Preventing Intimate Partner Violence in Uganda, Kenya, and Tanzania: Summary of a Joint Workshop by the Institute of Medicine, the National Research Council, and the Uganda National Academy of Sciences (2015)

Appendix C


Workshop Agenda

Preventing Intimate Partner Violence in Uganda, Kenya, and Tanzania: A Joint Workshop of the Uganda National Academy of Sciences, the U.S. Institute of Medicine, and the U.S. National Research Council

August 11–12, 2014

Sheraton Kampala Hotel, Rwenzori Ballroom
Ternan Avenue
Kampala, Uganda

Workshop Approach: Using an ecological framework that focuses on points of primary, secondary, and tertiary prevention and intervention, this 2-day workshop will focus on intimate partner violence (IPV) in Uganda, Kenya, and Tanzania and the far-reaching consequences of IPV as both a public health and human rights problem. Within this context, the workshop will address IPV and the intersection with HIV, the unique needs of individuals experiencing IPV across the lifespan, responding to IPV from screening to care, the role of social norms and community engagement in prevention, societal level policies and implications, and overall how to improve intervention and decrease IPV prevalence. The workshop will be an opportunity to explore promising and potential prevention models.

Workshop Objective: The objective of this workshop is to inform and create synergies within a diverse community of researchers, implementers, and decision makers committed to promoting IPV prevention efforts that are evidence-informed, innovative, and cross-sectorial.

Context for the Workshop: As defined by the World Health Organization (WHO), IPV refers to behavior by an intimate partner or ex-partner that causes physical, sexual, or psychological harm, including physical aggression, sexual coercion, psychological abuse, and controlling behaviors. IPV is recognized as a global human rights and public health issue. In the 2005 WHO Multi-country Study on Women’s Health and Domestic Violence against Women, between 15 percent and 71 percent of women at 15 different sites in 10 developing countries reported physical or sexual violence or both. Of the 10 countries in the WHO Multi-country Study, Tanzania had one of the highest prevalence rates (Uganda and Kenya were not included in this multicountry study but, in other prevalence studies, Uganda and Kenya also have shown to have significantly high rates of IPV). A more recent analysis from the WHO with the London School of Hygiene and Tropical Medicine and the Medical Research Council analyzed existing data from more than 80 countries and found that globally almost one-third of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner. Globally, more than one-third of all murders of women are committed by intimate partners. Evidence shows that women subject to IPV experience a wide range of serious negative physical, mental, sexual, and reproductive health outcomes, and may have increased vulnerability to HIV. Additionally, the social and economic costs of IPV are high and affect all levels of society.

Although there is growing understanding of IPV as an important public health and safety issue, making greater strides in prevention has been challenging for many reasons, including a lack of good data on the nature and magnitude of violence and its costs, limited understanding of regional and context-specific factors, fragmented effort and resources to address it, and assumptions that violence is both inevitable and cannot be prevented. However, preventing IPV is possible and can be achieved through a greater understanding of the problem, its risk and protective factors, and effective evidence-informed primary, secondary, and tertiary prevention strategies.¹

This workshop is being convened by the Uganda National Academy of Sciences (UNAS) and the U.S. Institute of Medicine (IOM) and the

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¹ Primary prevention aims to reduce risk of experiencing or exposure to violence by addressing risk factors and social norms that promote IPV. Secondary prevention focuses on improving the detection of IPV and providing appropriate services, and tertiary prevention focuses on strengthening institutions to respond thereby mitigating the adverse consequences of IPV.

U.S. National Research Council Forum on Global Violence Prevention. The UNAS and the IOM/NRC are both independent, unbiased scientific organizations. The mission of the UNAS is to contribute toward improving the prosperity and welfare of the people of Uganda by promoting, generating, sharing, and using scientific knowledge and information, and to give independent, merit-based advice to government and society, among others. Similarly, the IOM/NRC has equivalent responsibilities to the U.S. government and other domestic and international stakeholders who seek its advice.

As a convening activity of the IOM/NRC established in 2010, the Forum on Global Violence Prevention works to reduce violence worldwide by promoting research on both risk and protective factors and encouraging evidence-based prevention efforts. Given the unbiased reputations of the UNAS and the IOM/NRC and the established body of work of the IOM/NRC Forum on Global Violence Prevention, these entities are in a unique position to facilitate dialogue and exchange among a wide range of global experts and diverse stakeholders on preventing IPV.

This workshop was organized by an appointed planning committee who, with the assistance of the IOM/NRC and the UNAS staff, developed the workshop agenda and sessions, and selected speakers and discussants. Following the conclusion of the workshop, an individually authored summary of the event will be prepared by a designated rapporteur.

DAY 1: Monday, August 11, 2014

Session I. Understanding and Addressing the Intersection Between Intimate Partner Violence and HIV

A growing evidence base is demonstrating the intersection of IPV and HIV infection, including significant overlap in prevalence, as well as increased risk behaviors and barriers to testing as a result of experiences or fear of IPV. Furthermore, stigma and discrimination associated with both IPV and HIV increase the vulnerability of victims and result in underreporting. Pervasive gender inequalities, especially violence against women, have been recognized by The Joint United Nations Programme on HIV/AIDS and the WHO as a driver of the HIV epidemic. In sub-Saharan Africa, more than half of the people living with HIV/AIDS are women. Although there is research that reveals the links between IPV and HIV, important gaps still remain in understanding the complexities of these intersections across social contexts and among different populations. This session will explore the evidence for IPV as both a risk factor for and consequence of HIV infection and how better understanding of the intersection between IPV and HIV can inform and improve the prevention and response to both epidemics. Presentations will focus on the implications of the intersection for research, intervention design, and policy making in the region.

Session II. Effects of Intimate Partner Violence on Children

The effects of IPV reach beyond those who are direct victims or perpetrators. Exposure to violence has been shown to be associated with negative health, social, and economic outcomes as well as future experiences of violence. With IPV, often those who are exposed to it are children within the family or household where IPV occurs. Children who grow up in families where they are exposed to violence may suffer a range of behavioral and emotional disturbances. Exposure can also be associated with perpetrating or experiencing violence later in life. This session will illuminate the effects of exposure to IPV on children, including evidence of the effects of exposure to violence on child health and development and welfare in both the short term and later-life effects. Additionally, the session will include discussion on the implications and opportunities for designing interventions and implementing policies that address both IPV and violence against children.

Session III. What Are We Learning About Addressing Intimate Partner Violence Across the Lifespan?

IPV occurs at different stages across the lifespan, from adolescence to late life, and presents unique characteristics and challenges within these subpopulations. IPV may present in the form of dating violence, dowry abuse, marital rape, or elder abuse. Those who experience IPV in an earlier life stage may be more likely to experience it again at a later stage. However, there are limited data and number of interventions in general, but particularly within the region, that address the specific needs of individuals experiencing IPV in either early or late-life stages. This moderated plenary discussion explores what is being learned through research, policy, and interventions in IPV about the characteristics and vulnerabilities of specific populations across the lifespan and how research and interventions can begin to target the needs of adolescents and the elderly who experience IPV.

Session IV. Approaches for Responding to IPV and Its Consequences: From Screening to Care

Screening for IPV can potentially improve identification of individuals in need of care and the quality of care they receive, and provide health care professionals with needed information on the causes and risks of other health conditions IPV victims may be experiencing. Furthermore, screening can be an opportunity to provide support and link victims with services they need. Evidence on screening effectiveness is growing in developed countries and is emerging in the region. However, to respond effectively to IPV and its consequences, acceptability and feasibility of screening need to be assessed. Furthermore, services need to be available that can provide necessary care and treatment for those who screen positively. This panel session will focus on the acceptability and feasibility for screening in the region through an exploration of evidence from readiness assessments,

current screening efforts, evidence on effectiveness within the region, and experiences and lessons learned from outside the region from implementing and promoting screening. Additionally, the session will address access to services for those who have experienced IPV, gaps in service provision, and will highlight promising approaches to integrating IPV and HIV prevention and care.

DAY 2: Tuesday, August 12, 2014

Session V. Community Engagement in Intimate Partner Violence Prevention

To better understand and prevent IPV, upstream interventions that address social norms and community perceptions of gender roles and power dynamics within relationships are needed. Yet, few interventions are designed to explicitly address social norms through primary prevention strategies. This session will illuminate several interventions within the region that are engaging communities and attempting to change social norms that promote behaviors that contribute to IPV. Panelists will present their intervention strategies and models, focusing on evidence-informed approaches and context-specific considerations for design, implementation, and program improvement; how impacts and effectiveness are being measured; and lessons learned and/or potential opportunities for scaling up or developing intervention strategies within the region.

Session VI. Engagement of and Response from Various Sectors in Intimate Partner Violence Prevention

IPV is caused by multiple factors that interact across ecological levels and social context; it cannot be sufficiently addressed by one sector on its own. Engagement and collaboration of diverse sectors are needed to more effectively prevent IPV and respond to its consequences. This session will focus on regional policy-level approaches to IPV prevention, including efforts to improve the health sector response, legal protections, and access to social services. Discussions will explore potential opportunities for collaboration or sharing best practices for policy responses to IPV across Tanzania, Kenya, and Uganda.

Session VII. The Way Forward

The objective for this closing session is to examine through various perspectives how to improve the prevention of and response to IPV in Uganda, Tanzania, and Kenya. The focus will be on making progress in three areas: research, policy making, and program development. Questions to be addressed include: Based on what we know, what are the most important research questions that need to be addressed? How do we communicate more effectively with various constituencies that need to be involved in multisectorial prevention and response? How do we mobilize the various sectors and stakeholders who have important roles in research, program and policy development, financing, and implementation? Where are opportunities to coordinate or collaborate across countries to improve IPV prevention in the region? What are the significant barriers, and how can they be overcome? What are the priority items for the prevention agenda going forward? Panelists will be asked to draw from their own expertise as well as the key messages they have heard throughout the workshop presentations and discussions.

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