CDC Training Helps Healthcare Providers Respond to Gender-Based Violence

Freedom from violence is a human right for all persons regardless of sex, gender identity, race, or other characteristics.  Yet, 1 in 3 women worldwide has been beaten, coerced into sex, or otherwise abused in her lifetime. Gender-based violence (GBV) is violence directed at an individual based on his or her biological sex or gender identity. It includes physical, sexual, verbal, emotional, and psychological abuse, threats, coercion, and economic or educational deprivation, whether occurring in public or private life.[1] GBV has implications for almost every aspect of health and may lead to serious, and often fatal consequences.[2] Survivors of GBV have a right to high-quality health services that protect their health, well-being, and safety. [3],[4]  Moreover, as survivors of violence often face barriers to disclosing violence, healthcare providers may be the only people survivors of GBV turn to for support and help. ^{5, 2}

Recognizing the important role healthcare providers play in supporting survivors of GBV and helping to prevent future occurrences of GBV, the President’s Emergency Plan for AIDS Relief (PEPFAR) released guidance in 2020 requiring the implementation of routine screening for GBV, specifically intimate partner violence, as part of the implementation of certain HIV prevention initiatives and interventions, including index case testing and pre-exposure prophylaxis (PrEP).

PEPFAR recommends training providers to identify violence in a clinical context and provide first-line support. The training is based on a World Health Organization (WHO) initiative called LIVES (Listen, Inquire, Validate, Enhance safety, and Support).

• Listen – Listen closely with empathy, no judgement.
• Inquire – Assess and respond to the client’s needs and concerns – emotional, physical, social, and practical.
• Validate – Show the client you believe and understand them.
• Enhance Safety – Discuss how to protect the client from further harm.
• Support – Help connect the client to appropriate resources and services, including social support.

To support the new PEPFAR guidance, the Gender & Youth Team in the CDC’s Division of Global HIV and TB developed a LIVES training for CDC staff, Ministry of Health personnel, and implementing partner staff in 30 countries. The training provides participants with the opportunity to practice asking about violence and responding to those who disclose experiencing it. Participants are also provided with the tools they need to facilitate their own LIVES trainings to support the delivery of first-line support by staff and providers in PEPFAR-supported sites.

Participants enjoy some “face time” in a virtual training.

In response to new challenges presented by the COVID-19 pandemic, the new training was adapted to be delivered in an interactive virtual format. The training package consists of independent learning components made up of pre-recorded training materials and videos. Other components conducted via Zoom give participants opportunities to practice using LIVES strategies and develop a plan to facilitate the training in their country programs.

To date, over 250 individuals representing over 15 countries, primarily from Sub-Saharan Africa, have been trained on LIVES and how to deliver it as trainers. Before the end of 2020, additional trainings are planned for Asia, Ethiopia, and Francophone West Africa and Haiti with the goal of having CDC staff trained across every region of the world in 2021.

Participants share their motivations during the training

^[1] https://www.womenforwomen.org/blogs/series-what-does-mean-gender-based-violence

^[2] WHO. Responding to intimate partner violence and sexual violence against women: Clinical and Policy Guidelines. 2013.

^[3] WHO. Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence: a manual for health managers. 2017.

^[4] WHO. Sexual health, human rights and the law. 2015

^[5] Feder GS et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Archives of Internal Medicine, 2006, 166:22–37.