Mercy Luwi Katoka, FHI 360
Lauren R. Rutherford, FHI 360
Mwiya Mutandi, FHI 360
Chileshe Bwalya, International Development Enterprises (formerly FHI 360)
This post is part of a series about the real-life use and impact of technical tools, resources, technical assistance strategies, and materials developed by the Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) project.
The 16 Days of Activism Against Gender-Based Violence, an annual international campaign founded by the Center for Women’s Global Leadership, begins today. In honor of 16 Days, we are highlighting some of the work being done by our MOSAIC Zambia team to address sexual and gender-based violence (SGBV) and its impact on HIV prevention.
In Zambia, SGBV and intimate partner violence (IPV) remain significant barriers to accessing and effectively using HIV prevention products and services. A staggering 14% of Zambian women aged 15-49 have experienced sexual violence in their lifetime, hindering their ability to negotiate safer sex practices or consistently use HIV prevention products, such as pre-exposure prophylaxis (PrEP). A lack of supportive policies to eliminate SGBV, limited provider capacity, and the inadequate adoption of provider support tools for addressing SGBV have created a challenging environment for HIV prevention efforts. In 2023, Zambia recorded a concerning 12.6% HIV prevalence among women.
MOSAIC provides technical assistance to Zambia’s Ministry of Health (MoH) to integrate SGBV screening and response into the country’s HIV prevention program. Through MOSAIC-supported dialogues, consultative meetings, and gender integration activities, Zambia’s MoH has fostered an enabling policy environment to prioritize and address SGBV within HIV prevention and PrEP services.
MOSAIC’S COLLABORATIVE EFFORTS WITH ZAMBIA’S MINISTRY OF HEALTH
New guidelines on the role of health care workers in SGBV
The MoH is in the process of developing national guidelines on management of SGBV for health care workers to ensure that survivors of SGBV receive holistic, effective, and comprehensive care, including referral to and provision of HIV prevention services. These national guidelines will outline the importance of SGBV prevention and the role of health care workers in supporting survivors. The guidelines will also include sample questions for screening clients from key populations for SGBV. Those questions were adapted from MOSAIC’s Standard operating procedures for addressing partner relationships and GBV in PrEP services, a resource intended to be used by health care workers and staff to screen for and respond to SGBV in PrEP services.
Gender-transformative services training for health care workers and volunteers
MOSAIC provided technical review of the MoH’s training materials on gender-transformative sexual, reproductive, and maternal, child health, and nutrition services for health care workers and community-based volunteers. The materials provide definitions on forms of SGBV, explore cultural and systemic drivers, and outline strategies for prevention and response that empower health care workers and community volunteers to identify, address, and support survivors while challenging harmful societal norms. A national training of trainers was conducted with these materials in April 2023, and the content has since been cascaded to the Southern, Eastern, and Luapula provinces of Zambia.
Development of national PrEP and PEP guidelines
In 2023, MOSAIC assisted the Ministry of Health in creating the National pre- and post-exposure prophylaxis guidelines, a comprehensive tool for implementing PrEP and PEP in-country. MOSAIC shared resources, including the Standard operating procedures for addressing partner relationships and GBV in PrEP services, and offered technical input, suggesting the inclusion of a section on IPV screening and response.
“The integration of PrEP and IPV services aligns Zambia’s SGBV response services with the country’s Health Strategic Plan and ensures a more comprehensive approach to addressing SGBV in Zambia.”
Peter Phiri, Zambia Ministry of Health, Muchinga Province
Improved LIVES training for PrEP providers in local districts
MOSAIC adapted the World Health Organization’s listen, inquire, validate, enhance safety, and support (LIVES) approach to reflect the linkage between IPV and PrEP in Zambia. The adapted training enabled PrEP providers to identify clients experiencing IPV and offer appropriate response services, while using practical techniques for routine enquiry and delivering first-line support to PrEP clients who disclose violence. This adaptation places a survivor-centered and trauma-informed approach at the forefront of addressing IPV in Zambia PrEP programs.
“The LIVES training has empowered our health providers to identify and respond to SGBV cases more effectively, leading to a 50% increase in reported cases.”
Peter Phiri, Zambia Ministry of Health, Muchinga Province
Zambia’s MoH has taken significant steps toward realizing and surpassing PEPFAR’s and the World Health Organization’s requirements for responding to SGBV in PrEP services. The technical assistance provided by MOSAIC Zambia, the inclusion of effective MOSAIC tools such as the provider job aids and SOPs into national policies, and the development of robust trainings will make SGBV screening and response a long-term, integral part of HIV prevention and PrEP services in Zambia.
For additional information on SGBV and HIV prevention, please view the presentations from MOSAIC’s Global PrEP Learning Network webinar, “Building a comprehensive approach to HIV prevention: Strengthening gender-based violence response in PrEP services” onPrEPWatch.The presentations include “Leveraging PrEP product rollout to improve gender-based violence response in Zambia,” which was presented by the MOSAIC Zambia team at SVRI Forum 2024.
Featured Image: The MOSAIC Zambia team poses for a photo with Ministry of Health officials during a LIVES training conducted in Lusaka, Zambia (MOSAIC Zambia).