Connection between domestic violence, HIV, infections and TB
Intimate partner violence (IPV), defined as the experience of “physical, sexual or psychological harm by a current or former partner or spouse”, is a significant public health and human rights problem across the globe. In a nationally representative study, one in three South African women had experienced physical IPV at some point in their current relationship. According to a policy brief by Stellenbosch University, South Africa has the highest rate of women killed by their intimate partner in the world.
There is strong evidence that intimate partner violence is part of a vicious cycle. Victims are made vulnerable to HIV, mental illness, poor reproductive health and chronic disease. The cycle can lead to injury, disability and in some cases death. Abused women are twice as likely as non-abused women to report physical and mental health problems.
The Networking HIV and Aids Community of SA’s IPV programme, funded by the Global Fund, provides counselling services through supervised social auxiliary workers to victims between the ages of 14 and 64. Victims access the service by visiting the offices of the organisations running the service and through outreach using the “go and fetch” principle at clinics, police stations, courts and in schools. They are screened using nine simple questions. The counsellors talk to victims about the risk of HIV, sexually transmitted infections and tuberculosis, offer HIV testing, provide condoms and talk about contraception. They then link people to longer-term counselling and other forms of support. The programme will reach 90 000 people over three years with 54 social auxiliary workers, seven supervisory social workers working in seven community organisations in the Western Cape, Eastern Cape and Gauteng. At least 80% receive HIV testing services.
Recognising that support for victims is only part of the solution, Nacosa also manages an economic empowerment intervention in domestic violence shelters. Four organisations provide between eight and 12 sessions per quarter to shelter residents, former shelter residents and women referred through the IPV programme (where economic abuse has been identified). The women are provided with practical craft and business skills, job readiness support and basic financial literacy to support them to become economically independent. This intensive intervention will reach 1 560 women over three years.
Throughout the first year of this programme, we have been struck by the age group being positively screened. More than 30% are females aged between 14 and 24 and 29% are women between 25 and 40. Women in these age groups are more at risk of becoming HIV positive.
Organisations running the programme have noticed that there is still significant stigma involved in getting an HIV test at clinics, particularly for people experiencing intimate partner violence. Women report that their partners are reluctant. For this reason, it is essential that more social auxiliary workers are trained and certified to provide HIV testing services themselves so that they can test people immediately in the first counselling session. Officials at clinics need to make sure they are youth-friendly, non-judgmental spaces where young women at risk can get access to the full range of sexual and reproductive health services.
Social auxiliary workers must reach three new clients each day and do follow-up counselling as well - a heavy burden on these workers, who need extensive supportive supervision. They also need regular debriefing because the level of violence that they are seeing is traumatising. High numbers of positive HIV tests are also negatively affecting them. In general, we must find ways of dealing better with mental health issues within the IPV response - greater therapeutic interventions are needed to address the significant mental health issues we are seeing in victims of IPV and their children.
From the available evidence, it is clear that multi-level interventions work better than single level interventions and current IPV programming operates largely at the response level. Doing more to generate awareness of the available services, so that people can seek help earlier, will help to boost the prevention side of the equation. There is also a piece of the puzzle missing. The role of the private sector in responding to and addressing IPV should be boosted: companies that include IPV screening and referral to services in their workplace wellness programmes, for example, could have a significant impact on the IPV issue.
Although we are slowly making progress in understanding the causes and impact of IPV in South Africa, there is a great deal that still needs to be done to begin to turn the tide. Greater public awareness, particularly among young people, is essential. Violence in the home is the breeding ground for the country’s high levels of sexual and gender based violence, as well as its heavy HIV burden. We can’t afford to stand still on this.
* Sharon Kouta is a gender-based violence specialist at Nacosa.
** The views expressed here are not necessarily those of Independent Newspapers.