Partner and Sexual Violence Against Women: List of potential 

sources of data and information by data category (WHO and London School of Hygiene 

and Tropical Medicine 2010, 64)

Twubakane GBV/PMTCT Readiness Assessment: Questionnaires and focus group 

discussion guides designed for introducing GBV services within health care settings

(IntraHealth International 2008)
21

Use a Rights-based and Gender-sensitive Approach

Both GBV and HIV have strong links to human rights because violations of human rights contribute to 

vulnerabilities, and both can lead to further violations such as stigma, discrimination, and violence. Vulnerability to 

HIV and GBV can be traced to social, political, educational, and economic inequalities. 

A rights-based, gender-sensitive approach to programming supports the empowerment and agency of affected 

populations, particularly women, girls, and MARPs, and aims to upend the structural drivers of HIV and GBV, 

including all forms of discrimination.

Actions Principles of a rights-based approach to services:

• Participatory, nondiscriminatory, and a system for accountability

• Available to even the most marginalized groups, accessible (financially, geographically, 

linguistically), acceptable, and of high quality

• Voluntary and noncoercive; premised on informed choice and informed decision-making

• Available with guarantees of privacy and confidentiality

• Evidence-based and developed in light of acquired experience about how to best address 

the intersections between GBV and HIV (Women Won’t Wait 2010).

Principles of a gender-sensitive approach to programming:

• Work through community partnerships

• Support diversity and respect

• Foster accountability

• Promote respect for the rights of individuals and groups

• Empower women, girls, and communities

• Work with men and boys to transform harmful gender norms, attitudes, and behaviors

• Conduct gender analysis or gender assessments to identify the gender needs of women, 

girls, men, boys, and MARPs (Inter-Agency Gender Working Group [IGWG] 2006).

Recommended 

Resources

A Manual for Integrating Gender into Reproductive Health and HIV Programs: Sixstep process for enhancing gender-sensitive programming (Caro 2009) 

An Essential Services Package for an Integrated Response to HIV and Violence 

Against Women: Includes specific steps for providing a rights-based and gender-sensitive 

approach within health, legal, humanitarian, and faith settings (Women Won’t Wait 2010)

Engaging Men and Boys in Changing Gender-based Inequity in Health: Evidence from 

Program Interventions (WHO 2007a)

Gender and Sexual and Reproductive Health 101: Web course (Doggett, Krishna, and 

Robles 2010)

IGWG Gender, Sexuality, and HIV Training Module (IGWG 2010)

International Guidelines on HIV/AIDS and Human Rights: Guidelines for states; 

instructions for both policymakers and advocates, including how to ensure accountability

(UNAIDS 2006)

Virtual Knowledge Centre to End Violence against Women and Girls: Modules on 

adopting human right-based approaches and ensuring gender responsiveness (UN 

Women n.d.-a) 
22

Ensure Community Participation in Program Planning, Implementation, and Evaluation

Plan for and support community participation throughout all phases of the program cycle including planning, 

implementation, monitoring, evaluation, and program improvements.

Actions • Include key stakeholders in program planning, implementation, and evaluation, with 

particular consideration of the following groups:

– Women and girls

– PLHIV, especially women living with HIV

– GBV survivors

– Youth, especially girls and young women and including married adolescents and young 

adults

– Most at-risk and marginalized populations (e.g., people who inject drugs, sex workers, 

sexual minorities)

– Men and boys

– GBV experts, women’s groups, and youth-led and -serving organizations

– Community leaders

– Service providers (public, private, and nongovernmental organizations)

– Law enforcement

– Educators

– Health care providers

– Policymakers

• Conduct stakeholder analyses and needs assessments regarding, for example, the 

prevalence of GBV, availability of services, and knowledge of protective laws and policies

• Initiate and support community dialogues

• Establish and support program advisory committees or consultations, whether on an ad 

hoc or formal basis.

Recommended 

Resources

A Manual for Integrating the Programmes and Services of HIV and Violence against 

Women: Stakeholder mapping tool (Ferdinand 2009)

Greater Involvement of People with AIDS (GIPA) Good Practice Guide (IHAA and 

GNP+ 2010)

HIV & AIDS - Stigma and Violence Reduction Intervention Manual: Tools for

implementing community-owned processes in development programs (Duvvury, Prasad, 

and Kishore 2006)

Implementing Stepping Stones: A Practical and Strategic Guide for Implementers, 

Planners, and Policy Makers: Tools for engaging communities on gender and HIV 

(Agency for Cooperation and Research in Development [ACORD] 2007) 

Project H: Working with Young Men to Promote Health and Gender Equity (Instituto

Promundo 2002)

The SASA! Activist Kit for Preventing Violence Against Women and HIV:

Comprehensive set of tools for community-based action (Raising Voices 2009b)
23

Pay Attention to the Special Needs of Children and Adolescents

GBV can occur throughout the lifecycle, even starting before birth in some cases. Understanding the scope of 

GBV as it pertains to children and adolescents, including the settings in which GBV can occur and ensuring ageappropriate prevention and response strategies, is necessary to help break the cycle of violence in communities.

Prenatal: Sex-selective abortion; battering during pregnancy (emotional and physical effects on the woman; 

effects on birth outcome); coerced pregnancy (e.g., pregnancy as a result of rape). 

Infancy: Female infanticide; child abandonment; emotional and physical abuse; rape; differential access to food 

and medical care for female infants. 

Childhood: Early and forced marriage; genital cutting and mutilation; abuse by family members and strangers; 

incest; rape; differential access to food and medical care; child prostitution; parental abandonment; and forced 

labor and child trafficking.

Adolescence: Dating and courtship violence; physical violence; intergenerational and transactional sex; sexual 

abuse in schools and workplaces; rape (incest, “date rape,” coercion); forced prostitution; sexual harassment; and

trafficking in persons. 

Reproductive: Sexual abuse of women, girls, and sexual minorities; marital rape; dowry abuse and murders; 

partner homicide; psychological abuse; physical abuse; sexual abuse in the workplace; sexual harassment; rape; 

abuse of women with disabilities. 

Old-age: Abuse of widows; elder abuse.

Source: Heise, Pitanquy, and Germain 1994

Actions • Situational analyses should include data on the prevalence and forms of GBV 

disaggregated by sex, gender, age, marital status, and education level 

• Review and assess legal and policy environments as they relate specifically to children and 

young people (e.g., child protection policies; laws related to adolescent sexual and 

reproductive health; and age of consent)

• Build capacity and strengthen referral systems to address child sexual abuse as it is one of 

the most common forms of GBV experienced by children

• Raise awareness about the specific vulnerabilities of adolescent girls and young women to 

GBV

• Promote child- and youth-friendly services

• Ensure access to sexual and reproductive health information and services for young 

people

• Integrate GBV interventions within youth-specific services

• Involve youth in the program cycle 

• Include married adolescents and young people, especially girls, as key stakeholders

• Engage girls and boys, in community mobilization strategies.

Recommended 

Resources

Gender Matters: A Manual on Addressing Gender-based Violence Affecting Young 

People (Council of Europe 2007)

Gender-based Violence: Care and Protection of Children in Emergencies, A Field 

Guide (Save the Children 2004)

OVCSupport.net: Web portal (AIDSTAR-Two n.d.)

Protecting Children Affected by HIV Against Abuse, Exploitation, Violence, and 

Neglect (Long 2011) 

Report of the Independent Expert for the United Nations Study on Violence Against 

Children: Addresses all forms of violence against children including GBV (U.N. Secretary 

General 2006) 

Women, Girls, Boys, and Men: Different Needs – Equal Opportunities: Gender 

Handbook in Humanitarian Situations: Includes a series of questions on what to look 

for or ask so that programs are designed and implemented with sensitivity to the 

different needs of women, girls, boys, and men (IASC 2006)
24

Ensure Inclusion of MARPs

A review of available data found that GBV is an issue among MARPs (Spratt 2010). One study found that 68 

percent of young MSM received threats from family members or partners and that MSM are 19 times more likely 

to be HIV-positive. Likewise, a study of sex workers found that 49 percent experienced physical violence or 

forced sex (Betron and Gonzalez-Figueroa 2009). 

Government responses to addressing the HIV epidemic among MARPs have been disturbingly limited, and 

programs for MARPs are significantly underfunded (Spratt 2010). Very few programs are integrating a GBV 

response into programs with MARPs (MSM; transgender persons; male, female, and transgender sex workers; and 

people who inject drugs) and their intimate partners. In many places, the behaviors are illegal, stigmatized, or 

both, adding another layer of complexity to understanding the prevalence of GBV and providing appropriate 

responses.

Actions • Situational analyses should include data on MARPs and involve MARPs in program design, 

particularly to understand how sexual dynamics, normative expectations, and gender 

scripts influence individual behavior and risk reduction strategies

• Train health care workers on gender norms and sexual identity and address provider 

attitudes toward MARPs

• Identify and address gaps in services (e.g., policies barring female drug users from using 

shelters; services for male and transgender sex workers and pregnant women who inject 

drugs) 

• Target partners and families of MARPs

• End impunity for violence perpetrated by police and national security agencies and

provide training and sensitization on the needs and rights of MARPs

• Ensure gender-sensitive eligibility for post-exposure prophylaxis for male victims of 

sexual violence, incarcerated men, and transgender people

• Reduce stigma and discrimination of GBV survivors by police, judiciary, medical, and 

social services personnel. 

Direct services:

• Conduct ongoing training with all staff on the rights of MARPs and the special needs of 

each group and how to best meet their needs without judgment or discrimination

• “Do more than train”; engage stakeholders on issues of stigma and discrimination

• Establish safe virtual and physical spaces for specific MARP groups to seek information 

and referrals for care and support 

• Set up convenient hours with few criteria for eligibility and use of services (low threshold 

services).

Community mobilization:

• Increase awareness in the community, including among young people, that the use of 

alcohol and other drugs does not cause GBV, and will therefore not be accepted as an 

excuse for such behavior

• Refer to population-specific support (where they exist) such as drug treatment services, 

mental health services, peer-based counseling services, and advocacy organizations

• Link up with other partners, such as local authorities, service providers, human rights 

organizations, and welfare and social support organizations to help them respond to the 

needs of MARPs; help them let MARPs know that certain services exist

• Roll-out intensive training of police officers in gender sensitivity, laws about rape and 

intimate partner violence, the rights of women and children, investigation, and 

prosecution of officers’ abuse of MARPs, including fact-based discussion around 

economics and social inequality as driving factors for entry to sex work, drug use, and 

high-risk behaviors. 
25

Ensure Inclusion of MARPs (continued)

Actions Advocacy:

• Educate MARPs about the laws so they are aware of their rights and protections

• Conduct advocacy activities to ensure that MARPs have full access to human rights and 

social services, as they are often excluded from them

• Increase the implementation of laws and policies by law enforcement and judiciary to 

hold perpetrators of violence accountable

• Remove legal barriers that undermine access to HIV-related services such as laws that 

criminalize consensual sex between men, carrying injection equipment, or voluntary sex 

work

• Advocate for increased support and services from government and donors to be able to 

strengthen and expand on existing services and programs.

Recommended 

Resources

Blueprint for the Provision of Comprehensive Care to Gay Men and Other Men Who 

Have Sex with Men in Latin America and the Caribbean (PAHO 2010)

Comprehensive HIV Prevention for People Who Inject Drugs, Revised Guidance

(PEPFAR 2010)

Developing Services for Female Drug Users: Training module (EHRN n.d.) 

Gender Identity, Violence, and HIV among MSM and TG: A Literature Review and a 

Call for Screening: Screening tool (Betron and Gonzalez-Figueroa 2009)

Gender-related Barriers to HIV Prevention Methods: A Review of Post-exposure 

Prophylaxis Policies for Sexual Assault: Recommendations and key components for a 

gender-sensitive post-exposure prophylaxis policy for sexual assault (Herstad 2009)

Identifying Violence Against Most-at-Risk Populations: A Focus on MSM and 

Transgenders. Training Manual for Health Providers (Egremy, Betron, and Eckman 

2009)

IGWG Gender, Sexuality, and HIV Training Module (IGWG 2010)

Sex Work, Violence and HIV: A Guide for Programmes with Sex Workers (IHAA 2008)

Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, 

Treatment and Care for Injecting Drug Users (WHO 2009)

Technical Guidance on Combination HIV Prevention: Men Who Have Sex with Men

(PEPFAR 2011)

UNAIDS Action Framework: Universal Access for Men Who Have Sex with Men and 

Transgender People (UNAIDS 2009)

Understanding Drug Related Stigma: Tools for Better Practice and Social Change

(Harm Reduction Coalition n.d.)
26

Develop a Workplan

Efforts to respond to and prevent GBV must be developed within the context of a comprehensive, multi-sectoral, 

multilevel response, with interventions targeted at the individual, community, and policy levels. Because no single 

program can address all of these needs, effective coordination is essential not only to avoid duplication of efforts 

but also to ensure that individuals experiencing or at risk of GBV have access to services that are age-, sex- and 

gender-appropriate and address their physical, psychological, emotional, and economic needs and well-being.

Actions Policy environment: Develop, strengthen, and enforce protective laws and policies

Public sector: Improve health, education, social welfare, and judicial and legal systems

Direct services: Provide high-quality, compassionate services for GBV survivors

Community mobilization: Work with communities to support PLHIV and GBV 

survivors and identify and address harmful norms and HIV- and gender-related stigma and 

discrimination that perpetuate GBV

Coordination: Coordinate within and across sectors. 

Recommended 

Resources

A Manual for Integrating Gender into Reproductive Health and HIV Programs: Sixstep process for enhancing gender-sensitive programming (Caro 2009) 

A Step-by-Step Guide to Strengthening Sexual Violence Services in Public Health 

Facilities: Lessons and Tools from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within existing public health facilities, 

improve linkages with other sectors, and engage local communities (Keesbury and 

Thompson 2010)

Addressing Gender-based Violence through USAID’s Health Programs: A Guide for 

Health Sector Program Officers: Planning tool for addressing GBV within different 

types of health programs including community mobilization, communications for behavior 

change, and health policy (IGWG of USAID 2008) 

An Essential Services Package for an Integrated Response to HIV and Violence 

Against Women: Outlines key actions for mobilizing an integrated response to GBV and 

HIV within health care, school, humanitarian, faith, and legal settings (Women Won’t 

Wait 2010)

Improving the Health Sector Response to Gender Based Violence: Step-by-step 

guidance on addressing GBV within the health sector (Bott, Guezmes, and Claramunt 

2004)

Preventing Intimate Partner and Sexual Violence Against Women: Planning guide 

geared toward policymakers, program planners, and funding bodies (WHO and London

School of Hygiene and Tropical Medicine 2010) 

Strategic Framework for the Prevention of and Response to Gender-based Violence in 

Eastern, Southern and Central Africa: Program building blocks and sample activities

(USAID/Eastern and Central Africa and U.N. Children’s Fund [UNICEF]/East and 

Southern Africa Regional Offices n.d.)

Virtual Knowledge Centre to End Violence against Women and Girls: Module on 

programming essentials (UN Women n.d.-a)
27

Develop an M&E Plan

Although there has been an increase in services and programs designed to address GBV, there is a continuous 

and ongoing need for evidence-based knowledge regarding effective GBV prevention, integrated GBV and HIV 

programs, and scale up of services. Rigorous M&E plans are critical for tracking the prevalence of GBV; assessing 

the effectiveness of related services and programs, including outcomes for GBV survivors; and determining the 

impact of any given intervention. M&E processes and mechanisms create opportunities for community 

engagement, for example, through focus groups to determine baseline attitudes and changes over time, or client 

feedback surveys. 

Actions • Ensure data collection adheres to ethical and safety guidelines, including to ensure

confidentiality of client data

• Provide cross-sector training on complete and accurate data collection, including incident 

reports which are essential for facilitating GBV survivors’ access to justice 

• Coordinate data collection, record keeping and tracking between service providers and 

across sectors

• Employ participatory methods, especially to analyze and reflect on data and findings in 

order to translate them into program improvements

• Share evidence and findings with:

– Internal audiences (e.g., staff, GBV survivors)

– Partners in the response to GBV (e.g., advocacy organizations, and local governmental, 

nongovernmental, and private sector partners)

– Communities

– Policymakers

– Media.

Recommended 

Resources

Evaluating Services for Survivors of Domestic Violence and Sexual Assault (Riger et al. 

2002)

Outcome Evaluation Strategies for Domestic Violence Service Programs Receiving 

FVPSA Funding: A Practical Guide (Lyon and Sullivan 2007)

Researching Violence Against Women, A Practical Guide for Researchers and Activists

(Ellsberg and Heise 2005)

The Gender-based Violence Information Management System: Online tools for incident 

reporting, tracking, and analysis and data sharing protocols designed to facilitate 

coordination among agencies (U.N. Population Fund [UNFPA], IRC, and U.N. Refugee 

Agency [UNHCR] n.d.)

Violence against Women and Girls: A Compendium of Monitoring and Evaluation 

Indicators (Bloom 2008)

Develop a Budget

Dedicated resources are essential for operationalizing PEPFAR’s commitment to addressing and reducing GBV.

Analyses of budget allocations versus expenditures are also important for measuring and evaluating program 

impact, costs, and benefits.

Actions • Identify and prioritize the problem (e.g., the impact of GBV on accessing services; gaps in 

stakeholder knowledge, attitudes, and practices)

• Identify associated costs and develop a budget for planned activities (e.g., additional 

training; information, education and communication materials; communications 

campaigns; and advocacy)

• Monitor the extent to which resources are used for intended purposes and reach 

intended beneficiaries

• Evaluate the impact of the resources spent. 
28
29

PREVENTION

There is growing consensus that HIV prevention programs must not only address the biomedical 

and behavioral factors involved in transmission, but also the underlying social and structural drivers 

that increase vulnerability. Social, political, and economic inequities fuel women’s and girls’ 

vulnerability to HIV and GBV. Likewise, stigma and discrimination, including against MARPs such 

as MSM, sex workers, transgender people, and people who inject drugs, make it impossible to 

prevent or treat HIV through biomedical and behavioral approaches alone. While the evidence base 

for both HIV structural prevention and GBV prevention are limited, strategies to empower women 

and girls, engage men and boys, and challenge harmful social norms show promise for addressing 

the underlying drivers of HIV and GBV, simultaneously reducing the risk and vulnerabilities to 

both. 

Addressing GBV within prevention programs can have a direct impact on reaching 

PEPFAR prevention targets, specifically:

• Working with countries to track and reassess their HIV epidemic in order to fashion an 

evidence-based prevention response based on best available and most recent data

• Emphasizing HIV prevention strategies that have been proven effective at achieving intended 

outcomes and targeting interventions to MARPs with high incidence rates 

• Increasing emphasis on supporting and evaluating innovative and promising HIV prevention 

methods 

• Expanding integration of HIV prevention programs with family planning and reproductive 

health services, so that women living with HIV can access necessary care, and so that all women 

know how to protect themselves from HIV infection

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing GBV. 
30

Addressing GBV within Prevention Programs for the General Population

Combination HIV prevention strategies can simultaneously contribute to GBV prevention, dismantling the 

structural drivers of both.

Actions to Address Gender-based Violence Recommended Resources

Community-based actions:

• Include GBV in HIV prevention curricula and peer education 

programs and provide information about and access to GBV 

support services

• Mobilize communities on GBV and HIV, specifically, the links 

between the two and how harmful gender norms, beliefs, and 

practices contribute to both

• Support life skills education for boys and girls through both in- and 

out-of-school programs. 

Gender-related Barriers to HIV 

Prevention Methods: A Review of 

Post-exposure Prophylaxis Policies 

for Sexual Assault: Recommendations 

for increasing access (Herstad 2009)

Handbook for Legislation on Violence 

against Women (U.N. Division for the 

Advancement of Women [UNDAW] 

2009)

Implementing Stepping Stones: A 

Practical and Strategic Guide for 

Implementers, Planners, and Policy 

Makers: Tools for promoting 

community awareness and life-skills 

education (ACORD 2007)

Preventing Intimate Partner and Sexual 

Violence Against Women: Evidencebased promising practices in violence 

prevention (WHO and London School 

of Hygiene and Tropical Medicine 2010) 

Project H: Working with Young Men to 

Promote Health and Gender Equity

(Instituto Promundo 2002)

The SASA! Activist Kit for Preventing

Violence Against Women and HIV: 

Comprehensive set of tools for 

community-based action (Raising Voices 

2009b)

Training Professionals in the Primary 

Prevention of Sexual and Intimate 

Partner Violence: A Planning Guide

(Fisher, Lang, and Wheaton 2010)

Health facility-based actions:

• Raise awareness among all cadres of health care workers about 

GBV as a risk factor for HIV infection

• Train and support health care providers to screen for violence 

where counseling and referral services exist

• Link GBV and HIV prevention and awareness programs with 

voluntary medical adult male circumcision services

• Support GBV survivors in negotiating risk reduction behaviors such 

as condom use

• Ensure timely access to post-exposure prophylaxis

• Ensure access to female condoms. 

Structural actions:

• Ensure protective laws and policies are in place and enforced to 

prevent GBV

• Challenge harmful gender norms, roles, and behaviors, and reduce 

acceptance of GBV 

• Support girls’ and women’s access to education because increased 

educational attainment has been linked to increased protection 

from HIV infection and violence 

• Promote women’s and girls’ economic security through livelihood 

programs and ensure their property and inheritance rights

• Support research on female-initiated methods of HIV prevention

• Ensure policies are in place that promote linkages between GBV 

and HIV, and support programs that address harmful gender 

norms, beliefs, and practices that contribute to GBV and HIV.
31

Addressing GBV within Prevention Programs with MARPs

Actions to Address Gender-based Violence Recommended Resources

Community-based actions: 

• Ensure that information on GBV is addressed within 

HIV programs consistent with the context of the 

country’s HIV epidemic, including the most 

vulnerable populations.

Blueprint for the Provision of Comprehensive Care 

to Gay Men and Other Men Who Have Sex with 

Men in Latin America and the Caribbean (PAHO 

2010)

Comprehensive HIV Prevention for People Who 

Inject Drugs, Revised Guidance (PEPFAR 2010)

Developing Services for Female Drug Users: Training 

module (EHRN n.d.)

Gender Identity, Violence, and HIV among MSM and 

TG: A Literature Review and a Call for Screening:

Screening tool (Betron and Gonzalez-Figueroa 2009)

Identifying Violence Against Most-at-Risk 

Populations: A Focus on MSM and Transgenders. 

Training Manual for Health Providers (Egremy, 

Betron, and Eckman 2009)

IGWG Gender, Sexuality, and HIV Training Module

(IGWG 2010)

Sex Work, Violence and HIV: A Guide for 

Programmes with Sex Workers (IHAA 2008)

Technical Guidance on Combination HIV Prevention: 

Men Who Have Sex with Men (PEPFAR 2011)

Technical Guide for Countries to Set Targets for 

Universal Access to HIV Prevention, Treatment

and Care for Injecting Drug Users (WHO 2009)

UNAIDS Action Framework: Universal Access for 

Men Who Have Sex with Men and Transgender 

People (UNAIDS 2009)

Understanding Drug Related Stigma: Tools for Better 

Practice and Social Change (Harm Reduction 

Coalition n.d.)

Health facility-based actions: 

• Establish strong referral and coordination 

mechanisms between HIV and GBV services as well 

as services designed specifically for MARPs (e.g., 

methadone replacement therapy, outreach to sex 

workers)

• Address bias and discrimination among provider 

attitudes toward MARPs

• Train health care workers and counselors on highrisk populations’ increased vulnerabilities to violence 

• Address the impact of GBV on negotiating risk 

reduction strategies

• Ensure access to male and female condoms to all 

populations

• Create linkages with substance abuse prevention 

services and programs that are friendly towards 

MARPs and have staff trained in GBV screening.

Structural actions: 

• Ensure that information on GBV is addressed within 

HIV programs consistent with the context of the 

country’s HIV epidemic, including the most 

vulnerable populations.
32

Addressing GBV within Prevention Programs for Youth

HIV prevention programs for youth are an ideal vehicle for integrating primary prevention programs for GBV as 

there is consensus that such efforts should focus on younger age groups. 

Actions to Address Gender-based 

Violence

Recommended Resources

Community-based actions:

• Train and sensitize child- and youth-serving 

program staff and volunteers on GBV and the 

particular risk factors that children and young 

people face, for example, sexual violence 

including forced sex and coercion

• Ensure that services and programs are tailored 

to the distinct needs of girls, boys, young 

women, and young men, acknowledging that 

programming is not necessarily the same for 

each group

• Establish linkages between prevention 

programs and age-appropriate services for 

young GBV survivors

• Include information on GBV in school-based 

programs to prevent HIV

• Include HIV and GBV prevention information 

in comprehensive sexuality education for 

young people.

Adolescents: Missing from Programs for the World’s 

Orphans and Vulnerable Children: Overview of needs of 

vulnerable adolescents with examples of programs that work 

(Osborn 2007)

Elimination of All Forms of Discrimination and Violence 

against the Girl Child, Report of the Expert Group 

Meeting: Includes overview of the issues and 

recommendations for policy change, programming, and 

nongovernmental organizations and civil society (UNDAW

2006)

Gender Matters: A Manual on Addressing Gender-based 

Violence Affecting Young People (Council of Europe 

2007)

Gender-related Barriers to HIV Prevention Methods: A 

Review of Post-exposure Prophylaxis Policies for Sexual 

Assault: Recommendations and key components for a 

gender-sensitive post-exposure prophylaxis policy for sexual 

assault (Herstad 2009)

Preventing Intimate Partner and Sexual Violence Against 

Women: Includes age-specific promising practices for the 

primary prevention of violence (WHO and London School 

of Hygiene and Tropical Medicine 2010) 

Project H: Working with Young Men to Promote Health 

and Gender Equity (Instituto Promundo 2002)

Women, Girls, Boys, and Men: Different Needs – Equal 

Opportunities: Gender Handbook in Humanitarian 

Situations: Includes a series of questions on what to look 

for or ask so that programs are designed and implemented 

with sensitivity to the different needs of women, girls, boys, 

and men (IASC 2006)

Health facility-based actions:

• Ensure access to youth-friendly sexual and 

reproductive health services that include GBV 

screening

• Ensure gender-sensitive access to postexposure prophylaxis for young people.

Structural actions:

• Support efforts to prevent all forms of violence 

and abuse, especially child maltreatment and 

child sexual abuse.
33

HIV TESTING AND 

COUNSELING

GBV is a significant barrier to women’s use of HTC services, in turn hampering treatment scale-up 

and prevention efforts (WHO 2006). Violence and fear of violence are often cited as barriers to HIV 

testing and disclosing a positive test result (Hale and Vazquez 2011). In addition to physical 

violence, women cite fear of abandonment, loss of economic support, rejection, and accusations of 

infidelity as reasons for not seeking out HTC services or returning for test results. Experience with 

violence and women’s low status within the family can negatively influence knowledge of where and 

how to get tested; the level of autonomy and decision making individual family members have about 

accessing health care; and access to resources, such as money for transportation, that impede 

utilization of services (Ali 2007). 

A 2006 WHO expert meeting identified four thematic areas for addressing GBV within HTC: 

• A barrier to accessing services

• Safe disclosure of test results

• Ability to negotiate risk reduction behaviors 

• Access to post-test support and care (WHO 2006). 

Addressing GBV within HTC programs can have a direct impact on advancing

PEPFAR’s HTC strategies and reaching HTC targets, specifically: 

• Addressing GBV within testing and counseling programs can improve uptake of services, 

increasing the number of individuals who know their HIV status and 1) seek treatment, and 2) 

have the information, tools, and support to prevent further infection. 

• Expanding integration of HIV prevention, care and support, and treatment services with family 

planning and reproductive health services so that women living with HIV can access necessary 

care, and so that all women know how to protect themselves from HIV infection. 

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing GBV. 
34

Addressing GBV within Strategic Scale-up of Provider-initiated HTC and HTC in 

Community and Clinical Settings

Actions to Address Gender-based Violence Recommended Resources

Readiness: 

• Assess and identify if and how GBV influences women’s and men’s access to 

HTC services

• Assess community and policy environment to determine readiness to respond 

to GBV in HTC programs

• Establish linkages with police and law enforcement agencies.

A Manual for Integrating 

the Programmes and 

Services of HIV and 

Violence against Women: 

Recommendations for 

integrating GBV services 

within voluntary counseling 

and testing programs 

(Ferdinand 2009)

A Step-by-Step Guide to 

Strengthening Sexual 

Violence Services in Public 

Health Facilities: Lessons 

and Tools from Sexual 

Violence Services in Africa:

Tools and resources to

establish and strengthen

GBV services within existing 

public health facilities, 

improve linkages with other 

sectors, and engage local 

communities (Keesbury and 

Thompson 2010)

Guidance on Couples HIV 

Testing and Counseling 

(WHO Forthcoming)

Guidance on ProviderInitiated HIV Testing and 

Counselling in Health 

Facilities: Information on 

strategic scale-up of 

provider-initiated testing 

and counseling, including 

minimum information for 

obtaining informed consent

(WHO 2007b) 

Guidelines for Medico-legal 

Care for Victims of Sexual 

Violence (WHO 2003) 

Improving the Health Sector 

Response to Gender 

Based Violence: Checklist 

for conducting a situational 

analysis and step-by-step 

guidance for planning and 

implementing GBV services 

(Bott, Guezmes, and 

Claramunt 2004)

Training:

• Ensure adequate training in GBV screening and referral for all HTC providers

• Provide additional training as needed for issues on links between GBV and 

HTC. 

HTC services:

• Ensure services are financially, geographically, and linguistically accessible to 

women and MARPs

• Raise awareness about GBV within “male-friendly” services (i.e., 

mobile/outreach, evening/weekend hours)

• Utilize a family-centered approach that supports HTC for couples/partners and 

children

• Provide adequate and appropriate space for HTC services that allows for safety 

and privacy

• Ensure the “4 Cs” are adhered to: consent, confidentiality, counseling, and 

correct test results

• Ensure that HTC services are not implementing mandatory testing or unlawful 

disclosure

• Consider integrating screening and counseling for GBV as part of HTC services 

where training and support are available; ensure counselors are equipped to 

deal with GBV if suspected

• Ensure provision of quality services (see section: Addressing GBV in HTC 

Quality Assurance Approaches).

Ensuring safe disclosure: 

• Train and support HTC providers to identify women who fear violence as a 

result of testing or disclosure and counsel them on how to address these fears

• Offer alternative models for disclosure including counselor-assisted disclosure

• Provide couples/partner HTC to relieve burden on women for disclosing to 

male partners.

Linkages and referrals:

• Establish referral networks and coordination mechanisms within the

community and for GBV services

• Link clients proactively with GBV services as needed

• Refer women and marginalized populations to peer groups to provide ongoing 

psychosocial support

• Build support systems for GBV survivors where services do not exist

• Increase access to HTC by integrating HTC within GBV services. 
35

Addressing GBV within Strategic Scale-up of Provider-initiated HTC and HTC in 

Community and Clinical Settings (continued)

Actions to Address Gender-based Violence Recommended Resources

Risk-reduction: 

• Address violence as a barrier to negotiating risk reduction strategies and 

support survivors in developing strategies to protect themselves when 

negotiating safer sexual relationships.

Opening Up the HIV/AIDS 

Epidemic: Guidance on 

Encouraging Beneficial 

Disclosure, Ethical Partner 

Counselling & Appropriate 

Use of HIV Case-reporting

(UNAIDS 2000) 

Training Professionals in the 

Primary Prevention of 

Sexual and Intimate Partner 

Violence: A Planning Guide

(Fisher, Lang, and Wheaton 

2010)

Integrating GBV within Couples HIV Testing and Counseling (CHTC)

Actions to Address Gender-based Violence Recommended Resources

Increase availability of CHTC services:

• Train providers to deliver CHTC in all HTC settings

• Educate clients and patients about the benefits of CHTC services, including 

GBV prevention.

AIDS Information Centre

Uganda: Model program for 

addressing GBV within the 

context of couples counseling 

(AIDS Information Centre 

Uganda n.d.)

Couples HIV Counseling and 

Testing Intervention and 

Training Curriculum (CDC 

2007)

* Important note: this resource is 

currently under revision

Guidance on Couples HIV 

Testing and Counseling 

(WHO Forthcoming)

* See additional resources 

listed previously for HTC

Ensure quality CHTC service provision:

• Ensure that neither member of the couple (or polygamous family) has been 

coerced to attend CHTC; train HTC providers to identify signs that either 

partner has been coerced to attend CHTC or potential violence within the 

couple; these partners should be met with individually before proceeding 

with CHTC; for couples where coercion or violence may be present, HTC 

providers may wish to recommend individual HTC or delay CHTC to a later 

time

• Offer the entire HTC service together, including learning their test results 

together if couples presenting for CHTC have discussed this decision jointly; 

separating couples could suggest secrecy or distrust, and may put HTC 

providers in a compromising position if they learn something about one 

partner that the client is not willing to share with the other

• Confirm that both partners are ready to receive and to disclose their results 

together before the HTC provider reveals test results to the couple

• Offer both partners the opportunity to return to the HTC site (or refer to 

appropriate site) for additional counseling and support, either as individuals 

or as a couple

• Provide appropriate linkages and support for serodiscordant couples

• Provide additional follow-up to women in serodiscordant couples with 

special attention to HIV-positive women who are at increased risk for 

violence due to their HIV status.
36

Addressing GBV through Strengthened Linkages between HTC and Other Appropriate 

Treatment, Care and Support, and Prevention Services

Actions to Address Gender-based Violence Recommended Resources

Training and sensitization: 

HTC and other HIV treatment, care and support, and prevention services 

should provide and facilitate training on: 

• The links between HIV and GBV

• Incidence of and risk factors associated with GBV

• Special considerations for working with GBV survivors

• Risk factors for GBV specifically related to HTC.

A Manual for Integrating the 

Programmes and Services of 

HIV and Violence against 

Women: Recommendations 

for addressing GBV within HIV

testing and counseling and 

(Ferdinand 2009)

Training Professionals in the 

Primary Prevention of 

Sexual and Intimate Partner 

Violence: A Planning Guide:

Practical tools to help plan, 

deliver, and evaluate trainings 

appropriate for a broad range 

of community-based 

organizations and entities 

addressing GBV (Fisher, Lang, 

and Wheaton 2010)

Also see the resources in 

sections of this guide 

pertaining to:

Prevention

Adult Treatment

Guidelines for GBV 

Programming: MARPs and 

M&E

Implementation of linkage programs:

HTC sites should implement, monitor, and evaluate approaches to ensure 

linkages and successful enrollment of clients, which might include (but is not 

limited to):

• Integrating GBV screening, care, and support into HTC services

• Integrating or co-locating HTC services with other follow-up services, 

including GBV services

• Integrating additional services at the HTC site, such as point-of-care CD4 

testing

• Escorting clients to appropriate follow-up services

• Establishing partnerships between HTC sites and follow-up services (both 

clinic- and community-based)

• Improving HTC provider understanding of and engagement with GBV 

referral sites through visitation, contact points, and comprehensive referral 

lists

• Providing additional GBV counseling or social support services at the HTC 

site or within the community

• Providing transportation, child care assistance, nutritional support, or other 

incentives for providers, clients, or patients

• Sending SMS (short messaging service) text reminders, making phone calls, 

or conducting home visits (with informed consent) to follow-up on referrals 

that were given at HTC

• Training providers to create an enabling environment for all clients and 

patients within HTC services, particularly for women, MARPs, and other 

vulnerable populations who may be deterred from following through on 

referrals due to stigma and discrimination

• Establishing M&E systems that track linkages.
37

Addressing GBV in HTC Quality Assurance Approaches

Actions to Address Gender-based Violence Recommended Resources

Establish systems for HIV testing quality assurance to ensure correct test results 

are given by HTC providers and to monitor outcomes for clients, including 

GBV, related to their decision to get tested or disclosure of test results. These 

might include:

• Proficiency panel testing

• Utilization of pre-printed laboratory logbooks

• Engaging laboratory staff in supportive supervision of HTC providers

• Ensuring test kits and supplies are of sufficient stock, and are in-date

• Follow up visits or surveys for clients.

Couples HIV Counseling and 

Testing Intervention and 

Training Curriculum: 

Provides key steps and tools 

for ensuring the quality of 

HTC services (CDC 2007)

*Important note: this resource is 

currently under revision

Facilitative Supervision 

Handbook: Tools for 

supervisors to provide 

ongoing support when 

introducing new services 

(EngenderHealth 1999)

Also see the resources in 

sections of this guide 

pertaining to Guidelines for 

GBV Programming: M&E

Establish systems for HIV counseling quality assurance to ensure HTC providers 

provide adequate and client-centered counseling that addresses their risk 

factors and needs, including risk of GBV, fear of disclosure, etc. These might 

include:

• Provision of monthly or quarterly supportive supervision meetings with HTC 

providers from multiple sites to discuss challenging issues

• Provider self-reflection tools

• Client exit interviews

• Refresher trainings on key issues.

Linking GBV with Expansion of HIV Rapid Test Kit Technology

Actions to Address Gender-based Violence

• Utilize HIV rapid testing technology in all HTC settings, whenever possible, to reduce the need for HTC clients 

or patients to return to the site at a later time to access their test results. HIV rapid testing technology 

facilitates same-hour results, reducing loss to follow-up, and it can be provided by lay counselors with 

appropriate training and supervision. This is of importance to GBV survivors where violence or the fear of 

violence can prevent them from accessing services.

• Ensure sufficient stock of in-date test kits at all HTC sites through accountability and quality supply chain 

management. 

Linking GBV with Promotion of All Forms of HTC

Actions to Address Gender-based Violence Recommended Resources

• Mark available HTC services with appropriate signboards or lettering 

to increase access to these services

• Involve women, men, PLHIV, and other affected communities in the 

formulation, implementation, and monitoring of HTC communications 

campaigns

• Vet all messages and images used in HTC communications campaigns

in order to reinforce gender equality and positive norms and to avoid 

reinforcing negative stereotypes or harmful gender norms

• Include information about patient rights, including the right to privacy 

and confidentiality, the availability of no- or low-cost services, and 

linkages to both HIV and GBV support services in public information 

campaigns. 

Addressing Gender-based Violence 

through USAID’s Health 

Programs: A Guide for Health 

Sector Program Officers: 

Recommendations for 

communications on social and 

behavioral change (IGWG of USAID 

2008) 

Also see the resources in sections of 

this guide pertaining to Guiding 

Principles: Meaningful 

Engagement of PLHIV
38
39

PREVENTION OF MOTHERTO-CHILD TRANSMISSION

While PMTCT services can be highly effective in preventing vertical transmission of HIV, coverage 

levels have remained low. GBV, including during pregnancy, can pose a barrier to women getting 

tested, disclosing their status to partners, adhering to treatment regimens, and seeking antenatal care. 

Addressing GBV within PMTCT programs can facilitate uptake of strategies to prevent vertical 

transmission and provides opportunities to support HIV-positive women in exercising all of their 

pregnancy options, promote and support men’s participation in maternal health, reduce maternal 

and child mortality related to violence, and help women achieve their reproductive aspirations. 

Primary prevention strategies also offer numerous opportunities to address and integrate GBV 

services, for example, through pregnancy prevention services.

Addressing GBV within PMTCT programs can have a direct impact on advancing

PEPFAR’s PMTCT strategies and reaching PMTCT targets, specifically: 

• Increasing investment in PMTCT to meet 80 percent coverage levels in HTC of pregnant 

women and 85 percent coverage levels of antiretroviral prophylaxis for women who test positive 

• Expanding integration of HIV prevention, care and support, and treatment services with family 

planning and reproductive health services, so that women living with HIV can access necessary 

care, and so that all women know how to protect themselves from HIV infection 

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing GBV. 
40

Integrating GBV Services within Rapid HTC in Antenatal and Maternity Settings

Pregnancy-related care offers an entry point for both HIV and GBV interventions and creates opportunities to 

engage male partners and promote violence prevention strategies. However, GBV and unequal status within the 

family and community can pose barriers to accessing health services, including emergency obstetric care.

Actions to Address Gender-based Violence Recommended Resources

Readiness: Follow steps for establishing readiness to 

respond to GBV within clinical settings, including 

adopting appropriate policies and protocols; ensuring 

safety, privacy, informed consent, and confidentiality; 

training staff; equipping facilities; and establishing 

referral networks and coordination mechanisms. 

Pregnancy-related violence, stigma, and 

discrimination: Train and support staff in screening 

for violence and identifying harmful consequences 

including psychological and physical trauma that can lead 

to obstetric complications. 

Vulnerability to human rights abuses: Enact 

policies and enforcement mechanisms to prevent 

coercion, forced termination of pregnancies, or forced 

sterilization of women living with HIV, and address 

punitive laws and policies related to vertical 

transmission. 

HTC: Train providers on the linkages between GBV 

and HIV, specifically how violence or the fear of 

violence can prevent women from assenting to HTC or 

returning for results, the importance of confidentiality; 

potential negative outcomes of disclosure, and 

incidence of anxiety, depression, and stress when 

learning about HIV status during pregnancy. 

Risk reduction: Address violence as a barrier to 

negotiating risk reduction strategies and support 

survivors in developing strategies to protect themselves 

when negotiating safer sexual relationships; consider 

ongoing risk of infection as part of HTC even if tested 

negative. 

Pregnancy options: Sensitize providers to respect 

and support pregnancy intentions of women living with 

HIV, provide support and linkages to safe pregnancy and 

motherhood services, and provide information on 

access to safe abortion services where legal. 

Ensure access to safe delivery services: Violence 

or fear of violence may cause women to avoid hospitals 

due to fear of involuntary disclosure. 

Safe abortion and postabortion care:

Complications of abortion are of particular concern for 

women living with HIV given their potentially higher 

rates of morbidity due to unsafe abortion, and there is 

evidence to suggest that there are status, vulnerability, 

and stigma-related barriers that may compel women 

living with HIV to undergo unsafe abortions. Access 

should include accurate information on the legal status 

of abortion and health exceptions for seeking abortion. 

A Step-by-Step Guide to Strengthening Sexual 

Violence Services in Public Health Facilities: 

Lessons and Tools from Sexual Violence Services 

in Africa: Tools and resources to establish and 

strengthen GBV services within existing public health 

facilities, improve linkages with other sectors, and 

engage local communities (Keesbury and Thompson 

2010)

Family Planning–Integrated HIV Services: A 

Framework for Integrating Family Planning and 

Antiretroviral Therapy Services (Farrell 2007)

HIV & AIDS - Stigma and Violence Reduction 

Intervention Manual: Tools for implementing 

community-owned processes in development 

programs (Duvvury, Prasad, and Kishore 2006)

Improving the Health Sector Response to Gender 

Based Violence (Bott, Guezmes, and Claramunt 

2004)

Linkages and Integration of Sexual and 

Reproductive Health, Rights, and HIV: The 

Alliance Approach (IHAA 2009)

Men As Partners: A Program for Supplementing the 

Training of Life Skills Educators (EngenderHealth 

and Planned Parenthood Association of South Africa

2001)

mothers2mothers: Preventing Mother-to-Child HIV 

Transmission in Africa Using New Paradigms in 

Health Care Delivery: Model program using mentor 

mothers to promote treatment adherence (Besser 

2010)Technical Brief: Integrating Prevention of 

Mother-to-Child Transmission of HIV Interventions 

with Maternal, Newborn, and Child Health Services

(Stone-Jimenez et al. 2011) 

The One Man Can Action Kit: Tools for engaging 

men to address GBV (Sonke Gender Justice Network 

2006)

The Pregnancy Intentions of HIV-positive Women: 

Forwarding the Research Agenda: Important 

background reading for understanding barriers to 

access and stigma and discrimination (Harvard School 

of Public Health, WHO, and Harvard Center for 

Population and Development Studies 2010) 

Twubakane GBV/PMTCT Readiness Assessment:

Questionnaires and focus group discussion guides 

designed for introducing GBV services within health 

care settings (IntraHealth International 2008)
41

Integrating GBV Services within Rapid HTC in Antenatal and Maternity Settings

(continued)

Actions to Address Gender-based Violence Recommended Resources

Male involvement: Provide information and 

counseling to couples and men on violence prevention 

strategies and implement programs with men and boys 

that change harmful gender norms.

Support for follow-on care: Increase access to

follow-on care for GBV survivors, including antenatal 

care and PMTCT services. 

Also see the resources in sections of this guide 

pertaining to:

Guidelines for GBV Programming

HTC including Couples Counseling

Adult Treatment

Prevention

Integrating GBV Services within Antiretroviral Prophylaxis for Mother and Infant and ART 

for Eligible Mothers

Women living with HIV are particularly vulnerable to violence, stigma, and discrimination associated with both HIV 

and pregnancy.

Actions to Address Gender-based Violence Recommended Resources

Readiness: Follow steps for establishing readiness to 

respond to GBV within clinical settings, including 

adopting appropriate policies and protocols; ensuring 

safety, privacy, informed consent, and confidentiality; 

training staff; equipping facilities; and establishing 

referral networks and coordination mechanisms.

Confidentiality: Pay special attention to confidentiality 

as access to drugs for prenatal transmission may lead to 

unintended disclosure.

Stigma and discrimination: Women living with HIV 

choosing to continue pregnancy may face hostility and 

accusation from providers. Establish and enforce 

mechanisms to prevent coercion and educate women 

about their rights, as fear of forced or coerced 

sterilization or termination may pose a barrier for 

accessing ART; establish PMTCT and postnatal support 

groups for women living with HIV; reduce economic 

barriers to accessing ART; and promote and support 

family and community engagement to support women 

living with HIV including pregnant women. 

HIV & AIDS - Stigma and Violence Reduction 

Intervention Manual: Tools for implementing 

community-owned processes in development 

programs (Duvvury, Prasad, and Kishore 2006)

mothers2mothers: Preventing Mother-to-Child HIV 

Transmission in Africa Using New Paradigms in 

Health Care Delivery: Model program using 

mentor mothers to promote treatment adherence 

(Besser 2010)

Twubakane GBV/PMTCT Readiness Assessment: 

Questionnaires and focus group discussion guides 

designed for introducing GBV services within health 

care settings (IntraHealth International 2008)

Also see the resources in sections of this guide 

pertaining to: 

Guiding Principles for Working with Survivors of 

GBV

Adult Treatment
42

Addressing GBV within Counseling and Support for Infant Feeding

Women’s choices related to infant feeding may inadvertently reveal their HIV status or subject them to stigma, for 

example opting to use formula versus breastfeeding. Pressure to breastfeed or fear of stigma, discrimination, and 

violence can also interfere with women’s feeding choices.

Actions to Address Gender-based Violence

Confidentiality: Ensure mechanisms are in place to protect confidentiality as choices regarding infant feeding may 

have implications for disclosure within the family and community. 

Support women’s feeding choices: Promote family and community support to challenge negative perceptions 

based on infant feeding choices. Combine infant feeding support with referrals and support related to postpartum 

health, family planning, and ART adherence. 

ART: Provide support for access to antiretroviral prophylaxis during breastfeeding and ongoing access to ART for 

women living with HIV.

Linking GBV to Wraparound Services such as Nutrition, Family Planning, Services for 

Women Living with HIV, and Microeconomic Activities

Wrap around services, such as income-generating activities, can help address risk factors for GBV and provide 

needed support, such as legal services and support groups for survivors.

Actions to Address Gender-based 

Violence

Recommended Resources

Readiness assessments: Support social 

care organizations in conducting readiness

and needs assessments for addressing GBV 

including knowledge, attitudes, and practices; 

institutional policies; training; staffing; and 

linkages with GBV organizations and 

networks. 

Training and sensitization: Provide 

training for social care organizations on the 

linkages between HIV and GBV, the role of 

communities in addressing and preventing 

GBV, incidence and risk factors associated 

with GBV, and special considerations for 

working with survivors.

Establish linkages with existing GBV 

services and networks: Develop mutually 

reinforcing partnerships and referral 

networks among HIV-service and GBV 

organizations and promote bidirectional 

integration of HIV and GBV prevention and 

response efforts. 

A Manual for Integrating the Programmes and Services of 

HIV and Violence against Women: Tools for identifying 

opportunities for linkages between GBV and HIV services 

(Ferdinand 2009)

A Step-by-Step Guide to Strengthening Sexual Violence 

Services in Public Health Facilities: Lessons and Tools 

from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within 

existing public health facilities, improve linkages with other 

sectors, and engage local communities (Keesbury and 

Thompson 2010)

Family Planning–Integrated HIV Services: A Framework for 

Integrating Family Planning and Antiretroviral Therapy 

Services (Farrell 2007)

IMAGE Study Publication List 2005-2009: Model program for 

integrating microfinance and GBV interventions (Small 

Enterprise Foundation n.d.) 

Improving the Health Sector Response to Gender Based 

Violence: Tools for mapping available services (Bott, Guezmes, 

and Claramunt 2004)

Linkages and Integration of Sexual and Reproductive Health, 

Rights, and HIV: The Alliance Approach (IHAA 2009)
43

Addressing GBV by Strengthening Linkages between PMTCT Programs and Care, 

Treatment, and Support Services

Linking HIV services can contribute to increased access to services, for example, by making multiple services 

available in a single setting. Linkages may create opportunities for efficiencies such as through joint training, support 

groups for staff and clients, and information sharing.

Actions to Address Gender-based Violence Recommended Resources

Readiness assessments: Support HIV programs and organizations in 

conducting readiness and needs assessments for addressing GBV including 

knowledge, attitudes, and practices; institutional policies; training; staffing; and 

linkages with GBV organizations and networks. 

Training and sensitization: Provide training on the linkages between HIV 

and GBV, incidence and risk factors associated with GBV, and special 

considerations for working with GBV survivors.

Establish linkages with existing GBV services and networks: Develop 

mutually reinforcing partnerships and referral networks among HIV-service and 

GBV organizations and promote bidirectional integration of HIV and GBV 

prevention and response efforts. 

A Manual for Integrating the 

Programmes and Services of 

HIV and Violence against 

Women (Ferdinand 2009)

Training Professionals in the 

Primary Prevention of 

Sexual and Intimate Partner 

Violence: A Planning Guide

(Fisher, Lang, and Wheaton 

2010)

Addressing GBV Within Family-centered ART and Care Programs

Actions to Address Gender-based Violence Recommended Resources

• Train counselors to identify risk factors for violence within the family

• Use opportunities for partner involvement to provide information about 

violence prevention strategies

• Encourage support for PLHIV within the family. 

* See previous resources for 

PMTCT
44
45

ADULT TREATMENT

Addressing GBV within the context of adult treatment programs can help break down barriers to 

accessing ART that hamper treatment scale-up efforts toward universal access. GBV can pose 

multiple barriers along the spectrum of services related to adult treatment including access to HTC, 

PMTCT, and ART, as well as ART adherence, leading to worse patient outcomes and potential 

development of HIV drug resistance (Herstad 2010; Ali 2007).

Addressing GBV within adult treatment programs can have a direct impact on 

advancing PEPFAR’s adult treatment strategies and reaching treatment targets, 

specifically: 

• Directly supporting more than 4 million people on treatment, more than doubling the number 

of patients directly supported by PEPFAR in its first five years

• Scaling up treatment with a particular focus on serving the sickest individuals, pregnant women, 

and those with HIV/tuberculosis coinfection; increasing support for country-level treatment 

capacity by strengthening health systems and expanding the number of trained health workers 

• Working with countries and international organizations to develop a shared global response to 

the burden of treatment costs in the developing world, and assisting countries in achieving their 

defined treatment targets

• Expanding integration of HIV prevention, care and support, and treatment services with family 

planning and reproductive health services, so that women living with HIV can access necessary 

care, and so that all women know how to protect themselves from HIV infection 

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing GBV

• Increasing the proportion of HIV-infected infants and children who receive treatment 

commensurate to their representation in a country’s overall epidemic, helping countries to meet 

national coverage levels of 65 percent for early infant diagnosis, and doubling the number of atrisk babies born HIV-free.
46

Strengthening Political Commitment to Addressing both HIV and GBV

Addressing HIV with governments, policymakers, and leaders offers an entry point for raising awareness about and 

commitment to ending GBV.

Actions to Address Gender-based 

Violence

Recommended Resources

• Promote adoption of and adherence to 

international laws and policies against 

gender-based discrimination and 

violence

• Strengthen national laws and policies 

related to gender equality and GBV

• Address both statutory and customary 

laws that discriminate based on sex or 

sexual orientation

• Ensure enforcement and accountability

• Promote community participation, 

specifically of PLHIV and women, in 

decision making and coordinating bodies

• Include GBV in national action plans, 

targets, and indicators related to HIV, 

treatment, and GBV. 

Combating Gender-based Violence: A Key to Achieving the 

MDGs: Advocacy guide (UNFPA, U.N. Development Fund for 

Women, and Office of the Special Adviser on Gender Issues and 

Advancement of Women 2005)

Good Practices in Legislation on Violence Against Women, 

Report of the Expert Group Meeting and Handbook for 

Legislation on Violence against Women: Companion guides 

(UNDAW 2008, 2009)

International Guidelines on HIV/AIDS and Human Rights: Details

the responsibilities of states for protecting human rights within the 

context of HIV (UNAIDS 2006)

Preventing Intimate Partner and Sexual Violence Against 

Women: Guide for policymakers and program planners (WHO 

and London School of Hygiene and Tropical Medicine 2010)

UN Trust Fund to End Violence Against Women: Provides 

programmatic examples of local and national initiatives for raising 

awareness, legal literacy, training, prevention, and research (UN 

Women n.d.-b)

Virtual Knowledge Centre to End Violence against Women and 

Girls: Module on legislation (UN Women n.d.-a) 

Addressing GBV within National HIV Policy and Clinical Guidelines 

Actions to Address Gender-based 

Violence

Recommended Resources

• Ensure national AIDS policies address 

GBV

• Policies should include strong 

multisector coordination, community 

involvement, and participation of PLHIV 

and women

• Guidelines should include protocols for 

screening for and monitoring GBV

• Ensure availability and dissemination of 

guidelines on post-exposure prophylaxis 

including who is eligible and who can 

provide services.

Child Protection Policies and Procedures Toolkit (Jackson, 

Wernham, and ChildHope 2005)

Friends of the Chair of the United Nations Statistical 

Commission on the Indicators on Violence Against Women:

Proposed indicators for states (U.N. Secretary General 2009)

Gender-related Barriers to HIV Prevention Methods: A Review 

of Post-exposure Prophylaxis Policies for Sexual Assault: 

Recommendations and key components for a gender-sensitive 

post-exposure prophylaxis policy for sexual assault (Herstad 

2009)

Guidelines for Medico-legal Care for Victims of Sexual Violence

(WHO 2003)

Post-exposure Prophylaxis to Prevent HIV Infection: Joint 

WHO/ILO Guidelines (WHO and International Labor 

Organization 2007)

Violence against Women and Girls: A Compendium of 

Monitoring and Evaluation Indicators (Bloom 2008)
47

Addressing GBV within National ART Training Programs for Clinical and Laboratory Staff

Actions to Address Gender-based Violence Recommended Resources

• Include training on gender-sensitive 

communications and service provision and GBV 

within core and supplementary curricula

• Ensure gender awareness and GBV training are 

provided on an ongoing basis with opportunities 

for reflection

• Create mechanisms to support health care 

workers to handle incidents of GBV 

appropriately, including adequate and ongoing 

training, established guidelines and protocols, 

and supervision

• Include gender sensitivity and GBV within 

curricula guidelines for all health care workers. 

Communication Skills in Working with Survivors of 

Gender-based Violence (FHI, RHRC, and IRC 2004)

Community Treatment Literacy: Recognizing Gender 

Issues in Adhering to HIV Treatment, Workshop 

Manual: Designed for PLHIV networks to raise 

awareness about how stigma, discrimination, gender 

inequality, and GBV create barriers to treatment 

adherence and how to develop strategies to promote 

adherence (USAID Health Policy Initiative 2010)

IGWG Gender, Sexuality, and HIV Training Module

(IGWG 2010)

Training Professionals in the Primary Prevention of 

Sexual and Intimate Partner Violence: A Planning 

Guide (Fisher, Lang, and Wheaton 2010)

Providing Adequate Space and Personnel for Clinical Care in Medical Facilities

Actions to Address Gender-based Violence Recommended Resources

Readiness: Follow steps for establishing 

readiness to respond to GBV within clinical 

settings, including adopting appropriate policies 

and protocols; ensuring safety, privacy, informed 

consent, and confidentiality; training staff; 

equipping facilities; and establishing referral

networks and coordination mechanisms. 

Implications of rapid scale-up: Program 

planners should plan for additional needs resulting 

from rapid scale-up of treatment access including 

support services, ongoing training for counselors, 

and emergency services and supplies for GBV 

survivors. 

A Step-by-Step Guide to Strengthening Sexual Violence 

Services in Public Health Facilities: Lessons and Tools 

from Sexual Violence Services in Africa: Tools and 

resources to establish and strengthen GBV services within 

existing public health facilities, improve linkages with other 

sectors, and engage local communities (Keesbury and 

Thompson 2010)

Improving the Health Sector Response to Gender Based 

Violence: Management checklist (Bott, Guezmes, and 

Claramunt 2004)

Violence Against Women: The Health Sector Responds

(Velzeboer et al. 2003)

Addressing GBV within Efforts to Strengthen Laboratory Networks

Actions to Address Gender-based Violence Recommended Resource

• Ensure diagnostic tests are geographically, 

financially, and linguistically accessible

• Ensure laboratory services maintain privacy and 

confidentiality protocols. 

The Gender-based Violence Information Management 

System: Sample information sharing protocol (UNFPA, 

IRC, and UNHCR n.d.)
48

Integrating GBV within Community Outreach for HIV Prevention and ART Adherence

Actions to Address Gender-based Violence Recommended Resources

• Sensitize and train adherence counselors and 

support group leaders on GBV including barriers 

to accessing treatment on a consistent basis

• Include messages challenging harmful gender 

norms and stereotypes within HIV 

communications

• Address stigma, discrimination, and violence 

related to HIV and access to services

• PLHIV, women, and affected communities should 

be involved in the formulation, implementation, 

and monitoring of public information campaigns

• All messages and images should be carefully 

vetted to avoid reinforcing negative stereotypes 

or harmful gender norms

• Public information campaigns should include 

information about patient rights including the

right to privacy and confidentiality, the availability 

of no- or low-cost services, and linkages to both 

HIV and GBV support services.

Community Treatment Literacy: Recognizing Gender 

Issues in Adhering to HIV Treatment, Workshop 

Manual (USAID Health Policy Initiative 2010)

Implementing Stepping Stones: A Practical and 

Strategic Guide for Implementers, Planners, and 

Policy Makers (ACORD 2007)

Men As Partners: A Program for Supplementing the 

Training of Life Skills Educators (EngenderHealth and 

Planned Parenthood Association of South Africa 2001) 

Mobilising Communities to Prevent Domestic Violence: 

A Resource Guide for Organisations in East and

Southern Africa (Michau and Naker 2003)

Project H: Working with Young Men to Promote Health 

and Gender Equity (Instituto Promundo 2002)

Soul City Series: Television and radio program and related 

tools for addressing HIV, sexuality, and violence (Soul 

City Institute for Health & Development Communication 

n.d.)

Linkages between GBV and National, Unified HIV M&E Systems

Actions to Address Gender-based Violence Recommended Resources

• Include GBV surveillance indicators in M&E 

systems.

The Gender-based Violence Information Management 

System: Online tools for incident reporting, tracking, and 

analysis and data sharing protocols designed to facilitate 

coordination among agencies (UNFPA, IRC, and UNHCR

n.d.)

Violence against Women and Girls: A Compendium of 

Monitoring and Evaluation Indicators (Bloom 2008)
49

Effective Links among HIV Services, Including PMTCT and HTC

Linking HIV services can contribute to increased access to services, for example, by making multiple services 

available in a single setting. Linkages may create opportunities for efficiencies such as through joint training, support 

groups for staff and clients, and information sharing.

Actions to Address Gender-based Violence Recommended Resources

Readiness assessments: Support HIV programs 

and organizations in conducting readiness and needs 

assessments for addressing GBV including knowledge, 

attitudes, and practices; institutional policies; training; 

staffing; and linkages with GBV organizations and 

networks. 

Training and sensitization: Provide training on the 

linkages between HIV and GBV, incidence and risk 

factors associated with GBV, and special 

considerations for working with GBV survivors.

Establish linkages with existing GBV services 

and networks: Develop mutually reinforcing 

partnerships and referral networks among HIVservice and GBV organizations and promote 

bidirectional integration of HIV and GBV prevention 

and response efforts. 

A Manual for Integrating the Programmes and 

Services of HIV and Violence against Women

(Ferdinand 2009)

An Essential Services Package for an Integrated 

Response to HIV and Violence Against Women: 

Details the full range of programs and services needed 

to end violence against women and HIV (Women 

Won’t Wait 2010)

Technical Brief: Integrating Prevention of Mother-toChild Transmission of HIV Interventions with 

Maternal, Newborn, and Child Health Services

(Stone-Jimenez et al. 2011)

Training Professionals in the Primary Prevention of 

Sexual and Intimate Partner Violence: A Planning 

Guide (Fisher, Lang, and Wheaton 2010)

Addressing GBV within HIV Treatment and Care Programs that Promote HIV Prevention 

Actions to Address Gender-based Violence Recommended Resources

Risk reduction:

• Address violence as a barrier to negotiating risk 

reduction strategies and support survivors in

developing strategies to protect themselves when 

negotiating safer sexual relationships

• HTC must consider ongoing risk of infection even if 

tested negative

• Address the special needs of serodiscordant 

couples

• Provide access to female initiated methods of 

prevention. 

A Manual for Integrating the Programmes and 

Services of HIV and Violence against Women

(Ferdinand 2009)

Also see the resources in sections of this guide 

pertaining to: 

Prevention

HTC

Care and Support
50

Optimal Human Resource Management, Including the “Network System” and 

Appropriate Task Shifting, to Maximize Treatment Access

Actions to Address Gender-based Violence Recommended Resources

• Ensure all cadres of health care workers are 

sensitized to GBV, understand the role of the 

health sector in addressing GBV, and have the skills 

to work with survivors

• Provide training and support on GBV on an 

ongoing basis

• Address provider knowledge, attitudes, and 

practices, particularly regarding harmful social 

norms that may reinforce and perpetuate GBV

• Ensure post-exposure prophylaxis policies for 

sexual assault address who can provide services.

Communication Skills in Working with Survivors of 

Gender-based Violence (FHI, RHRC, and IRC 2004)

Gender-related Barriers to HIV Prevention Methods: 

A Review of Post-exposure Prophylaxis Policies for 

Sexual Assault: Recommendations and key 

components for a gender-sensitive post-exposure 

prophylaxis policy for sexual assault (Herstad 2009)

IGWG Gender, Sexuality, and HIV Training Module

(IGWG 2010)

Training Professionals in the Primary Prevention of 

Sexual and Intimate Partner Violence: A Planning 

Guide (Fisher, Lang, and Wheaton 2010)
51

CARE AND SUPPORT 

PLHIV are more likely than those not infected to experience GBV (WHO and UNAIDS 2010). 

Violence or fear of violence can prevent PLHIV from seeking or accessing care and support services 

consistently. Several studies among women living with HIV reveal large gaps between the number of 

women living with HIV and the portion of those women receiving treatment, care, and support 

(Lindsey 2003). HIV care and support services and networks provide a ready-made infrastructure for 

screening PLHIV for violence, providing a minimum response to GBV survivors, linking them to 

other basic health care services, and providing referrals. Linkages to organizations and programs that 

address GBV can be mutually beneficial: strengthening health surveillance and referral networks, 

creating efficiencies around shared strategies such as economic self-sufficiency, mobilizing a 

comprehensive community-based response, and increasing successful programmatic outcomes and 

sustained results.

Addressing GBV within care and support programs can have a direct impact on 

advancing PEPFAR’s care and support strategies and reaching care and support 

targets, specifically: 

• Expanding integration of HIV prevention, care and support, and treatment services with family 

planning and reproductive health services, so that women living with HIV can access necessary

care, and so that all women know how to protect themselves from HIV infection and have 

access to women-initiated prevention technologies such as female condoms and microbicides 

(once the latter are approved)

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing gender-based violence.
52

Addressing GBV within Clinical Services

Service delivery networks can be entry points for screening clients for GBV and providing basic GBV services and 

referrals. Addressing GBV within HIV care and support services can help mitigate barriers that GBV survivors face 

in gaining access to priority services, such as ART, diagnosis and treatment of STIs, PMTCT, healthy pregnancy 

services, and prevention and treatment of opportunistic infections. Services and supplies should be made available 

at no or low cost, and financial assistance for related support (e.g., transportation, nutrition) should be made 

available.

Actions to Address Gender-based Violence Recommended Resources

Situational analysis: Assess provider knowledge, attitudes, and 

practices; review policies and protocols with respect to client 

safety, privacy, and confidentiality; review existing local or national 

data on GBV prevalence; review relevant laws and policies 

including obligations of health providers; and identify existing 

services (including basic health; sexual and reproductive health; 

mental health; and social, legal, financial, and family services). 

Staff training and sensitization: Ensure all facility staff, 

including program managers, health providers, counselors, and 

administrative staff, are sensitized routinely to GBV, trained on 

GBV organizational policies and protocols, integrate GBV into 

core and supplemental training programs, and provide GBV 

training to others on a consistent, regular basis. 

Organizational policies and protocols: Ensure client safety, 

privacy, and confidentiality including with respect to managing 

client information, and establish accountability and enforcement 

mechanisms. 

Infrastructure and supplies: Ensure facilities allow for client 

safety and privacy (e.g., private screening rooms) and procure 

emergency supplies; information, education, and communication

materials; rapid test kits; and male and female condoms. 

Public sector coordination: Establish and maintain linkages 

with public sector responders (e.g., police, and public health 

providers); support training on and sensitization to GBV, human 

rights, gender power relations, and legal obligations. 

Related services: Map existing services (including health, social, 

legal, and financial) and establish referral pathways and protocols. 

GBV screening: Where referral services are available, adopt 

protocols to screen clients for GBV including how to identify risk 

factors, ask clients about violence, and validate their experience. 

Care for GBV survivors: Where referral services are available, 

adopt protocols for care of GBV survivors, including emergency 

services and safety planning. 

A Manual for Integrating the Programmes 

and Services of HIV and Violence 

against Women: (Ferdinand 2009)

A Step-by-Step Guide to Strengthening 

Sexual Violence Services in Public 

Health Facilities: Lessons and Tools 

from Sexual Violence Services in Africa:

Tools and resources to establish and 

strengthen GBV services within existing 

public health facilities, improve linkages 

with other sectors, and engage local 

communities (Keesbury and Thompson 

2010)

Addressing Gender-based Violence through 

USAID’s Health Programs: A Guide for 

Health Sector Program Officers:

Intended to help integrate GBV activities 

into health sector portfolios during project 

design, implementation, and evaluation 

(IGWG of USAID 2008) 

Guidelines for Medico-legal Care for 

Victims of Sexual Violence: Developed to 

improve professional health services for all 

victims (men, women, and children) of 

sexual violence (WHO 2003)

Improving the Health Sector Response to 

Gender Based Violence (Bott, Guezmes, 

and Claramunt 2004)

Twubakane GBV/PMTCT Readiness 

Assessment: Questionnaires and focus 

group discussion guides designed for 

introducing GBV services within health 

care settings (IntraHealth International 

2008)
53

Addressing GBV within Social Care and Community Mobilization 

Like HIV, GBV requires a comprehensive, multidimensional, multisector response. Social care, such as incomegenerating activities, can help address risk factors for GBV and provide needed support, such as legal services and 

support groups for GBV survivors.

Actions to Address Gender-based 

Violence

Recommended Resources

Readiness assessments: Support social 

care organizations to conduct readiness

and needs assessments for addressing 

GBV; to review institutional policies, 

training, and staffing; and to create linkages 

with GBV organizations and networks. 

Training and sensitization: Provide and 

facilitate training for social care 

organizations on the linkages between HIV 

and GBV, the role of communities in 

responding to and preventing GBV, 

prevalence and risk factors associated with 

GBV, and special considerations for 

working with GBV survivors.

Establish linkages with existing GBV 

services and networks: Develop 

mutually reinforcing partnerships and 

referral networks among HIV-service and 

GBV organizations and promote 

bidirectional integration of HIV and GBV 

prevention and response efforts. 

HIV & AIDS - Stigma and Violence Reduction Intervention 

Manual: Guide for community-based organizations to facilitate 

community-led and -owned processes that address stigma and GBV 

in HIV prevention efforts (Duvvury, Prasad, and Kishore 2006)

Implementing Stepping Stones: A Practical and Strategic Guide 

for Implementers, Planners, and Policy Makers: Tools for 

engaging communities on gender and HIV (ACORD 2007) 

Project H: Working with Young Men to Promote Health and 

Gender Equity (Instituto Promundo 2002)

The SASA! Activist Kit for Preventing Violence Against Women

and HIV: Comprehensive set of tools for community-based action 

(Raising Voices 2009b)

Training Professionals in the Primary Prevention of Sexual and 

Intimate Partner Violence: A Planning Guide: Includes practical 

tools to help plan, deliver, and evaluate trainings appropriate for a 

broad range of community-based organizations and entities 

involved in addressing GBV (Fisher, Lang, and Wheaton 2010)

Violence Against Women: The Health Sector Responds: Provides 

an overview of PAHO’s integrated strategy for addressing GBV, 

not only within the clinical setting, but also within policy, the health 

sector, and the community (Velzeboer et al. 2003)

Addressing GBV within Psychological Services 

Psychological reactions to GBV are similar to, but distinct from, those experienced by people infected and affected 

by HIV, such as anger, denial, and depression (UNFPA 2004). Just as community attitudes, such as HIV stigma and 

discrimination, can influence PLHIV’s sense of self, harmful gender norms can fuel and reinforce GBV survivors’ 

feelings of shame, isolation, and self-blame. 

Actions to Address Gender-based Violence Recommended Resources

• Include mental health services in referral networks for PLHIV and GBV 

services

• Train and sensitize community-based support workers to provide 

counseling and support

• Employ community-based strategies to address the role of survivors’ family 

and friends in overcoming the trauma of GBV (UNFPA 2004)

• Ensure children and youth receive age-appropriate trauma counseling

• Facilitate access to quality counseling by trained workers, such as 

counselors, nurses, social workers, psychologists, or psychiatrists

• Develop support groups specifically designed for GBV survivors and their 

families.

Communication Skills in 

Working with Survivors of 

Gender-based Violence (FHI, 

RHRC, and IRC 2004)

IASC Guidelines on Mental 

Health and Psychosocial 

Support in Emergency 

Settings: Information on 

providing psychosocial support 

to survivors of GBV (IASC 

2007)
54

Addressing GBV within Positive Prevention Efforts 

Actions to Address Gender-based Violence Recommended Resources

• Train and sensitize providers on increased risk of violence for PLHIV, 

particularly women living with HIV

• Train and sensitize providers on GBV, especially on the sexual and 

reproductive health rights of PLHIV and increased risk to GBV survivors of

pressure and coercion regarding pregnancy and childbearing within health 

care settings

• Train and sensitize providers on barriers that GBV can pose for treatment 

access and adherence; ensure services are available and at no or low cost, 

and that financial support is available for related expenses such as food and 

transportation. 

Community Treatment Literacy: 

Recognizing Gender Issues in 

Adhering to HIV Treatment, 

Workshop Manual (USAID 

Health Policy Initiative 2010)

IGWG Gender, Sexuality, and 

HIV Training Module (IGWG 

2010)
55

ORPHANS AND VULNERABLE 

CHILDREN

GBV against orphans and vulnerable children (OVC) can take the form of physical and emotional 

violence, sexual abuse, forced and early marriage, forced labor and child trafficking, and inequitable 

access to household resources, including nutrition, schooling, and health care. GBV against children 

can occur in multiple settings: in the home, in school, in institutional settings, in the community, and 

in situations where children are living outside of family care. Perpetrators include family members, 

neighbors, caretakers, teachers, employers, service providers, and others. Children without adequate 

adult protection and care are highly vulnerable to all forms of maltreatment including sexual 

violence.

GBV against children is increasingly pervasive. An evaluation of GBV programs in sub-Saharan 

Africa showed that children constitute a significant portion of GBV survivors seeking services but 

that they are underserved by adult-oriented services (Keesbury and Askew 2010). Although sexual 

violence tends to increase with age and to affect girls more than boys, it is known to occur against 

children of both sexes and at all ages, including infancy. 

Numerous studies illustrate young women’s particular vulnerability to sexual violence; for example, 

one study showed that the younger women are at the age of first sex, the more likely it is to have 

been forced (Moreno 2005). In another study, young women living with HIV were 10 times more 

likely to report partner violence than their counterparts. Economic vulnerabilities for OVC are 

especially acute. Girls may be pressured to leave school in order to take on household 

responsibilities or paid work, and they are more likely than boys to exchange sex for food or money 

or be forced into prostitution (Plan UK and Plan International 2007). Likewise, boys may be 

pressured to leave school to take on paid work and be turned out of their house in order to relieve 

the economic burden (real or perceived). The consequences are numerous and far reaching. 

Addressing GBV within OVC programs can have a direct impact on advancing

PEPFAR’s OVC strategies and reaching OVC targets, specifically: 

• Strengthening the ability of families and communities to provide supportive services, such as 

food, nutrition, education, and livelihood and vocational training to OVC

• Expanding PEPFAR’s commitment to cross-cutting integration of gender equality in its 

programs and policies, with a focus on addressing and reducing GBV. 
56

Integrating GBV Services within Support to OVC and Their Families and Caregivers

The best protection for a child against maltreatment is a safe, stable and caring family. 

Actions to Address Gender-based Violence Recommended Resources

• Home visitation and parent education programs to prevent 

child maltreatment, especially of OVC and children living 

with HIV

• Identify and treat emotional disorders in children, especially 

OVC and children living with HIV

• Interventions for children and adolescents subjected to child 

maltreatment 

• Early childhood development programs for young OVC that 

actively engage the community, caregiver, and family

• Working with parents and other caregivers to raise 

awareness about different forms of child maltreatment and 

sexual abuse and the role of parents and caregivers in 

preventing abuse.

Gender-based Violence: Care and Protection 

of Children in Emergencies, A Field Guide

(Save the Children 2004)

Preventing Child Maltreatment: A Guide to 

Taking Action and Generating Evidence

(WHO 2006)

Protecting Children Affected by HIV Against 

Abuse, Exploitation, Violence, and Neglect

(Long 2011)

Integrating GBV Services within Community-based Assistance to Vulnerable Households

Safe communities help to ensure that children and their families thrive; community groups often step in to help 

struggling families. 

Actions to Address Gender-based Violence Recommended Resources

• Enhance the capacity of all who work with and for children 

to identify and take action against GBV

• Provide recovery and social reintegration services 

• Ensure equal access to services, support, and resources for 

girls and young women, OVC, and children living with HIV

• Ensure programs and services address factors that can 

disproportionately lead girls to drop out of school and/or 

pursue domestic or paid labor, forced prostitution, or child 

labor.

Child Protection Policies and Procedures 

Toolkit (Jackson, Wernham, and ChildHope 

2005)

Rethinking Domestic Violence: A Training 

Process for Community Activists (Naker and 

Michau 2004)

The SASA! Activist Kit for Preventing Violence

Against Women and HIV: Comprehensive set 

of tools for community-based action (Raising 

Voices 2009b)
57

Integrating GBV Services within Essential Services for OVC

Safe communities help to ensure that children and their families thrive; community groups often step in to help 

struggling families. 

Actions to Address Gender-based Violence Recommended Resources

• Review or enact gender-sensitive child protection policies within all 

institutions and organizations that serve children and adolescents

• Train all service providers about gender inequality and equip them to 

recognize and address gender disparities in access to and provision of 

services to OVC

• Ensure health services are child-friendly, gender-sensitive, and confidential, 

and that providers are trained and equipped to identify and respond to GBV

• Provide access to sexual and reproductive health care

• Support girls’ education and address barriers to access

• Ensure equal access to birth registration

• Provide legal services for girls and young women related to property and 

inheritance rights.

Advocating for Sexual Abuse 

Free Classrooms (Meintjes 

2009)

Child Protection Policies and 

Procedures Toolkit (Jackson, 

Wernham, and ChildHope 

2005)

Addressing GBV within OVC Policy, Legislation, and Resource Mobilization

Strong government child protection systems are necessary along with champions for children who lack adequate 

adult protection at home.

Actions to Address Gender-based Violence Recommended Resources

• Integrate gender equality principles into national plans, laws, and policies 

related to children

• Enact and enforce legal protections against all forms of violence against 

children including early and forced marriage, harmful practices such as female 

genital cutting, child labor, and trafficking in persons

• Protect and promote inheritance rights for children, particularly girls and 

young women

• Ensure customary laws protect children, particularly girls and young women.

Resources for communities:

• Ensure resources are allocated for violence prevention programs

• Invest in programs to get and keep girls and young women in school and 

ensure schools and the trip to school are safe for children, especially girls 

and young women.

Child Protection System 

Mapping and Assessment 

Toolkit: Users’ guide, 

comprehensive toolkit, and 

core toolkit (UNICEF 2010)

Council of Europe Policy 

Guidelines on Integrated 

National Strategies for the 

Protection of Children from 

Violence (Council of Europe 

n.d.)

Report of the Independent 

Expert for the United 

Nations Study on Violence 

Against Children:

Recommendations for states 

(U.N. Secretary General 2006)
58

Addressing GBV within Efforts to Challenge Stigma and Discrimination against Children 

Living with and Affected by HIV 

Actions to Address Gender-based 

Violence

Recommended Resources

Strategies for addressing social and 

cultural norms that support GBV:

• Media awareness campaigns

• Working with men and boys

• Promote nonviolent values and 

awareness raising, especially at a young 

age with girls and boys.

HIV & AIDS - Stigma and Violence Reduction Intervention 

Manual: Tools for implementing community-owned processes in 

development programs (Duvvury, Prasad, and Kishore 2006)

Implementing Stepping Stones: A Practical and Strategic Guide 

for Implementers, Planners, and Policy Makers: Tools for 

engaging communities on gender and HIV (ACORD 2007) 

Project H: Working with Young Men to Promote Health and 

Gender Equity (Instituto Promundo 2002)

Addressing GBV within HIV Prevention Programs for OVC

Actions to Address Gender-based Violence Recommended Resources

GBV prevention education:

• Teach children from a young age about good and bad touching and how 

to report suspected maltreatment

• Help children recognize and avoid potentially abusive situations through 

school- and community-based training 

• Institute bullying prevention programs

• Provide school- and community-based programs to prevent dating 

violence

• Implement school- and community-based multicomponent violence 

prevention programs

• Establish safe spaces within the community for girls

• Include life skills education and self-esteem programs

• Work with parents and caregivers to ensure their understanding of child 

sexual abuse and the important role they play in its prevention.

Advocating for Sexual Abuse Free 

Classrooms (Meintjes 2009)

Gender Matters: A Manual on 

Addressing Gender-based 

Violence Affecting Young 

People (Council of Europe 2007)

Good School Toolkit (Raising 

Voices 2009a)

Project H: Working with Young 

Men to Promote Health and 

Gender Equity (Instituto

Promundo 2002)
59

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