Centers for Disease Control and Prevention
>> Taking action against HIV and violence to help
Create an equal and enabled world for women and girls.
Let’s all be each for equal. Visit globalhivtb
>> The speaker is Seh Welch. The president of the
Centers for Disease Control American Indian, Alaskan Native,
and Native Hawaiian Employee Group.
>> Good morning, everyone.
Thank you so very much for joining us today.
My name is Seh Welch.
I am the president of the Center
for Disease Control American Indian, Alaskan Native,
and Native Hawaiian Employee Group.
I am honored to be here today with an esteemed panel of guests
to continue the conversation we started back in November
about violence and its connection
to health and well-being.
>> More than 1 in 4 girls experienced sexual violence in
most countries surveyed. The following will show sexual
violence as a child reported by females or males.
Haiti – 26% reported by females. 21% reported by males.
Nigeria – 25% reported by females. 11% reported by males.
Cambodia – 4% reported by females. 6% reported by males.
Malawi – 22% reported by females. 15% reported by males.
Kenya – 32% reported by females. 18% reported by males.
Zimbabwe – 33% reported by females. 9% reported by males.
Tanzania – 27% reported by females. 12% reported by males.
Tanzania data may differ from the VACS final report due to different analytic approaches.
Swaziland – 38% reported by females. Swaziland VACS only surveyed girls.
Data are reported by individuals aged 18 to 24 who experienced sexual violence prior to age 18. Sources are Violence Against Childredn Survey Data, about-the-vacs, and globalhivtb
>> The speaker is Seh Welch.
>> This panel today, "Taking Action Against HIV and Violence
to Help Create an Equal and Enabled World for Women
and Girls," this is being presented in partnership
with the Center of Global Health Division of HIV and TB,
the HIV Prevention Branch, and the Gender and Youth Team.
Today we will talk about how we can make the dream
of a violent-free world a reality.
A dream is not just something you sketch on a paper, on a pad,
and wait for it to come to life.
A dream is a way to move forward and come true through dedication
and hard work and focus.
The dream includes safety and health for all girls and women.
This dream, too, can come true even in light
of uphill struggles against cultural norms regarding the
role of women and girls.
Preventing violence against women
and adolescent girls is imperative
to achieving epidemic control of HIV globally.
Over the last 15 years,
evidence-based approaches have been developed and implemented
to counter the root causes of violence and increase support
and linkages to care for women and girls affected by HIV.
There is no single magic solution but rather a layering
of approaches and programs.
Together for Girls, represented on our panel today,
galvanizes coordinated actions across sectors to end violence
and raise awareness guided by data.
CDC offices in many African countries supported
by the President's Emergency Plan for AIDS Relief, or PEPFAR,
implements the DREAMS program.
DREAMS stands for Determined, Resilient, Empowered,
AIDS-Free, Mentored, and Safe.
Today we will hear from representatives from CDC Kenya
about their involvement with the DREAMS program.
In addition to local and national actions,
inspiration to realizing one's dream also comes
through the commitment of communities.
CDC Nigeria will share experiences collaborating
with local and national governments and communities
to lead changes in policies and practices that prevent violence.
Dr. Regina Benevides de Barros is the lead for the Gender
and Youth Team in the Division of Global HIV and TB at CDC.
She will serve as our moderator today and will lead our panel
in a discussion about the importance
of a multiprong approach to prevent violence
and improve HIV outcomes among women and girls globally.
Panel members will share not only their expertise
and experience but also mechanisms to support people
who are subjected to violence.
We are grateful to everyone for their participation
in this important discussion and extend thanks
to those not seen today who work diligently behind the scenes
to make this a reality to ensure this important conversation
takes place, to ensure that a dream is not just something
that is sketched on a pad.
Regina, let's begin.
>> The Speaker is Regina Benevides de Barros. The lead for the Gender and Youth Team in the Division of Global HIV and TB at CDC.
>> Thanks, Seh.
It's really an honor to be part of this panel.
Good morning, good afternoon, and good evening, everyone.
In honor of this year's International Women's Day,
we'll be highlighting the role that each of us has to play
in creating a more equal and enabled world
through the experience of four amazing women who are
on the front lines of addressing two forms
of gender inequality -- violence and HIV infection.
A 2003 analysis conducted by WHO across 80 countries tell us
that globally one in three, or 35%,
of women have experienced physical and/or sexual violence
by an intimate partner.
The CDC's Violence Against Children Surveys estimate
that 1 billion children, or half the children in the world,
will experience violence.
And data is still revealing that more than one
in four girls experience sexual violence before their
18th birthday.
Because violence is both a cause and a consequence of HIV,
we are at an opportune moment to address both epidemics
with data, with action, with our voices.
It is my pleasure to introduce our first speaker,
Dr. Daniela Ligiero.
She is the executive director and chief executive officer
of Together for Girls, a global public-private partnership
dedicated to ending violence against children,
especially sexual violence against girls.
She also serves as the chair of the executive committee
of the Global Partnership to End Violence Against Children.
She's also a survivor of sexual violence herself
and has been speaking publicly
about her story for the last decade.
Daniela, thanks for joining us today.
I want to start with you, asking to tell us a little bit
about your work and what drew you to this issue.
>> The speaker is Daniela Ligiero. The executive director
and chief executive officer of Together for Girls,
a global public-private partnership dedicated to ending
violence against children, especially sexual violence
against girls.
>> Hello. Yes.
Good morning, good afternoon, and good evening.
It's such an honor to be with all of you here today.
Thank you for joining us.
As you mentioned, Regina, I run an organization called Together
for Girls, And we are a public-private partnership
focused on ending violence against children
but paying special attention to sexual violence and to girls.
And we've been around for about 10 years.
The U.S. government has been an instrumental partner
for Together for Girls, the CDC, as well as USAID,
the Department of State, PEPFAR.
And really the nexus of the partnership,
the reason for being of the partnership is that we believe
that a problem of this magnitude cannot be solved
by a single actor or a single sector alone.
And so the idea is to bring UN agencies, governments,
private sector, many other stakeholders together
to address the problem of sexual violence against girls.
And at this point, we are active in over 22 countries
and have been able, as you mentioned,
to collect a lot of data.
I'll talk a little bit more about that later,
but really making an impact on the issue of violence.
And for me, personally, as you also mentioned,
the passion for me really comes from a very personal place.
I am a survivor of sexual violence and childhood,
and many years ago, over a decade ago,
started telling my story because really the silence
around this issue was deafening.
And I believe that part of what we need to do
to really make a difference on this issue is break that silence
and make it safe for survivors to come forward.
So it's a real honor to be with you here today.
Thanks so much.
>> The speaker is Regina Benevides de Barros.
>> Thanks, Daniela.
This is super important that you are, as you're saying,
making visible the situation that many, many girls
and women have been going through.
So now I want to go to our second speaker, Dr. Adeola Ayo.
She's joined us from the CDC in Nigeria
as the gender program specialist,
where she provides technical guidance
on gender mainstreaming,
gender-based violence prevention, and response.
She has over 12 years work experience in health
and developing organizations.
She holds degrees in medicine, surgery, and public health
and has received multiple U.S. Mission Awards for leadership
and dedication to addressing gender inequalities
and gender-based violence.
Thanks for joining us today, Adeola.
And I also want to ask you to tell us a little bit
about your work and why it resonates with you.
>> The speaker is Dr. Adeola Ayo. The gender program specialist at CDC in Nigeria.
>> Thank you, Regina.
I feel so honored to be a part of this panel.
Greetings from Nigeria.
So what I do essentially is that I ensure
that implementing partners are integrating gender
in all aspects of the HIV prevention, care,
and treatment programs; they are looking at the gender data
to make informed decisions; and most importantly,
they are programming effectively
for gender-based violence, care, and response.
I also sit on a number of technical working groups
in Nigeria with governments, civil societies, academia,
and other stakeholders, where I provide technical supports
on gender-sensitive programs and policies.
I think right from -- to answer your question
on what keeps me going, I think right from when I was
in medical school, I've always been interested in issues
around women's health because a women's health is often more
complex than that of a man
and requires greater understanding and care.
And at one point in my career too, I was appointed to design
and lead an innovative project
where adolescent girls create a demand for sexual
and reproductive health services using storytelling,
writing poems, you know, and all the likes.
And seeing that was really rewarding for me.
And then since right now majority
of violence survivors are women and girls, I see going to work
as an opportunity to provide
and design effective health programs to suit their needs.
And I think I enjoy what I do.
Thank you.
>> The speaker is Regina Benevides de Barros.
>> Great. Great.
Great. Thank you very, very much, Adeola.
And we'll hear more about your work in a minute.
I'm going now to our third speaker, Caroline Kambona.
She's a behavior scientist with the CDC Kenya office,
where she provides technical oversight in the coordination
of adolescent programming, orphans and vulnerable children,
and gender-based violence interventions.
Caroline has over 18 years of experience with local
and international NGOs, government,
and civil society alliances in east Africa.
She was integral in setting up the establishment
of the Gender-Based Violence Recovery Center
in Kisumu County.
So welcome to our panel today.
And, again, the same question for you, Caroline.
What -- tell -- could you tell us a little bit about your work
and what made you want to focus in this area?
>> The speaker is Caroline Kambona.
Behavior scientist at CDC in Kenya.
>> Thank you so much, and jambo from Kenya.
As has been mentioned, I work for CDC Kenya,
based in western Kenya branch, and I support
and provide technical supporting coordination
of the DREAMS program, obviously,
and gender-based violence.
Actually, I got inspired when I helped set
up a gender-based violence recovery center,
which was a standalone center.
And I observed that majority of the survivors who are walking
into the facility to access services were actually
adolescent girls and young women.
And most of them were coming and reporting late,
and so it was very challenging to me
to [inaudible] HIV infection because, as we know,
administering PEP requires 72 -- within 72-hour duration.
And so that really motivated me to begin thinking of how best
to respond, how best to prevent cases of violence.
And so in DREAMS, we actually go beyond just health
to address vulnerabilities associated with gender,
gender-based violence, and HIV.
And so helping girls develop into determined, resilient,
empowered, AIDS-free, mentored,
and safe women is actually my motivation and inspiration.
>> The speaker is Regina Benevides de Barros.
>> That's amazing.
That's really nice.
And that -- this is a very good segue to let me introduce you
to the fourth speaker of our panel, Thweyyibah Omar,
a young woman who is using her voice to create change
in her local community as a DREAMS ambassador
for the Utalii ward in Kenya.
Thweyyibah, she is 22 years old, and she was born and raised
in the informal settlement of Mathare, Kenya,
and has shown amazing resilience in overcoming challenges
and representing the voices of survivors.
After enrolling in the DREAMS program in 2018,
Thweyyibah soon became a mentor and facilitator
to support other adolescent girls
and young women in her community.
She's currently studying social work
to further her commitment in this area.
Thweyyibah, welcome our panel.
Could you please tell us a little bit about your experience
in DREAMS and how it impacted your life?
>> The speaker is Thweyyibah Omar. DREAMS ambassador in Kenya.
>> Thank you for this opportunity.
My name's Thweyyibah Omar.
I live in Mathare, and I was raised by a single mother,
of which the challenge that I faced as I was growing up --
I managed to be -- to join the DREAMS program,
and I went through mentorship program and other program,
like gender-based violence.
So after that, I was enrolled as --
I was trained as a mentor and also facilitator.
So, for me, my work is to communicate
or to engage other girls in how to prevent themselves
in getting HIV and how to avoid cases
like gender-based violence, how to report those cases
in case it happens to them.
And that is my work in DREAMS program.
That is what I do.
>> The speaker is Regina Benevides de Barros.
>> Awesome.
Thank you very, very much, Thweyyibah.
And we will hear more about your experience in a minute.
Let me go back to Daniela because, Daniela, you mentioned
that we now have data available,
data that can show us the magnitude
of the problem that we are facing.
Could you please tell us a little bit about these Violence
Against Children Survey, what these surveys are telling us
about the overall health impacts on violence against children?
>> The speaker is Daniela Ligiero.
>> Yeah. Absolutely, Regina.
So let me just start by saying that the Violence
Against Children Surveys, or VACS, that are led by CDC
and in particular the Division of Violence Prevention
with support from PEPFAR
and other partners have really been a game-changer
in our field.
Ten years ago, we had almost no data on the kinds
of sexual violence
that adolescent girls were experiencing,
and now we have data for over 10% of the world's population
under the age of 24, which is just phenomenal
because you can't fix a problem
or you can't address a problem unless you fully understand the
magnitude of the problem,
the risk factors, and the consequences.
And one of the things we've been able
to document is really the connection between violence
and important health outcomes for girls.
For example, we found girls who experience sexual violence
in childhood are much more likely, up to three times
as likely to have an unintended pregnancy, up to five times
as likely to have HIV.
There are also risk factors for suicide attempts, depression,
substance use, educational outcomes beyond health.
And so really what we're beginning to understand is
that when we think of HIV and sexual violence against girls
and young women, we're really talking about twin pandemics
that kind of feed off each other.
And so having these data have been instrumental
in helping us respond adequately and prevent violence.
So I think all of you at CDC should feel really proud
that you helped to contribute through all the work
that you've done and the investments
to really change the nature of our understanding globally
when it comes to this issue.
>> The speaker is Regina Benevides de Barros.
>> Yeah. I mean, thank you, Daniela.
Yes, I mean, it's so important to have data available.
And as you were saying, it shows where to invest,
how programs have to be responding to this data.
So I want to go to Adeola
and ask exactly a little more about that.
Adeola, from your perspective and from the experience
that you have, how do you think
that violence is really threatened to health problems?
>> The speaker is Adeola Ayo.
>> So I don't think we can reach HIV epidemic control
without addressing violence in our programs.
Daniela has mentioned it's a twin epidemic
or a twin pandemic, if I may.
So violence increases vulnerability to HIV
and also has effects on the entire HIV clinical cascade.
So sexual violence, for instance,
directly increases the risk of HIV transmission.
Child sexual abuse may lead
to increased risky sexual behaviors, such as engagement
in sex work, having multiple concurrent partners.
Physical violence, on the other,
especially by an intimate partner, may limit the ability
to use condom or even to say no to sex.
Those who experience violence are less likely to test
for HIV services and disclose their status
if they are positive.
They're less likely to be linked to HIV care and treatment
and started on medications, and they're less likely
to be retained in care, stay on treatments
and anti-viral suppression.
So I believe that if we are to reach HIV epidemic control,
we have to address violence in PEPFAR programs.
>> The speaker is Regina Benevides de Barros.
>> Absolutely.
And I think that you are making a great point showing the
relationship between the two epidemics, if you can say so.
But now I'm going to go to Caroline again.
And just to dig in a little bit on what you have mentioned
about what are the roles
that violence play vis a vis the HIV infection among adolescent
girls and young women.
>> The speaker is Caroline Kambona.
>> Yes. So just as has been mentioned, violence
and HIV are a twin pandemic.
I would also call it double tragedy.
And a lot of adolescent girls and young women are
at increased risk of both violence and HIV.
And this we see in the gender inequalities
that affect the ability of adolescent girls
and young women actually to negotiate for safer sex,
which means their ability to use condoms correctly
and consistently is compromised, and as well as the use
of other HIV preventive interventions, like PrEP,
may be compromised as a result of violence.
And so adolescent girls
and young women actually stand a high risk of acquiring HIV
because of also their age-based vulnerabilities exposing them
to things like transactional sex,
things like early marriages, you know,
therefore compromising their ability, you know,
to negotiate for safer sex.
And so in DREAMS, we work
to actually empower the adolescent girls and young women
with appropriate skills to prevent exposure
to violence and the risk of HIV.
And some of the skills -- we focus on negotiation skills,
refusal skills just to help the adolescent girls
and young women, you know, to prevent this twin pandemic.
>> The speaker is Regina Benevides de Barros.
>> Yeah. That's a very important point that you're making.
And now I'm going to go to Thweyyibah.
I mean, from your perspective, Thweyyibah,
how have you seen violence play
out in the lives of your youth peers?
>> The speaker is Thweyyibah Omar.
>> Okay. So when it comes to my peers, they get involved
in physical and sexual gender-based violence
because one of the thing is that majority of people --
or majority of young girls in Mathare,
you find that they get married earlier.
So it increases percent of them getting physical
and sexual gender-based violence as they always depend on a man
to provide for their basic need.
And in case the man refuses, and now the woman becomes so angry.
So [inaudible] the man now becomes so angry with the woman
and just start beating her and use the woman.
So in another perspective, you find, like,
young women they're being shared with friends.
In case, maybe you find, like --
I have my friend and the other friend --
in case [inaudible] my husband is like, "Okay.
Yes. You can also sleep with my wife,"
because I don't have a choice
because I'm always depending on a man.
So that is -- those are the kind of examples
that my peers have experienced in Mathare,
and those are examples
of gender-based violence that I have.
>> The speaker is Regina Benevides de Barros.
>> Yeah. I mean, it's a big concern that,
as you were mentioning, the importance of having women
and increasing their agency to deal with these kind
of pressures and situations.
So we have to do much more in terms of violence response
and violence prevention.
Let me go a little bit more on the violence response.
Daniela, I know that you have mentioned that Together
for Girls is an important public and private partnership working
with a lot of other partnerships globally
and with governments and locally as well.
Who are the key stakeholders for violence response,
and how can we use data on the burden
of violence to make a change?
>> The speaker is Daniela Ligiero.
>> Absolutely.
Yeah. So I think one of the really important lessons
that we've learned from HIV that needs to be applied
to preventing and responding to violence is that prevention
and response actually go hand in hand, so one is kind
of interdependent with the other.
When we think of about response, though,
one of the important things the VACS has shown us is that only
about half of people ever tell someone
about the sexual violence they've experienced.
And then much fewer seek services, and even fewer,
less than 5%, actually get services.
So if you think about that cascade,
there are important steps and interventions at every step
of the cascade that we need to think about.
Now, when you think of breaking the silence,
we need to create a community, a society, and safe spaces
for survivors to come forward.
And then when you think about service delivery and access,
really you have to think about health.
There's important components around, for example,
post-rape care, which is something PEPFAR has done a
lot of.
But also thinking about justice, education, social services.
And so, really, you're talking
about multiple sectors coming together for adequate response
but first ensuring that those folks --
or, actually, those women
and young girls are actually seeking those services
and then receiving quality services.
And I think one of the most important things here is
to understand that we have to do this in a multisectoral way.
Health is a critical component of this, but justice,
social services also have to be integrated.
And I think there's some really good examples in terms
of the work DREAMS is doing that really show the way
in how we can do effective response,
which is very encouraging.
>> The speaker is Regina Benevides de Barros.
>> Yeah. Thanks.
I mean, you are highlighting an important point which shows
that to respond to violence, it has to be a multisectoral,
multilayered approach.
So, Adeola , from your experience working
in this response to violence, how --
could you give me one or two good examples
of how you have been doing it programmatically?
>> The speaker is Adeola Ayo.
>> Thank you.
So I think the starting point for us was to ensure
that our HIV clinics are able
to provide first-line support to survivors.
First-line support is the immediate response we provide
to any clients when they disclose violence.
And we provide first-line support
through the acronym LIVES.
LIVES is L, we listen with empathy.
I, we inquire about the needs and respond
to the particular needs and concerns of the client.
V is we validate their stories.
We'll make them to understand that we believe them,
we understand what they're going through.
And E is we enhance safety.
We discuss on how to protect the client from further harm.
And S is support, show support, refer support,
and refer all the services, such as social support, justice,
like Daniela mentioned.
And I think this is very, very critical
in even responding to violence.
And then we also provide other clinical services,
such as management of injuries,
provision of post-exposure prophylaxis within 72 hours,
provision of emergency contraceptives
within 120 hours both for cases of sexual violence,
treatment of sexually transmitted infections,
and rapid HIV testing and counseling.
But beyond that, what we are doing presently is to ensure
that quality -- the highest quality
of care is provided for survivors.
This we're doing through program monitoring,
quality performance reviews with partners.
And more recently, we instituted a quality improvement project
using the WHO/PEPFAR quality assurance tool, which allows you
to collect baseline data on aspects
of post-violence care services, identify existing gaps,
and support facilities to fill those gaps.
And the good thing about this is that during the rollout
of the quality improvement project,
we're able to engage the National HIV, AIDS,
STI Control Program here in Nigeria, which is an agency
of the Federal Ministry of Health,
to constitute a gender team, which right now they are trying
to push gender issues forward
and definitely will support our advocacy efforts going on.
So these are some of the few things that we've been able
to do in Nigeria for the past couple of years
in response to violence.
>> The speaker is Regina Benevides de Barros.
>> Thanks, Adeola.
It's so important that you are highlighting the tools
that we have available now and the importance of looking
at this in comprehensive ways.
So we have tools to improve the quality of services,
but we have to be sure
that everybody is engaged in this same aspect.
So -- but I want to go back to Caroline a little bit more
to know how DREAMS -- I know that DREAMS is looking
for keeping girls HIV negative and free from violence.
And we know as well that there is a very strong problem
in preventing violence, but we also have the responsibility
to provide services to respond to the needs of girls.
So how DREAMS have been addressing this issue in terms
of mitigating the health effects of violence?
>> The speaker is Caroline Kambona.
>> Just as Adeola has given us perspective at what happens
at the health facilities, we work very closely
with the Ministry of Health.
And, actually, as a Kenyan program,
we have trained a number of health care providers to be able
to offer comprehensive post-violence care
at facilities.
And so in DREAMS, as we enroll girls into the program,
we screen for vulnerabilities, and we also screen for violence.
And in most cases, as we do the screening at enrollment,
we find adolescent girls and young women
who have faced different forms of violence.
And so because these are chronic cases,
we straight away link them for psychosocial support.
But where such occurrences are fresh, we link them
for comprehensive post-violence care services as appropriate.
So among those who are sexually active
and at very increased risk of acquiring HIV,
we actually provide education on pre-exposure prophylaxis
and link quite a number of them for PrEP.
So we have seen a number of adolescent girls,
young women who are at risk of acquiring HIV using PrEP
as a method of prevention.
And so within DREAMS, we do multilayered approach
where we implement multiple interventions
that are evidence-based,
that also integrate gender-based violence response
and prevention.
And so through these interventions,
we create awareness among girls and young women
so that they're able to report --
if at all cases of violence occur, they're able to report
in good time for purposes of administering PEP.
And so we also encourage for medicolegal justice linkages
so that it is not just reporting to health facilities
but also getting legal support.
>> The speaker is Regina Benevides de Barros.
>> Yeah. I think -- yeah, again,
it's a very comprehensive package.
And I'm happy to hear as -- from Daniela said and Adeola said
and you too that programs are really trying
to address this multilayer --
through a multilayered approach what violence and HIV needs
to be controlled and to be mitigated.
So, Thweyyibah, I mean, in the DREAMS program,
I know that you have been playing an important role
connecting with other survivors and girls
that are more vulnerable or they have witnessed --
or witnessed or also they experience violence.
So, from your experience, the work that you have been doing,
could you please let us know a little more
about what are the unique needs of youth survivors of violence?
>> The speaker is Thweyyibah Omar.
>> So the unique needs of the survivor --
in case we come across a girl who or a young woman
who [inaudible] violence, first of all, they need to be believed
in because it is not like something they are making up.
No. So, for us, we believe in them first of all.
Then we take them to health facility
where they offer youth-friendly service.
As they have said earlier, those -- in health facility, like,
they believe in them, and they also give them
youth-friendly service.
So, like, there is no judgment.
They give them the PEP because they are already exposed to HIV
and also the psychosocial support
so they can be able to take it.
Like, they shouldn't see themselves like --
they should [inaudible] themselves.
So, like, after they are believed in,
they get the services from health facilities.
And now, like -- yeah.
So those are the -- kind of the unique needs of the survivor.
For them, youth-friendly service at the health center and also
for them to be believed
in because those are the two things they usually want
for them.
>> The speaker is Regina Benevides de Barros.
>> Yeah, that's a very important point -- not to be judgmental,
to be supportive, to understand their unique needs,
and to provide services in a timely way.
But more than that, to support them
at the community-level as well.
So definitely we have to think about how to address violence --
how to respond to violence, but also,
as Daniela was also mentioning, we have to look and focus
on what we can be doing to prevent violence.
Violence is preventable, as we know.
What else can we do, and what are we already doing?
So, Daniela, going back to you, what does the evidence say
about violence prevention programs?
I know that you have a lot of experience,
and you have been working with other partners in this area.
>> The speaker is Daniela Ligiero.
>> Yeah. So I think something you said [clears throat] --
excuse me -- Regina, is really important, and that is that,
you know, for the last decade we've been working
to accumulate evidence this size,
the magnitude of the problem.
And we have quite a lot there.
And we've also been trying to examine and study what works
to prevent the problem from happening in the first place.
And the good news is that there actually is quite a bit
that works.
And so now it's about really changing that narrative
from there's a problem and there's nothing we can do
about it to there's a problem
and there's actually quite a bit we can do to prevent it
from happening in the first place.
And at Together for Girls, we have been working with a variety
of partners, including the World Health Organization, UNICEF,
the U.S. government, and many others, the World Bank,
and we've been able to look
at the global evidence on what works.
And we put together a framework called INPSIRE,
and INSPIRE really highlights the strategies that we know work
to prevent violence against children,
and that includes adolescent girls.
So the first I in INSPIRE is really about the implementation
and the enforcement of laws, so the justice sector.
The N in INSPIRE is about changing norms
at community and social level.
The S in INSPIRE is about creating safe spaces,
in particular for adolescent girls.
The P is around parenting programs and working
with families, like the Families Matters Program
that CDC has been implementing around the world.
The next I is really about income strengthening
and economic interventions that can help families
and girls have access to resources.
And then, finally, you have response.
We've talked a little bit about that
and the importance of response.
And E in INSPIRE is education and life skills,
the kinds of things you can do to empower girls in communities
to understand and better prevent violence.
So that really gives us hope
that there's quite a bit that can be done.
And one of the things we need to do is shift
to further investments in prevention.
>> The speaker is Regina Benevides de Barros.
>> Yeah. I mean, that's really important, as you were saying.
We have evidence.
We have programs that are working.
And we have to keep increasing the knowledge
and increasing the evidence in this area.
So thanks for sharing these frameworks
and also the huge work that many different partners are working
-- are doing this area.
So going back to one of the points that you made --
and I want to hear from Caroline now.
I know that DREAMS has also --
I mean, the big focus of DREAMS is preventing violence,
preventing HIV, preventing violence.
So could you just give us one or two examples
of how is DREAMS preventing violence, one of the things
that in Kenya you have been doing?
>> The speaker is Caroline Kambona.
>> Yeah. So for the DREAMS program, we mobilize communities
and work with the traditional change audience really
to challenge harmful gender norms, which include things
like violence, early marriages, and gender inequalities
within the communities where we work.
And we also work with adolescent girls
and young women whom we cluster in different safe spaces
that are headed by mentors.
And as I mentioned earlier, we do a lot of layering
of different interventions
that have gender-based violence services
and information integrated in there for purposes
of preventing violence.
And so within the communities,
we use a phrased intervention called SASA, and SASA stands
for Start Awareness, Action, and Support.
And this is delivered at community level consistently
over a period of time.
And so, basically, we promote knowledge and skills
on gender-based violence, how we can prevent it,
alongside HIV prevention.
And we also work on response in terms of --
in case it happens and we have survivors, then we are able
to link them to facilities and also to the police
for purposes of legal justice.
So, basically, having a multipronged approach
in ensuring that we address issues relating to violence.
>> The speaker is Regina Benevides de Barros.
>> Yeah, super important what you said, I mean,
how you can keep moving the two aspects together, response
and prevention, all the time.
Thweyyibah, I would -- I now want to hear more
about what have you learned about that.
In your experience in DREAMS within this prevention,
do you think that we are really getting better?
Do you think that we could do better?
So tell us a little more about your experience
with violence prevention programs.
>> The speaker is Thweyyibah Omar.
>> Yes. We're actually getting better because --
and what I learned is, first,
the refusal skills on how to say "no."
I can say "no" to a man because you can't force me
to do anything.
So one of the things that I learned
in the prevention program is on how to say firmly "no."
Like, "No.
I mean no.
I don't want it."
And, also, on the other aspect on how we also have, like, SWAT,
of which it explain on say "no."
You explain the reason why do I say "no."
Like, I want to finish school.
So now I provide other alternative.
Like, maybe instead of doing this, why don't we work
out or do something else?
And then you try that alternative
that you've already provided.
And the next one is about SWAG.
It's kind of the same perspective on say "no."
You explain why.
You provide an alternative.
Now, on the G part is that for getting out.
In case I'm in a harmful relationship,
I experience violence,
I experience sexual gender-based violence or physical,
now it's giving me a chance to get out.
So those are the kind of intervention programs
on gender-based violence that I've interacted with,
and that is what I have learned specifically.
In case I have explained anything, like, I need to get
out of that relationship so that I can be able to rescue myself.
>> The speaker is Regina Benevides de Barros.
>> Wow. Important resources that you are mentioning.
And I'm really happy to hear that girls are being --
getting prepared to respond by themselves
and to get support that they need.
So -- and, Adeola, you mentioned that you have been doing a lot
of work with the government and civil society and other partners
in the response, responding to violence.
But you also mentioned the importance
of linking both aspects.
So what does violence response provide --
how does it provide insight into violence prevention programs?
>> The speaker is Adeola Ayo.
>> Okay. So we need to understand
that violence is a vicious cycle.
Experience of violence is a risk factor for future violence
and even for perpetuating violence.
And so what we've seen programming
for gender-based violence response is
that when we provide high-quality services,
especially the first-line support using LIVES,
we're able to empower survivors.
We're able to expand the capacity
to make informed decisions about their lives, and so, therefore,
we break the vicious cycle of violence.
The other thing is that we've heard over
and over again violence is a cause of HIV
and is also a result, as a consequence of HIV.
HIV-positive patients are much more likely
to experience violence more than their HIV-negative counterparts.
So when we provide post-exposure prophylaxis as part
of our post-violence care response,
we're able to go a long way in preventing violence,
especially secondary violence.
>> The speaker is Regina Benevides de Barros.
>> Yeah. I mean, again, the linkage between response
and prevention are there, and we just have to make sure
that we have -- we have to put the other resources together
and engage people on the different aspects of it.
I will go to another last question before we go
to our closeout, which is -- okay.
We have data.
We have programs.
We have engagement of different partners.
We have programs that are working at, you know,
ground level but also at policy level.
From your point of view --
and this is a question for all of you.
From your point of view, what is missing?
What is missing?
So I would like to hear one thing of each of you
of what is missing as a way of really drawing our attention
to these specific points.
Let's start with you, Daniela.
What do you think is missing?
>> The speaker is Daniela Ligiero.
>> Yeah. So I think one of the things that's really missing is
that they're -- we need to move beyond kind of a group of folks
like us who understand the issues, who are working
on the issues to really go to the general public,
to decision makers with two important messages.
One is that we need to fight this idea
that violence is inevitable and that there's nothing we can do
about it to really show there's a lot we can do
and to change minds and hearts there.
And the second is this belief
that violence is something that's private,
that the public doesn't necessarily need to do anything
about the public sector.
And I think taking it outside of the private sphere
to really say governments, organizations,
community leaders, they all have a role in making sure
that we're preventing and responding
to violence adequately is another step.
So it's really about reaching the general public
and decision-making, you know, people who have power,
decision makers to change the way we invest
and the way we resource violence prevention response.
>> The speaker is Regina Benevides de Barros.
>> Perfect.
That's a very, very, very good point, Daniela.
So now I'm going to go to Caroline.
And I know that we are -- oh, okay.
We are having some issues with her video,
but let's see if we can get her.
Yes, we can.
Good. Caroline, tell us what is missing from your point of view?
>> The speaker is Caroline Kambona.
>> Yeah. We know that violence has very far-reaching effects
in the life of an individual, and the truth is
that the problem is continuously growing,
and we just have to do something.
We need a unified, multisectoral approach to ensure
that we take very immediate, you know --
not just immediate but effective
and sustained action to prevent violence.
And we can contain violence if we work together,
and that working together means that we must act now because all
of us have power to do something.
And we can act now and we can start now,
and that starting begins with you and me.
We must actually just help create an equal
and enabling world for girls and women.
>> The speaker is Regina Benevides de Barros.
>> Awesome.
Thank you very much.
And Thweyyibah, from your point of view, what is missing?
>> The speaker is Thweyyibah Omar.
>> Mm-hmm.
So, for me, I would say, like, we need more of the trainings
to the youth so that the youth can be able to be trained
on their communication skills, like when it's time
to communicate in any kind of issue,
maybe when we face the leaders, like the real message on how
to impart the message [inaudible]
and have the leadership skill to stand firmly
so that we can be able to express ourselves well.
That is what I feel like is missing.
>> The speaker is Regina Benevides de Barros.
>> Good point.
And, Adeola, with you, what is missing?
>> The speaker is Adeola Ayo.
>> So I think violence is still under-reported probably
because of survivor stigma and maybe because of fear
of repeat attacks from perpetrators
because most violence survivors know their perpetrators.
So I think we need to end the culture of silence,
like Daniela mentioned.
We need to use existing platforms to create awareness
about violence and create awareness
about post-violence care services.
And the other big thing, I think,
is that support services are not really available.
For example, there are few temporary shelters
for adolescent girls and women.
None particularly exists for men, at least here in Nigeria.
But for the few that are available, we need --
as the health system, it's our obligation to find
out what services exist and to make sure that we are able
to link survivors to the services.
>> The speaker is Regina Benevides de Barros.
>> Perfect.
Very, very, very good point, Adeola.
Thank you very much.
So, dear amazing women, we are coming
to a conclusion of our panel.
So looking forward, from your perspective --
again, I'm going to [inaudible].
What would you leave as a call to action?
Let's start with you, Adeola, first.
What would be your call to action in a few words?
>> The speaker is Adeola Ayo.
>> Okay. So I ask that anyone working on HIV programs
and more broadly within the health sector should think
about the impact of violence on their program and make efforts
to fully integrate violence response
within their existing programs.
Thank you.
>> The speaker is Regina Benevides de Barros.
>> Great. Thank you.
And you, Daniela.
What is your call to action?
>> The speaker is Daniela Ligiero.
>> Yes. You know, Seh started with the idea of a dream.
And I think for a long time our dream was to make sure
that girls and young women were healthy, and we've since evolved
that to also say they should be educated.
And I think the third piece
of that really important dream is safe
because those three things go together.
So really thinking about how do we make sure girls
and young women are healthy, educated, and safe as a vision
for us moving forward.
>> The speaker is Regina Benevides de Barros.
>> Fantastic.
And Thweyyibah, you, what is your call to action?
>> The speaker is Thweyyibah Omar.
>> So my call to action will be whenever it comes to anything
that concern the youth, let all of the youth be there
because in case in gender-based violence [inaudible],
they don't know.
They don't know that, like, these things are happening.
So, for me, I feel like engagement
of the youth is very important.
Whenever it comes to an issue that is concerning the youth,
let all of the youth be there to talk it out, to advocate for it
because we are the ones experiencing.
We are the ones who know how it feels to be [inaudible].
So, for me, I feel like let's always engage the youth
in these things so that they can [inaudible] understand
and fight it over.
That would be my call for action.
>> The speaker is Regina Benevides de Barros.
>> Fantastic.
And you, Caroline, what is your call to action?
>> The speaker is Caroline Kambona.
>> Let us work together.
Let us work together to support the processes.
Let us prevent violence.
That change begins from me.
It begins from everyone else.
And if we are all convicted that we can make a difference,
indeed we will make a difference
to have a better world free from violence.
And preventing violence against girls
and women is the place to begin with.
>> The speaker is Regina Benevides de Barros.
>> Fantastic.
On that note, I would like to -- I'd like us to walk away knowing
that we all can join this global movement to end violence.
We can do more to involve stakeholders
and elevate these issues in each of our communities.
We can prevent violence by implementing interventions
that we know are working.
We can do a better job responding to violence
with health, psychosocial, education, and legal services.
We have to engage youth in our actions.
We can seek collaborators in the fight against violence.
Violence is a global issue, and what we have heard today
from these amazing four women is just a small piece
of the efforts happening all around the world.
But this conversation doesn't end here.
To learn more, you can look for some of our resources.
Thank you very, very much for joining us today in this panel.
Have a great day.
>> The speaker is Seh Welch.
>> I would also like to thank everyone for joining us today.
As Regina and our esteemed panel members indicated,
here are some resources for you to click on, explore.
But, you know, some of the things
that the panel said really resonate with me.
And I started out talking about the dream,
and it's not just a sketch on a pad.
And Daniela talked about how we really have three issues,
four issues, five issues.
You know, violence and HIV
and twin epidemics, as Caroline said.
And when you add HIV on top of that, we have a tripod
of epidemics, pandemics.
But if we are not safe, we are not secure,
we are not educated not only on what we can do and can become
in our dream, but if we are not safe in our environment
and as individuals, then our dreams cannot come true no
matter how much we believe in those dreams.
I would like to ask each of you -- as Caroline said,
we can create a world without violence.
It starts with each of us.
It starts with me.
It starts with you, you as an individual, whether it's
within your own actions or reactions to something
or within your family,
within your community, within your village.
One of the things we witnessed today
on this first ever global international panel via
technology was Caroline's video going in and out.
In our field offices, that is a daily challenge.
As we witnessed Adeola's lights going off because of loss
of electricity and use of her laptop battery,
that is a reality in many of our CDC field offices as well
as in the villages and remote and rural locations
in which we are striving
to reach women and adolescent girls.
Dreams. I dreamt when I was little
that I would become Batwoman, Catwoman,
that I was the Lone Ranger and not just Tonto.
Words matter.
Microaggressions matter.
Those are all violence.
It's not just physical violence.
It's psychological violence.
It's social violence.
It's cultural norms.
It's traditional norms that have been learned oftentimes
from colonialism.
Today in United States it's actually 200 years the very
first day the Constitution went into effect.
The very first action of the first Congress
of the United States was to adjourn.
We are not going to adjourn.
This topic will continue on and move and move forward.
As our young and our youth and our ambassador
to DREAMS has talked about today, when we engage our youth
and our children and our adolescence
into developing what they want their future to look like,
we are here to support them.
Thank you.
Thank you, every single person for watching.
Take a look at these resources.
Explore how CDC, PEPFAR, DREAMS, Together for Girls
and other global, local,
and national organizations have come together
to help you make your dream a reality.
>> To learn more about the CDC’s Global Work to End HIV, visit globalhivtb. To learn more about the CDC’s Violence Against Children and Youth Surveys (also known as VACS), visit violenceprevention/childabuseandneglect/vacs/index.html. To learn more about PEPFAR, visit pepfar. To learn more about Together for Girls, visit .
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