Janel Smith, MPH, RNClinical Care for Sexual Assault Survivors Specialist

International Rescue Committee

Multimedia training to strengthen clinical care capacities for sexual assault survivors and

HIV/AIDS prevention in humanitarian settings

Background

Worldwide, an estimated 1 in 3 women will be physically or sexually

abused, and 1 in 5 will experience rape or attempted rape in their lifetime.*

The risk of HIV among women who have experienced violence may be up to 3 times higher than among those who have not.*

Limited access to compassionate, competent, and confidential clinical care, essential to begin a survivor’s physical and emotional healing and prevent HIV.

Training health care providers to strengthen the clinical response to GBV and HIV has been prioritized by humanitarian actors globally.*

*WHO, 2009**UNHCR, 2011; USAID, 2010

Evaluating the Clinical Care for Sexual Assault Survivor training

Goal: Evaluate impact of training on clinician compassion, competence, and confidential care

Design: Comparison at pre and 3 months post-training

Sample: 106 clinicians in 39 health facilities in refugee camp and post-conflict settings in DRC, Ethiopia, Kenya, and Jordan

Method: Mixed-methods: KAP surveys, in-depth interviews, health facility checklists, participatory mapping, medical record audits

Compassionate care: patient rights

Non-discrimination

Self-determination

0tan28a5

66028

0tan19a5

66019

0tan9a5

6609

0tan29a5

66029

0tan19a5

66019

0tan10a5

66010

Proportion of clinicians demonstrating respect for patient rights

Pre-trainingPost-training

Before we thought they would not understand…now we give them the information…the patient has the right to accept or refuse interventions.

Doctor, KenyaNow I know it’s not my responsibility to find sexual assault…my work is not to judge but to give treatment according to the patient’s right. Nurse, Kenya

Compassionate care: attitudes

Women lie about sexual assault

Women may be to blame for sexual assault

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66028

0tan19a5

66019

0tan9a5

6609

0tan29a5

66029

0tan19a5

66019

0tan10a5

66010

Proportion of clinicians demonstrating negative attitudes

Pre-trainingPost-training

They don’t come with medical problems, they come for referral… a chance of resettlement. Nurse, Ethiopia

We have the consultation to determine if it is true or false…to diagnose and guide treatment… I would ask her what she was doing, what is her occupation, if she sells sex or is married. Nurse, DRC

Competent care: HIV PEP

% of eligi-ble sur-

vivors re-ceiving HIV PEP within 72 hours

0tan28a566028

0tan19a566019

0tan9a56609

0tan29a566029

0tan19a566019

0tan10a566010

Pre-trainingPost-training

Competent care: follow-up

Follow-up HIV testing

HIV PEP treatment duration

0tan28a5

66028

0tan19a5

66019

0tan9a5

6609

0tan29a5

66029

0tan19a5

66019

0tan10a5

66010

Proportion of clinicians demonstrating competence in HIV testing and treatment follow-up

Pre-trainingPost-training

We’ve found that the nurses providing the care didn’t know PEP. She [the survivor] showed us what was provided and said she was told to take them but not told what it was. GBV Manager, Ethiopia

Confidential care: private room

Maternity is too congested and lacks privacy …it attracts a lot of onlookers…so they perceive it as not a very safe place.

There is now improvement in the facility, there is more privacy and confidentiality because now we are giving the services at one center.

Nurse, Kenya

Conclusion

Limited capacity of the health care response to GBV and HIV in humanitarian settings were identified including negative attitudes among health care providers, lack of follow-up, and limited resources

Multimedia CCSAS training demonstrated effective at improving health care provider respect for patient rights, HIV PEP treatment initiation, and coordination of services to protect patient confidentiality

Additional interventions should be implemented with training to ensure a quality comprehensive health care response to GBV and HIV including long term BCC interventions, multi-sectoral coordination , and supply chain management

Thank you

Training materials in English and French: clinicalcare.rhrc.orgContact: Janel.smith@rescue.org