HIV+ and Rural Women Who Survived Violence: What Works in Ukrainian Communities? Halyna Skipalska ICF “Ukrainian Foundation for Public Health” HealthRight International Ukraine – Office Representative
HealthRight International is a global health and human rights organization that works to build lasting access to health for excluded communities. Since 2005, HealthRight International has been working in Ukraine. Ukrainian foundation for Public Health (UFPH) was founded in 2008 by HealthRight International. Our priorities in Ukraine: • Equal access to health and social services • Social rehabilitation for women and girls in difficult straits • Prevention and response to gender-based violence (GBV) and domestic violence • Development of the social service area • Building professional capacity of local experts Geographical coverage: 18 out of 24 Ukrainian regions Beneficiaries in 2017: more than 17,000 women and girlss.
Rural Women D on’t Know How to Defend Themselves From Violence, and They Look for Help in Big Cities “My husband and I loved each other. At first, our marriage was happy. But, as time passed by, something began to shift. He started beating me for nothing, often when he returned from work. I was ashamed to admit that my husband was abusing me. I was confused and didn’t know what I was doing wrong. When he started beating my small son, I couldn’t stand it any longer. But I didn’t know whom I can turn to, tell my story and receive advise or support. So I just escaped with my child to the big city where I had a better chance of finding help.” Tetiana, HIV+ mother on maternity leave, client of a psychosocial support mobile team
HIV in Ukraine More than 312,000 cases of HIV-infection identified.139,000 people living with HIV registered in Ukraine* Among new HIV infections in 2016: 57,5% were among men 73,7% live in cities 42,5% among women 26,3% live in villages (compared to 44,1% in 2014) (compared to 24,4% in 2014) The highest HIV incidence among rural residents is observed in Mykolaiv, Odesa, Dnipropetrovsk and Kyiv regions (128,7 to 58,2 incidents per 100,000 people) * Public Health Center, Ministry of Health of Ukraine, November 2017
Rural Women at High Risk of HIV and Violence 25% of all people who inject drugs in Ukraine are women* • HIV prevalence among women IDUs is higher than among men IDUs (23,6% compared to 20,8%) Only 18,7% receiving OST are women Out of 151 OST sites only 13 are located in villages 35% of women living with HIV have experienced violence (compared to 19% who are not HIV+)** 70% of HIV+ women who experience violence never turn for help Married women in rural areas are 5 times more likely to experience violence*** *Public Health Center, Ministry of Health of Ukraine, 2017 ** Survey by NGO “Positive Women”, 2017 ***UNPFA survey, Kyiv, 2014
Availability and Accessibility of Services for Rural HIV+ Women Survivors of Violence In rural areas women specialized services (social, legal, psychological, medical) are not available in sufficient quantity. Many rural settlements do not have pre-school facilities or kindergartens, other social determinants like housing or job trainings are available only in big cities. Women have to travel to big cities having additional travel expenses and allocating their time. Some of the barriers preventing HIV+ women from receiving quality help: • Lack of awareness of their human rights • Lack of information about support services • Not recognizing the partner’s behavior as violence • Threats from the partner to reveal their HIV status, history of drug misuse, and total control of the partner over the woman’s life. According to UFPH research, all respondents recognized that they have experienced psychological violence • Stigma and discrimination from the environment *UFPH Research. UN Trust Fund to End Violence Against Women, 2014
Specialized Services for Rural Survivors of Violence: Identification, Response and Support Mobile teams of psychosocial support are special units that consist of three psychologists/social workers who reach out to those violence survivors who live in remote areas and refrain from reporting their care or communities affected by conflict. Shelters provide rehabilitation services and transitional housing. Mobile teams that operate in shelters can bring client to city. Day service centers provide social, psychological and legal services to women and girls in need, access to HIV, HCV and STI testing and treatment.
Mobile Teams are the First Link in a Continuum of Specialized Services for Rural Women 46 MTs operate in 10 regions covering 54 cities and 42 rayons (districts) and cover more than 2,500 villages. MTs provide vital emergency and routine psychological and social support, case management, disseminate information about services, HIV, violence and human rights, and refer survivors to other specialized services. MTs have a stationary base, usually located at the local center for social services and have a rented vehicle for outreach visits.
Mobile Teams Provide Services in Rural Areas Outreach visit to conflict-affected communities of Donetsk region
Shelters for Survivors of Domestic Violence Shelters are available only in big cities providing the following services: Safe accommodation for survivors and their • children Case management • Rehabilitation: individual psychological • counselling, behavior change programs, education and training, access to health services The average rehabilitation time is 3 months • Such shelters work in large cities: Kyiv, Shelters also maintain contacts with main • Kharkiv, Berdiansk, Kryvyi Rih, Dnipro, GBV response bodies ensuring the Sloviansk and Mariupol coordinated response to domestic violence
Day Service Centers Operate in big cities: Kyiv, Slaviansk; Kharkiv (in the process of establishment). Provide case management support, access to medical services, confidential testing for HIV, HCV and STIs, group HIV and violence prevention sessions. Conduct outreach work and awareness raising among vulnerable populations. Day centers have children’s spaces with staff where women can comfortably leave their children for several hours.
Conclusions It is especially important to develop effective non-discriminative human-rights based HIV prevention, treatment and care practices. HIV+ positive rural women are at higher risk of violence and lack access to HIV- related and violence protection support services. The majority of services for HIV+ women (treatment, support, OST) and women survivors of violence (day centers, shelters) are located in big cities. MTs are efficient services addressing the needs of rural women (HIV+ mothers, their children, survivors of violence), conducting prevention work, and human rights, violence and HIV education. AAAQ model can be integrated into programming and improved through advocacy and involvement of NGOs. Ratification of international conventions (Istanbul Convention, Security Council Resolutions 1325 and 1820, etc.) can ensure implementation of human-rights based standards.
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