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 .

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download