2173.0 - HIV care provider and stakeholder insights on factors affecting gender-based violence screening, referrals, and counseling in the context of HIV care in Uganda
Session: HIV and Comorbidities
Author: Trace S. Kershaw
Abstract
Background
Because HIV and gender-based violence (GBV) are closely linked, Uganda adopted the World Health Organization’s guidelines to incorporate routine GBV screening and the immediate provision of support and referrals for survivors in HIV care settings. However, there are considerable barriers to implementation. This study aims to explore factors influencing HIV care providers’ implementation of Uganda Ministry of Health (MOH) GBV protocol in HIV care, with the goal of identifying areas for growth.
Methods
In 2023, we conducted a qualitative study in rural and peri-urban public health clinics in central Uganda. We conducted 7 focus group interviews with 53 health workers, lay health workers, and staff that engage regularly with HIV care clients, and 12 individual interviews with community partners (e.g., health leaders, HIV/gender program leads). Data were analyzed through thematic analysis and guided by the Consolidated Framework for Implementation Research.
Results
We identified multilevel barriers affecting GBV screening and response, including factors related to provider motivation, institutional support, the clinic environment, and community and health systems. Health workers and stakeholders were aware that GBV affects HIV care clients and of the MOH’s GBV protocol. However, health workers reported infrequently implementing GBV screening and viewing it as a low priority. Some expressed bias and stigmatizing behaviors towards GBV-affected clients (e.g., survivor-blaming). Many providers had not received the MOH’s mandatory GBV training due to limited resources and frequent staff turnover. The ability to screen and respond to GBV was diminished by a lack of privacy due to insufficient space and high client volumes. Participants discussed a limited network for psychosocial service referrals and hesitation to make police and legal referrals due to concern that doing so would erode community trust. Participants identified community GBV stigma as preventing clients from seeking support.
Conclusions
This study highlights the need to strengthen the implementation of GBV screening and response, and identifies multilevel barriers to its implementation, in HIV care. System-wide strengthening is needed to bolster provider training and motivation, create time and space in clinics for implementation, strengthen external referral systems, and reduce provider bias and community stigma related to GBV.