Results from Integrating Gender-Based Violence Services into HIV Care – a Case Study of Lighthouse Trust ART Clinic in Malawi

Abstract

AbstractIntroductionGender-based violence (GBV) not only poses significant public health and human rights challenges but is also closely associated with HIV. GBV acts as a barrier to HIV prevention, testing, and treatment adherence, and fear of GBV inhibits disclosure of HIV status to sexual partners. In Malawi, where both GBV and HIV prevalence is high, integrating GBV services into HIV care is crucial. We describe the integration of GBV services into Lighthouse Trust’s ART clinics in Malawi, including screening, documentation, program implementation, and outcomes.MethodsWe conducted a retrospective analysis from January 2020 to September 2023. Data on cases identified, post-GBV services, and perpetrator demographics were collected from the GBV register. We used descriptive statistics to describe the program outcomes.ResultsWe documented 7148 reported GBV cases from January 2020 to September 2023. Young women, particularly those aged 10-19, constituted a significant proportion of survivors. Psycho-social services were the most common type of service that was offered to GBV survivors (25%), followed by HIV testing (19%) and STI screening(18%). Perpetrators were mostly known to survivors or intimate partners of the survivor.ConclusionWe successfully integrated GBV services into the Lighthouse Trust ART clinic, in close collaboration with the one-stop centers. Training healthcare providers enhanced support for GBV survivors, with a focus on increasing awareness, especially for minors. Recommended actions include improving access to services, confidentiality, and multi-sectoral collaboration to ensure comprehensive care aimed to create a safer, more dignified healthcare environment for all, particularly GBV survivors.Key MessagesKey Findings Teaser Key MessageWe successfully integrated GBV services into HIV care via adequate training, screening and identification procedures, and documentation.Integrating GBV screening into ART care identified over 7000 cases with most cases of sexual violence in women aged 10 to 19 years.There is still a need for public awareness of GBV and access to support services.Key Messages and Implications to policy, program managers, donors etcWe provide a replicable model for healthcare providers and facility administrators, demonstrating the effectiveness of standardized screening, care, and referral processes in improving the support and outcomes for GBV survivors in low-resource settings.Our findings can inform the development of more inclusive health policies and support services that address the needs of all GBV survivors.