PEPFAR supports training of health care providers on comprehensive management of GBV and VAC services. The training curriculum include practical sessions that helps trainee to gain skills on screening and management for GBV ad VAC survivors

A 39 years woman on ART attended health facility a week after delivery for postnatal care. On her clinic visits she was screened for GBV by HCPs who was doing field practice during GBV training. The woman reported to be on ART for the past four years and she opted for exclusive breast-feeding. The woman was too quiet and looked unhappy during the waiting area, the trainee called her and tried to enquire some information that include her and children well being. The women stated “I have every little breast milk, not enough for my daughter, baby is crying and I cant afford artificial milk, therefore am afraid I will transmit HIV infection to her” As she stated the face was full of tears.

Health care provider decided to screen for GBV and investigate for possible causes for milk production, her screening started by asking few questions and understanding the environment/ circumstance that women faced before and after delivery. The woman responded by telling her life story. She is married with two children, used to live in Mwanza region, together with her husband they owned a house, a car and a hardware shop. Just four months ago her husband died while she was six months pregnant, her brothers in laws chased her away and denied her the rights to own any of the family property. She said “I have gone through very difficult moment just after the death of my husband, my brother in law took every thing and told me to go back to my family with my children, its very painful. I asked my sister who lives in Dar es Salaam to join and live with her. Meanwhile I tried to ask for guidance and support on how I can get my property back from in laws but I failed. Currently, am living with my sister who is a primary school teacher, my sister knows my HIV serostatus and at times she abused me in front of other family member and stigmatizes my children. She attempted to throw out my ARVs and refuse to give any social assistance for example on the day when I went for delivery she refused to take me to hospital. At that moment she was hiding my ART drugs on the soil. She was complaining that if I continue to take ART, I will be alive and hence increase the chance of transmitting HIV infection to her and her family.

The screening reveled several forms of GBV that woman is going through hence contribute to her depression and un happiness this include psychological, economical and physical violence to mention a few

Trained health care provider used her knowledge and skills to initiate management by providing psychosocial counseling, empowering about existing laws and her rights that including reconnection counseling to self and family member. She scheduled the woman for follow up visits. Through community services her sister was counseled on positive living, modes of HIV transmission, importance of breast milk to reduce MTCT and care for PLHIV. On first scheduled visit women was empowered to identify treatment supporter and received adherence and psychosocial counseling. Further more she was referred for legal aid and social support for her children.

On the subsequent visit, she gave the feedback on the support she received from the legal aid that includes education on her rights as a widow and children right. Moreover, the legal organization helped her to file for claims, she was transferred back to Mwanza and recently reported to receive some of her property.

The women received routine clinical and psychological care, she managed to continue with exclusive breast-feeding and her baby tested HIV negative six weeks after stopping breast feeing.

Lesson leant

Screening for GBV is essential and should be integrated in all health care services including RCH, CTC and PMTCT services.
Referral and feedback even to lower community level enabling comprehensive GBV management

Economic violence can contribute to health related problems and there proper documentation is the cornerstone for quality of care

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