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Citation
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Laurenzi CA, Mutambo C, Mwamba C, Mupakile E, Busakhwe C, Ronan A, Toska E. J. Int. AIDS Soc. 2023; 26(10): e26181. |
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Abstract
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Young women living with HIV (YWHIV) commonly experience overlapping vulnerabilities, especially in low-resource, HIV-endemic settings. They are likelier to experience violence, and have poorer antiretroviral adherence, HIV care disengagement and low viral suppression [1]. Despite strong prevention programming, HIV incidence among 15- to 24-year-olds in Zambia remains high, potentially exacerbated by the COVID-19 pandemic [2]. Additionally, nearly two-thirds of YWHIV in Zambia have experienced sexual violence from intimate partners [3]. HIV and violence commonly co-occur in the context of harmful gender norms, early marriage, and power-inequitable relationships, hindering access to healthcare services [4].
Violence screening at the health system interface can identify women at risk and link them to necessary services. While the World Health Organization recommends against universal screening for violence in healthcare settings, it provides guidance and training for integrating routine enquiry about violence into antenatal care [5]. However, more tailored screening approaches would help identify women requiring violence-responsive services in settings with overburdened health systems and high rates of HIV and gender-based violence (GBV) [5]. One clear evidence gap is designing and testing these integrated approaches.
Clinic-community collaborations may be able to address this gap. Social stigma and norms surrounding HIV and GBV shape how they are experienced, reported and addressed in healthcare settings. For younger women, peer-led approaches can facilitate less judgemental, more relatable interactions - opening a critical entry point for screening and referrals, and improving post-GBV service access. Yet, there is limited evidence about how to effectively upskill peer workers to respond to GBV [6], including for YWHIV. We aimed to explore how violence screening could be integrated into peer-enhanced HIV care, using a clinic-community collaborative model, for YWHIV.
In one low-income community outside Lusaka, Zambia, we leveraged an existing partnership to co-develop an integrated package, Screen & Support. This package included WHO's minimum requirements for violence screening (standard operating procedures, training, privacy, confidentiality and referral systems). It aimed to guide facility-embedded youth peer supporters and their clinic-based mentors to identify YWHIV--to whom they were already providing support--experiencing, or at risk of, violence, and link them to appropriate additional services...
Language: en |