Gender Based Violence (GBV) Related HIV Infection

by

The Case of Sexual Harassment against Women Food Vendors- Mama Ntilie

TO EFFECTIVELY engage in the Linkages between HIV/AIDS; Gender Based Violence and Poverty in the context of advocacy and service provision, one must adopt a diverse range of strategies to bring issues which are often considered controversial and insignificant, from the periphery to the centre of the struggles for social justice by providing information on HIV Prevention with the inter linkages which are causal to HIV infection and the strategies needed to address the causality to all sectors in our society.

While Marginalized Women like Women Food Vendors face severe forms of oppression not only in terms of Poverty and Lack of Upward Mobility in their Economic Livelihoods, they also face a marked lack of information on Coercive Sex as one of the conduits of HIV infection and that Coercive Sex is grouped in the Gender Based Violence scenario which can and has had a adverse impact in their community lives. They also lack awareness that they can be trained to become agents for change in their communities.

They often feel they are victims of their circumstances, but try to cope with the barrage of stigma; discrimination and sometimes violence in their lives and often dream of the kind of life that they want to live which includes the dream of living in a society which is ‘Free of Gender Based Violence; Poverty; HIV/AIDS; a society in which women have control over and own their bodies and the decisions over their bodies, decisions which should be informed while given a diversity of options ’.

This willpower to ‘live’ even in the face of insurmountable challenges needs to be tapped so that the HIV/AIDS programs become all encompassing by ‘reaching out’ to constituencies which are often diverse but whose diversity are yet to be analyzed or included in National Policies and Strategic Plans as a matter of interface and inter linkage: Poverty- Gender Based Violence/Coercive Sex- HIV infection.

Their plight of being poor; uninformed on Human Rights and their economic livelihoods (being in the peripheries of the economic circle) is either ignored by society or they are abused; marginalized from the mainstream to the extent HIV/AIDS Prevention Programs rarely access this constituency.

Positive changes in Policies, Legislation and Gender Related HIV infections are increasingly recognized in International Human Rights law, particularly in the areas of Poverty and Economic Livelihoods and Gender Based Violence. Their Low Literacy Levels place Marginalized Women like Women Food Vendors at the mercy of abusive clients; local authorities and sometimes, the police.

Their low literacy makes them ineligible for formal employment while lack of capital and lack of surety for loans forces them to engage in the informal sector of vending food without business licenses and since they do not pay income tax, they are placed at the disadvantage of being compelled to engage in Coercive Sex in order to protect their sources of livelihoods and their persons from being prosecuted for operating outside the formalized structures of business which in turn places them at a high risk of HIV infection. It is a fact that in Coercive Sex, the woman would have no say in condom protection as opposed to Consensual Sex.

Moreover, though changes in policies, laws and development approaches at the international, regional and national levels have helped to advance the realization of the linkage between and among HIV/AIDS; Gender Based Violence and Poverty, the implementation has lagged. (Source: Impact of Sexual Harassment on Women’s Incomes/Leila Sheikh/2009).

Most Pressing Needs in Sexual Harassment related HIV infection

The most pressing needs in reducing the vulnerability of Women Food Vendors to Sexual Harassment related HIV infections in Tanzania include the following:

  • Access to free, comprehensive, confidential, friendly, and appropriate health services.
  • Access to free female condoms, and lubricants in the case of post menopausal women who society tends to see as asexual and cannot be sexually harassed which is often the opposite.
  • Opportunities for Economic Justice and financial assistance through micro-credit facilities and small business management training which give options to women for upward mobility and breaking free from Poverty and in the process, break the cycle of Gender Based Violence related HIV infection..
  • Increased access to Sexual and Reproductive Health information and services.
  • Individual empowerment, life skills training and leadership building opportunities.
  • Increased security and protection from violence, exploitation, and sexual abuse by employers/sexual harassment at places of employment; rape by police on sex workers and sex extortion by the police and municipal authorities from women in the informal sector like Women Food Vendors etc.
  • Increased access to justice and equal legal protection in the instance of HIV infection- this is most common in rural communities in which the culture of VCT has not yet taken root.

 

  • Human Rights and advocacy skills development for women in vulnerable circumstances like women who have ‘to beg’ for slots/locations from which they can vend food.
  • Increased networking and movement building opportunities for rural/community based HIV Prevention activists.

 

Critical to these change processes have been government initiated programs which one must say have been quite innovative in reaching out to a broad based constituency so that intervention against HIV infection and Care and Treatment has almost become universal in the country. (Source: National Strategic Plans on HIV/AIDS).

In addition, several initiatives aimed at strengthening health systems, usually in the context of harmonization and alignment in support of country-led processes; demonstrate heightened donor attention to HIV/AIDS. (Source: UNAIDS).

 

HIV/AIDS Intervention encompasses health and well-being in matters related to sexual relations. It deals with the most intimate and private aspects of people’s lives, which can be difficult to write about and discuss publicly. As a result, the public misunderstands many HIV/AIDS related matters like Coercive Sex for example. In addition, cultural sensitivities and taboos surrounding sexuality often prevent people from seeking information and care, while lack of sufficient data and testimonies preclude the government from addressing the interlinking issues of Poverty, Coercive Sex and HIV infection.

Yet, HIV/AIDS profoundly affects the social and economic development of the country. When parents die from AIDS related causes, children are orphaned. When girls must take over care of their siblings, they drop out of school. Without an education, girls often engage in the informal sector or become sex workers and are often prone to HIV infection or to begin having children early, which can jeopardize their health and limit their opportunities to add productively to their lives; those of their families and to the community and their country’s development.

 

The media play a critical role in bringing the inter linkages between HIV infection; Gender Based Violence and Poverty to the attention of people who can influence Public Health Policies. These people include government officials and staff; leaders of nongovernmental organizations, including women’s groups and religious groups; academics and health experts; and health advocates and other opinion leaders. (Source: Journalists’ Guide to SRHR Monitoring).

Many of these influential people read news reports and listen to broadcasts daily, and their opinions are shaped by them. Occasionally, one news report can spur a decision maker to act. More often, however, a continuous flow of information is needed to educate diverse audiences about issues and inform public policy debates.

Therefore, it is crucial that a program which has a three-pronged approach: HIV Prevention- Gender Based Violence and Confronting Poverty as an important starting point which should lead to conversations around linkages and the impact of addressing linkages to have a holistic approach on HIV Intervention.

Key Areas

The majority of organizations involved in HIV/AIDS in Tanzania are using a Health Approach to programming. Due to the taboos surrounding sex and sexuality and the social stigma, and negative perceptions on women’s bodies, most organizations have yet to adopt a clear Rights Based Approach framework to their programming. The Rights Based Approach should be able to identify the hindrance to HIV Intervention often caused by Gender Based Violence and Poverty.

While a number of organizations recognize that a more holistic approach is needed to advance Intervention against HIV/AIDS, most of the interventions being used are still very conventional and often ignore the Rights of Marginalized Groups like disadvantaged and marginalized women in the peripheries of the economic circle and women in forced marriages who have to put up with sexual relations with a partner they do not want.

It is also important to note that the majority of organizations engaging in this agenda, only begun to do so in the last 8 years, are operating at a relatively small scale, and are still in the process of developing their own theories of change and home-grown strategies to address a Feminist/Gender Oriented Approach on HIV/AIDS and the Linkages issues in Tanzania.

It has to be acknowledged that tradition; religious orientation and patriarchy often shape the mainstream’s perception of sex and sexuality. This connotation makes Women Food Vendors easy prey to their customers; to local authorities and sometimes to the police who perceive such women as lacking empowerment and the assertiveness to say “No” to Coercive Sex and which places them at the risk of contracting HIV because they lack the skills or the muscles to negotiate to say “No” to Coercive Sex or to insist on protective sex.

Owing to the fact that many of the initiatives of the past have failed for example the high rate of schoolgirl/teenage pregnancies, most initiatives are now focusing on reducing vulnerability to HIV, AIDS and STIs, without focusing on increasing access to training and sensitizing women with Legal Literacy and Human Rights awareness which would make them become assertive and informed about their rights.

Providing financial and technical support to groups engaging in income generating activities would give Marginalized Women the impetus to refuse to engage in enforced sex which places them in a vulnerable position of lacking negotiating powers for protective sex.

Gender Based Violence in relation to HIV/AIDS

Gender-based violence (GBV) is a grave reality in the lives of many women in Tanzania. It results from gender norms and social and economic inequities that give privilege to men over women. There is a mounting recognition in Tanzania of gender discrimination and gender equity in different facets of life.

This awakening includes a growing acknowledgement of how prevalent gender-based violence is and the ways and extent to which it harms not only women and girls but also men and boys and, furthermore, the country’s developing economy and Health and Social Welfare systems.

.Reports from Legal Aid CSOs indicate that many forms of gender-based violence, including Intimate Partner Violence (IPV) and rape, are seen as normal and are met with acceptance by both men and women— although the justifications for acceptance differs between women and men.

Women and girls are also frequently blamed for causing or provoking gender-based violence. In part due to blame and shame, women and girls rarely report Gender-Based Violence to authorities or seek other kinds of treatment or support.

.Tanzanian law has shown some progress in preventing and punishing GBV crimes. For example, the Sexual Offence Special Provisions Act of 1998 poses harsh penalties for perpetrators of sexual violence. However, gaps remain in the legal system.

.Central to the need for the Stronger Voices initiative is women’s empowerment, as the crux to strengthen women’s voices for assertiveness training on negotiating skills for protective sex and for saying “No” to coercive sex. Knowledge in Human Rights empowers women to make informed decisions regarding their Sexual and Reproductive health.

Despite these incipient reforms, the key informant interviews revealed that the number and quality of services and resources available to survivors of Gender-Based Violence is minimal. While service providers interviewed, including doctors and police, said that they respond to GBV when presented with a case, there are no protocols for working with survivors. Likewise, little training on proper protocols is available to service providers.

Legal aid services run by small nongovernmental organizations (NGOs) with limited budgets are available in cities throughout the country, but there is a wide gap in health, counseling, and social welfare services for GBV survivors. (Source: Sexual Harassment, the Silent Crime/Leila Sheikh/2007).

 

Interventions which should be used

The majority of stakeholders therefore need to adopt the following key interventions to address the above needs:

  • Promoting Peer Education that focuses on STI and HIV prevention, care, and treatment.
  • Distributing male and female condoms.
  • Creating support groups and providing safe spaces for women experiencing sexual harassment to meet and to be given basic legal aid.
  • Supporting income generating activities.
  • Training and sensitizing Health Service Providers.
  • Using community outreach to promote public awareness & sensitization campaigns.
  • Contributing to the National Health Policy Reform process.
  • Mapping and research.
  • Conducting outreach activities, including mobile VCT.

HIV/AIDS Advocacy CSOs and CBOs need to use other strategic interventions which, if scaled up, could have a big impact and increase the efficacy of the more conservative interventions mentioned above:

  • Providing personal well-being and psychosocial support to women especially PLHIV women.
  • Training and sensitizing the police force on Gender Based Violence and Human Rights issues.
  • Providing targeted Sexual and Reproductive Health Services to Marginalized Women.
  • Providing legal counsel and representation to women who engage in sex work and to create opportunities for Exits from sex work.
  • Strategic Litigation.
  • Promoting movement building and networking between women in vulnerable circumstances and other social justice organizations and movements
  • Sensitizing and training the media
  • Promoting Human Rights advocacy and training for Marginalized Women.
  • Training paralegals
  • Developing programs targeting Youth to Youth Outreach.
  • Providing direct funding to Marginalized Women led groups which can be made Gender Rights and HIV Prevention activists.
  • Identifying and assessing gaps, challenges, strengths, opportunities and needs of Marginalized Women’s organizations in the context of HIV/AIDS.
  • Creating networks for peer learning, joint advocacy, sharing of resources, support and solidarity.
  • Providing learning to strengthen skills, knowledge and develop tools for change.
  • Developing innovative strategies to use ICT and media tools for community based HIV Prevention Programs.
Interventions Required
  1. Legal and Policy environment
  2. Incorporate GBV into HIV policies and plans
  3. Facilitate dialogue among parliamentarians about the health, development, and social impacts of GBV
  4. Assist gender focal points in ministries with addressing GBV issues and developing sector-specific action plans on GBV
  5. Work with local government leaders to translate the GBV plans of action into concrete components of community by-laws.
  6. Reform health centers systematically to address GBV, starting with how-to policies, protocols, and guidelines
  7. Incorporate GBV screening and referrals into HIV counseling and testing program
  8. Incorporate a GBV response into HIV counseling and testing programs that have adequate capacity and resources
  9. Incorporate GBV curriculum into universal health, justice, and legal programs and/or continuing education programs for health professionals
  10. Form peer support and counseling groups by training community members as facilitators
  11. Awareness-Raising and Community Mobilization

Inclusion of Marginalized Women/Informal Sector Food Vendors   into the HIV/AIDS Agenda

Issues of sex and sexuality are often made central to the HIV/AIDS agenda, especially considering how culture, tradition and religion still perceive the main mode of transmission through sexual engagement as ‘Retribution and Sowing what You plant’. To this end, the conceptualization of the disease is contextualized by associating it with ‘Punishment’. This is especially so because all organized religions have structures for ‘Reward and Punishment’.

Associating HIV/AIDS with Reward or Punishment has served to perpetuate the notion that sex and sexuality are a source of sin and there is still a section of society which believes that “adultery causes HIV infection”. Society becomes more judgmental and sometimes abusive and/or violent towards Women Food Vendors who also do sex work as an aside source of income whom the majority of the mainstream describes as ‘dustbins or conduits’ of HIV and STI.

This attitude and behavior has served to entrench them underground outside the protection of the law; HIV Prevention Programs; counseling and care among Mama Ntilie who are PLHIV and who are in urgent need of such services.

Violence against women food vendors; fear of arrest and the ensuing legal process has driven Mama Ntilie to the periphery of HIV and AIDS Interventions and few HIV Prevention Programs reach them.

We must therefore continue to interrogate the linkages between patriarchy, gender stereotypes and Gender Based Violence (GBV) because violence against Women Food Vendors who also moonlight as sex workers is gender based and then we need to move beyond gender and give HIV/AIDS a feminine face in order to analyze these critical issues.

Irrespective of the moral and/or other judgment one might have about Women Food Vendors who also moonlight as sex workers in so far as rights are indivisible, the abuse and denial of a basic right like information; strategies and resources for HIV Prevention; and Care and Support to PLHIV to them must be addressed.

There is need to set up intervention strategies on mitigating the level of abuse and brutality to Women Food Vendors. There is also need to initiate discussions on setting up structures to provide support to Women Food Vendors with respect to Legal Aid, access to health information and services, and mainly, it will provide a prescription to design lobby and advocacy strategies, and public education programs which would lead to law reform, policy analysis and amendments in existing policies which do not address Marginalized Women’s needs and rights.

Activists need to interrogate the level of commitment from various stakeholders towards advocacy for the rights of Women Food Vendors to legal protection even though they operate without business licenses; do not have permanent structures from where they do business and do not pay income tax; and give an inventory of the allies and potential allies who are already working on Marginalized Women’s Rights.

  • Reconciling the different policies and legal stipulates that address socio-culturally perpetuated gender and other forms of discrimination, exclusion and abuse in order to prevent further transmission.
  • The continued low comprehensive knowledge on HIV which is matched with slow progression of behavior change, health seeking behaviors and stigma.
  • Challenges around funding, that include fund flow, heavy dependence on external financing, inadequate mobilization of domestic resources and developing a transparent mechanism for disbursement and accountability.
  • Inadequate comprehension of the drivers of the epidemic and actual impact of HIV at the micro and macro levels that could provide evidence in mainstreaming HIV in development programs.
  • Providing quality services in treatment and care that match both rural and urban needs and diversity. These services include Home-based care, access to ART, retention on care and treatment, nutrition supplements, PMTCT, STI treatment etc.
  • Improving access to male and female condoms outside the hospital corridor. (Source: Amended National HIV and AIDS Policy, 2001/2010).

“Together We Can Make it Happen”

Leila Sheikh