Addressing Gender-Based Violence Included in Minimum Package of HIV Services for Female Sex Workers in Luanda

Role playing activity at a violence prevention and response workshop. Photo credit: LINKAGES/MSH

Gender-based violence (GBV) prevention services have been integrated with HIV prevention and testing services under the LINKAGES Project in Angola since 2017. Outreach workers from the Associação de Solidariedade & Ajuda Mútua (ASCAM), as part of their HIV-prevention messaging, now provide GBV awareness and support to those who experienced such attacks.

Today, ASCAM’s teams no longer conduct HIV work without discussing violence prevention. In the words of ASCAM supervisor Maria Elisabete Mussengue: “Talking about violence today is part of our service kit.”

Management Sciences for Health (MSH), as the implementer of LINKAGES in Angola, worked with its local civil society organization partners to deliver GBV services as part of their daily work. This was possible through a strategic partnership between USAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria, working through their principal recipient, the United Nations Development Programme (UNDP).

The initiative began after LINKAGES evaluated the risk of contracting HIV among 5,750 female sex workers (FSW) in a six-month period. The results indicated that 11 percent had been the victim of at least one type of violence. Seventy-three percent of the incidents occurred at hot spots and usually were perpetrated by clients (41 percent). Violence prevents many FSW from seeking and receiving HIV services. More specifically, it promotes the spread of HIV by limiting the ability to negotiate safe sexual practices, disclose HIV status, and access health and other critical services due to discrimination and fear of reprisal.

By the end of 2017, ASCAM outreach teams received training on the link between HIV and violence among key populations, social gender norms, GBV, violence screening, communication, and self-care. Since then, 18 ASCAM peer educators and 18 HIV lay counselors have included these topics in their HIV outreach work.

At first, ASCAM peer educators and lay counselors hesitated to discuss violence prevention and provide psychosocial support to victims, thinking it would interfere with their HIV-prevention work and increase their workload. But after three months of integrating these services they realized that talking about violence helps raise awareness about HIV and vice versa.

At weekly supervisory meetings, team members shared stories. At first, only a few sex workers were willing to talk about violence to outreach teams. After teams incorporated psychosocial support and created connections with FSWs, assault reporting increased from 1 to 182 between September 2017 and September 2018. Sex workers increasingly felt more confident in sharing their traumas with ASCAM community teams.

The key to the program’s success is providing knowledge about GBV, establishing a trusting bond with the sex workers, and offering psychosocial support when FSWs share reports of assaults. Additionally, often peer educators end up seeking support for themselves as well because many have also suffered violence.

Some peer educators have taken their work beyond providing their standard services, but even intervening when seeing violence in the community. ASCAM peer educator Teresa* was working at a hot spot in the municipality of Kilamba Kiaxi when she overheard a man beating his wife after discovering she was conducting sex work. Teresa and her team immediately intervened. Teresa spoke with the couple, de-escalated the violence, and followed up later.

With ASCAM’s support, between 2017 and 2019, a total of 24,975 FSW had been sensitized, and 355 cases of violence, mainly physical violence (52 percent), had been identified and referred to weekly support and empowerment group meetings, Mulheres Abençoadas (Blessed Women), that ASCAM and MSH created in 2017 under the auspices of LINKAGES and the Global Fund/UNDP. The mission of the support group, created by ASCAM and MSH in 2017 under LINKAGES, is to promote FSW empowerment, GBV prevention, and access to health services.

*Pseudonym to protect identity.

The Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project, a global cooperative agreement led by FHI 360, was implemented in Angola by MSH in partnership with civil society organizations (CSOs), government stakeholders, and key population (KP) individuals, with support from the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). 

ASCAM envisions an Angola where everyone has the opportunity to live a healthy life, to feel integrated into society, and to have a voice. It was founded in Luanda in 1989 to promote the improvement of the physical, intellectual, social, and moral conditions necessary for human development.