HIV-service-based screening for violence (GBV and discrimination) in marginalized vulnerable populations (MSM/TG)
Background: Gender-based violence is central to MSM and transgender (TG) vulnerability to HIV, especially in the context of sex work. Yet, few interventions address this vulnerability. This pilot sought to develop an intervention to integrate screening for gender-based violence (GBV) into HIV-related services. The pilot hypothesized that health providers, with linkages established to appropriate referral networks, would be an effective entry point to 1) identify violence perpetrated against MSM and TG and 2) facilitate access to support that could address HIV-vulnerability related to GBV.
Methods: The pilot was implemented in Mexico and Thailand, countries with concentrated epidemics but different cultural, health services, and community responses to MSM/TG. Based on formative research with 28 TG, 32 MSM, and 40 service providers, a screening tool and protocol were developed for detecting GBV among TG/MSM. The pilot also hypothesized that GBV screening developed for violence against women could be adapted to HIV services for MSM/TG.
Results: The pilot was carried out in the two countries with approximately 400 sex workers, 25% TG and 75% MSM, across 4 settings (specialized hospital-based HIV services, integrated HIV clinics, STI clinics, and drop-in services for TG and MSM). Screening was integrated into clinical care services and VCT programs in each setting; doctors, nurses, counselors and peer educators administered the tool. The initial screening tool and protocol were validated among study participants. Evaluation assessed the acceptability of the tool from provider and client perspectives, the prevalence and types of GBV identified, referrals made and accepted, and supports and barriers to implementing screening in different health setting and provider contexts.
Conclusions: Integrating GBV screening into HIV services identifies high levels of violence among MSM/TG, can be effectively integrated into HIV service settings across different cultural and service contexts, and provides important impetus to initiate broader community-health system response to address this vulnerability.
-Abstract available at link below-