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Tackling HIV and gender-based violence in South Africa: organisational responses to PEPFAR

Presented by Elena Ghanotakis, United States.

E. Ghanotakis1, S. Mayhew2, C. Watts3

1Freelance, Cambridge, United States, 2London School of Hygiene and Tropical Medicine, Epidemiology and Population Health, London, United Kingdom, 3London School of Hygiene and Tropical Medicine, Health Policy Unit, London, United Kingdom

South Africa has some of the highest levels of both HIV and GBV in the world and a growing international literature has highlighted the importance of tackling GBV in the fight against AIDS. Although the link between these epidemics is increasingly acknowledged by South Africa’s medical and NGO communities, government response has largely dealt with them separately. PEPFAR is South Africa’s second largest HIV/AIDS donor, representing significant funding potential for programmes seeking to tackle these twin epidemics.
Using a combination of document analysis and key informant interviews at national and provincial level we examined PEPFAR’s response to the GBV-HIV link, the extent to which PEPFAR is aligned to government policies and the extent to which implementing agencies have felt able to work with PEPFAR funding.
PEPFAR’s mandate prioritizes treatment over prevention and an ideology of ‘abstinence’ and ‘be faithful’ over ‘condom use’. A number of PEPFAR-South Africa’s positions stand in contradiction to South Africa’s own laws.
PEPFAR-South Africa officials paid lip-service to the need to address the GBV-HIV link, but it does not form an explicit strategic goal and there are no indicators for it.
Not a single implementing agency interviewed agreed with PEPFAR’s ideological stance, feeling it to be inappropriate in a social context defined by violence and HIV. Nevertheless, many organisations were prepared to apply for funding, and those awarded it found creative ways to work around PEPFAR’s restrictions to ensure the delivery of an appropriate range of much needed services to South Africans facing the twin epidemics of HIV and GBV.
The expected change in the US administration in late 2008 offers an important opportunity for broader links between HIV and GBV to be supported through PEPFAR. This paper makes a series of recommendations for building a more systematic approach on the current ad hoc experience of PEPFAR in South Africa.

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