Number of people identified to have experienced sexual, physical, or emotional violence

Background

This indicator can be used by community HIV programs to connect beneficiaries who are victims of sexual, physical, or emotional violence to appropriate support services. This number includes men, women, boys, and girls who have been the victim of violence by an intimate partner, a family member, a friend, an acquaintance, or a stranger. This information can support personnel and organizations involved in national social and child protection systems in their efforts to prevent and respond to violence in supported communities, measure the outcomes of anti-violence campaigns, strategize with partners to ensure resources are available to adequately address needs, and link individuals to care and support services. There is a body of evidence linking violence to HIV and HIV to violence bidirectionally. This information will help programs to devise strategies to address increased vulnerability faced by those who live in areas with high prevalence of violence in supported locations. If beneficiaries are regularly exposed to forced sex, war, conflict, sex work, exploitation, or are refugees they can be linked to post-prophylaxis services, for instance.

Numerator

Community-based HIV programs targeting adults (18+ years old):

Number of men and women (18+ years old) who have been identified during the reporting period to have ever experienced sexual, physical, or emotional violence

Community-based HIV programs targeting children (<18 years old):

Number of female and male children and adolescents (<18 years old) who have been identified during the reporting period to have ever experienced abuse, neglect, or exploitation that is physical, sexual, or emotional in nature

Alternative: Note that programs can alternatively collect information on whether the violence occurred during a specific period: since the last time the community worker visited the household, over the past year, or in the past three months, for instance. This alternative language would tell community programs whether immediate action is needed to address the violence or abuse and prevent further harm.

Note that members of key populations, and their children, are more vulnerable to violence and more likely to have experienced violence in their lifetime; therefore, programs that serve them are advised to use the alternative indicator language specified above. For effective case management, skilled personnel should monitor violence during each visit if vulnerability to violence is high or past violence has occurred; in this case, the reporting period would be defined as since the last visit.

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

This indicator should be determined by counting the number of cases of violence or abuse that are reported or brought to the attention of community-based HIV programs and community workers. A case can be defined as an individual identified to have experienced violence.

Community-based HIV programs should defer to country law and national case management procedures on appropriate handling of cases of violence for children and adults when brought to the attention of community workers. Mechanisms should be in place to handle formal complaints that allow children and adults to safely report abuse, neglect, or exploitation, and to protect those who may experience negative consequences as a result of disclosure. If a community health or extension worker becomes aware of violence or suspects violence in his or her community, it is recommended that he or she ensure that victims or potential victims are connected to the correct, trained authorities immediately. However, they should be trained on the appropriate procedures to follow if they suspect or become aware of violence, instead of handling these cases, which could lead to further harm.

Skilled personnel at the community level, which can include social workers, health workers, police and the justice sector, are often trained to identify and respond to any signs of abuse, violence, exploitation, or neglect. If a child or adult has been sexually assaulted and this information is disclosed, it is imperative that he or she be referred to a health facility as soon as possible for adequate examination and care and materials to be collected.

Child victims of violence should be treated with utmost care, demanding even stricter consideration of ethical and safety issues. Community workers and community-based organizations should be trained on child-friendly communication and relevant laws and policies—including those related to consent, mandatory reporting, definitions of violence and exploitation, and case management.

Data source

Numbers of victims identified, referred, and prescreened for gender-based violence at the community level are often tracked using HIV activity reports for community organizations, monthly community reports, community health worker registers, and community family folders.

Vulnerable children programs often report numbers of cases of abuse, violence, exploitation, or neglect and track the support they provide using quarterly reporting, household assessment, graduation, enrollment, and beneficiary support activity forms. Enrollment and beneficiary forms, predominantly completed by community extension workers, usually include data elements regarding whether any child or family member accessed violence support or was referred for protection services.

Key population programs typically collect relevant information for this indicator through outreach peer calendar or behavior change communication forms, and peer educators report on whether they addressed violence through decision-making or action planning support counseling. Behavior change communication forms can often include risk behaviors and themes of the messaging provided during activities with members from key populations. 

Disaggregation

• Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–17 years for children; 18–24 years, 25–49 years, and 50+ years for adults)
• Sex
• Pregnancy/lactation status
• Key population type (sex workers, men who have sex with men, transgender people, people who inject drugs)
• HIV status
• Type of violence or abuse: sexual, physical, emotional

Sexual, physical, or emotional violence can include rape and sexual abuse, child sexual abuse, child marriage, female genital cutting, marital rape, dowry-related violence, female infanticide, femicide, sexual harassment, forced prostitution, sex trafficking, and sexual violence used during war or conflicts as forms of intimidation and torture. It can also include threats, coercion, arbitrary deprivation of liberty, or economic deprivation.

Child abuse can include physical abuse (the deliberate use of force on a child’s body which may result in injury), sexual abuse (violent sexual assault or other sexual activities, including inappropriate touching, where the child does not fully comprehend, is unable to give informed consent, or for which the child is not developmentally prepared), and emotional abuse (persistent attacks on a child’s sense of self). Child neglect is defined as the failure to provide for the child’s basic needs and can include physical neglect (failure to adequately meet the child’s needs for nutrition, clothing, healthcare, protection from harm) and emotional neglect (to satisfy the developmental needs of a child by denying the child an appropriate level of affection, care, education, and security). Exploitation is abuse of a child where some form of remuneration is involved or whereby the perpetrators benefit in some manner—monetarily, socially, or politically.

Data quality considerations

When asking about lifetime experiences of violence, beneficiaries may be less inclined to remember an event, and its details, if it happened many years ago. Collecting and interpreting data related to this indicator should be done with care, because disclosure may engender hostile reactions. Individuals who recently participated in a community awareness initiative related to violence reduction and reduction of associated stigma may be more inclined to report their experiences at the next household visit or encounter with community workers.

The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided. Since this indicator can be reported by both unskilled and skilled personnel, programs should be careful to avoid double counting of cases. It may be advisable to only include this information on forms used by skilled personnel at the community level once referral of cases is made from unskilled community workers, which can also be tracked through their reporting forms.

Reporting frequency

Skilled personnel should collect this information regularly but, they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Cases identified of physical, sexual, or emotional violence

Category

Vulnerable Children, Key Populations, HIV Prevention, Home-Based Care, Prevention of Mother-to-Child Transmission

References

Sexual and Gender-Based Violence. (2018, January 12). Retrieved from https://www.measureevaluation.org/prh/rh_indicators/womens-health/sgbv

PEPFAR. (2018). Monitoring, Evaluation, and Reporting (MER 2.0) Indicator Reference Guide Updated Release (Version 2.2). Washington, DC: PEPFAR. Retrieved from https://www.pepfar.gov/documents/organization/263233.pdf

Kerrigan, D. L., Fonner, V. A., Stromdahl, S., & Kennedy, C. E. (2013). Community Empowerment Among Female Sex Workers is an Effective HIV Prevention Intervention: A Systematic Review of the Peer-Reviewed Evidence from Low- and Middle-Income Countries. AIDS and Behavior, 17(6), 1926–1940. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23539185

Onyango, M. A., Adu-Sarkodie, Y., Agyarko-Poku, T., Asafo, M. K., Sylvester, J., Wondergem, P., . . . Beard, J. (2015, March 01). "It's all about making a life": Poverty, HIV, violence, and other vulnerabilities faced by young female sex workers in Kumasi, Ghana. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25723977

Silverman, J. G. (2011). Adolescent female sex workers: Invisibility, violence and HIV. Archives of Disease in Childhood, 96(5), 478–481. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21357241

Rolon, M. L., Syvertsen, J., Robertson, A. M., Rangel, M., Martinez, G., Ulibarri, M., . . . Strathdee, S. (2013, June 1). The influence of having children on HIV-related risk behaviors of female sex workers and their intimate male partners in two Mexico-US border cities. Retrieved from http://europepmc.org/articles/PMC3667590

Violence against women and HIV. (2014, November 28). Retrieved from http://www.who.int/reproductivehealth/topics/violence/hiv/en/

Bloom, S. (2017, December 13). Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators. Retrieved from https://www.measureevaluation.org/resources/publications/ms-08-30

Action for the Rights of Children. UNHCR. Critical Issues Abuse and Exploitation. Retrieved from http://www.unhcr.org/en-us/protection/children/3bb81aea4/action-rights-children-arc-critical-issues-abuse-exploitation.html