Supporting Social Change to Curb Violence and Eliminate HIV in Guyana, by Anne Stangl of ICRW

By Anne Stangl

*This blog originally appeared on ICRW

As I fly home from the humid, vibrant and bustling Georgetown, the capital city of Guyana, I am a bit overwhelmed by the daunting task the country faces to address the high levels of intimate partner violence, sexual assault, child abuse and suicide in the country.

Over the last week, my colleague Jocelyn Lehrer and I had the privilege of speaking with people working at community-based organizations throughout the country who are an integral part of tackling these challenges. Peer educators, social workers, nurses, counselors, people living with HIV, LGBT advocates, and survivors of violence all took time from their important work to speak with us about their efforts to create a path forward for Guyana.

My visit to the South American nation was the kick-off trip for ICRW’s grant work under Advancing Partners & Communities (APC), a USAID funded project, implemented by JSI Research & Training Institute, Inc., in partnership with FHI 360. ICRW is assisting in the implementation of the project in Guyana over the next three years, helping to strengthen the capacity of local organizations in Guyana to provide HIV prevention, care and treatment services to key populations at heightened risk of HIV infection, including women, men who have sex with men, transgender individuals and sex workers. Reaching these populations is critical for eliminating new HIV infections in Guyana, but extremely challenging, as these groups face high levels of stigma, discrimination and violence in society.

Given mounting global evidence that sexual assault and partner violence are directly linked with HIV infection, it is crucial for Guyana to tackle these key drivers of the HIV epidemic head-on.

During the trip, I learned of the great work these organizations and individuals are doing to support survivors of gender-based violence and to ultimately break the cycle of violence so that no woman or girl has to experience it in her daily life. From training police to be gender- and LGBT-sensitive, to supporting abused women, men and transgendered individuals in accessing justice, to sheltering women and children when their homes are unsafe, I could see firsthand that change is coming to communities in Guyana.

And while these conversations gave me great insight into the powerful individuals working to reduce violence in Guyana, I did see something worrying.

In interview after interview, themes began to emerge: Gender-based violence is pervasive. Services for survivors are limited or very difficult to access. Marginalized populations such as men who have sex with men, transgendered individuals and sex workers are at heightened risk of experiencing violence. Resources are limited for carrying out community- and national-level programs to change harmful gender norms and break the cycle of violence.

The stories shared by these frontline workers were reinforced daily by headlines in the local newspaper: a police officer charged with sexually assaulting a young man with a wooden police baton; a 23 year old who murdered his 14-year-old girlfriend and then hung himself. 

Despite these challenges and the ubiquitous headlines, I am cautiously optimistic about what we can accomplish.

On our final evening in Georgetown - the country’s largest urban center- we attended a production of “Before Her Parting” at the National Cultural Center. The play was written by Mosa Mathifa Telford, directed by Tivia Collins and staged by Merundoi Incorporated - a community-based organization that utilizes entertainment to educate the public, affect individuals’ attitudes and behaviors, and shift social norms. The gripping drama portrays a reality that’s all too common in Guyana in which young woman is murdered by her husband, who then kills himself. The plot could have been ripped straight from recent headlines.

The play also explores the intergenerational cycle of abuse that fosters violence generation after generation in Guyanese society: A woman is abused by her husband and is violent toward her son; her son grows up to beat and ultimately murder his wife, and the cycle continues. The play was followed by a facilitated discussion with the more than 400 audience members, ranging from students to teachers to civil servants, and a panel of speakers from various government institutions. It was heartening to hear these young Guyanese demand both action to reduce violence and expanded services to support survivors.

It is my hope that though USAID’s Advancing Partners and Communities Initiative, ICRW and John Snow International will be able to strengthen the capacity of local organizations so they are better equipped to respond to gender-based violence in Guyana and can continue to facilitate social norm changes to reduce violence and reduce the spread of HIV infection.

Above all, from my time in Guyana, I saw hope and determination. Hope that the next generation will not see the type of endemic violence that has pervaded Guyana for decades, and be determined to tackle these problems head-on. It’s important that those of us in the global community echo that hope and determination, too. We need to ensure that community workers and advocates have the tools to end these human rights violations as well as to empower women and girls to live free from fear of violence or abuse.

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Thank you to Anne for allowing us to share this post. If you would like to know more about what Anne does at ICRW, check out her twitter feed.

HIV Care for Refugees

By Adriana Ganci 

Since 2001, June 20^th has been recognized as World Refugee Day.  A refugee is defined as someone who is forced to flee her country due to violence or fear of persecution due to reasons of “race, religion, nationality, political opinion or membership in a particular social group.”  [1]  Refugees face an array of difficulties in resettling. They are often hundreds or thousands of miles away from home, in a place where they know no one and in a culture of which they are not a part. Resettlement can be particularly difficult for those refugees and displaced persons living with HIV. They are subject to facing a variety of the stigma of being in a cultural or ethnic minority as well as  the stigma of living with HIV.

Luckily, there are agencies who make it part of their mission to guide HIV-positive populations to the proper resources and help ease their transition as much as possible. The UN Refugee Agency (UNHCR) has seven strategic objectives in their Strategic Plan for HIV and AIDS, these include:

1. Protection  
2. Coordination and Integration      
3. Prevention  
4. Care, Support and Treatment      
5. Durable Solutions 
6. Capacity Building  
7. Assessments, Surveillance, Monitoring and Evaluation and Operational Research

In setting these seven objectives, UNHCR supports and promotes HIV and AIDS programs which aim to reduce mortality and enhance the quality of life among refugees. The UNHCR works with many partners to ensure the best care for refugees, including governments, NGOs, and health care providers. [2]

Unfortunately, all HIV care for refugees is not created equally. The heath care the individual receives is obviously based on the country in which they have resettled. In the U.S., those with refugee status are given a caseworker that will set them up with Medicaid. In Canada they are enrolled in the Interim Federal Health Program, ensuring that they will receive the full gamut of HIV services. But if a refugee is resettled into Ethiopia their access to HIV care will be limited. Resettlement agencies will often try to take these caveats into consideration when placing a person or a family, but nothing is guaranteed. Organizations such as UNHCR and the International Organization for Migration work to advocate for refugees in order to find a home that can accommodate these needs. However, even if placed in a setting with a strong health care system, cultural differences may still pose additional challenges. For example, a traditional woman from Somalia might not be comfortable in an urban health clinic that is largely geared toward supporting homosexuals, indicating a strong need to guide refugees to culturally appropriate resources.  

Fortunately, policies regarding refugees and HIV are improving. In recent years, UNAIDS and the World Health Organization have come out against mandatory HIV testing of refugees, stating that it is a violation of human rights and leaves those living with HIV open to discrimination and persecution. [3] Hopefully, policies like this will continue to be made to improve the lives of refugees living with HIV. 


Furthermore, there have been more resources published for resettlement agencies, host countries, and for refugees themselves. The U.S. Committee for Refugees and Immigrants has included a guidebook for resettlement agencies serving refugees with HIV/AIDS.[4] The USCRI also has many toolkits for healthy living in many languages. They cover everything from mental health, to communicable disease, to cultural orientation, all of which are relevant to those living with HIV and can be found here.[5]  Canada’s Source for HIV and Hepatitis C Information also has lengthy information available for both refugees and immigrants living with HIV. [6] 

While it is fantastic that these resources exist, they are still limited. With over 15 million refugees in the world, many of whom come from high HIV prevalence areas, there needs to be more advocates for those living with HIV. Health care services can be complicated enough to navigate in one’s own country, let alone in a foreign setting, with the stigma of living with HIV and being  a national, ethnic, or religious minority posing an additional hurdle.  Many organizations suggest lawyers for those refugees living with HIV to ensure that they get the support they need. However, the burden cannot be on these populations who are already grappling with so many challenges and changes. We must urge governments, intergovermental organizations, NGOs, and other stakeholders to put their efforts into improving the lives of these refugees living with HIV so that they may lead the fulfilling life everyone deserves.

1.   http://www.unrefugees.org/site/c.lfIQKSOwFqG/b.4950731/k.A894/What_is_a_refugee.htm
2.  http://www.unhcr.org/488495642.pdf
3.  http://www.unfpa.org/emergencies/manual/5a1.htm
4.http://www.uscrirefugees.org/2010Website/5_Resources/5_1_For_Refugees_Immigrants/5_        1_1_Health/5_1_1_1_Healthy_Living_Toolkit/5_1_1_1_1_Communicable_Diseases/English_Guidebook_HIV.pdf
5. http://www.refugees.org/resources/for-service-providers/hiv-aids.html
6. http://www.catie.ca/en/practical-guides/managing-your-health/17