Julius Mwanpashe, a community caseworker in the Mbeya region of Tanzania, visits households in his village as a part of his daily routine to encourage families to get tested for HIV. If people test positive, he refers them to health and social welfare services and tracks their progress until they are virally suppressed. He also ensures victims of violence, especially adolescent girls and young women, are identified and referred to the correct health, social welfare, and protection services.
Julius, who is one of more than 18,000 USAID-trained community caseworkers in the country, became a caseworker to help people in his village improve their health. But he says it is not an easy job due to stigma in the community.
During a round of household visits, Julius recalls discovering a girl who had been sexually abused. He found her in unsuitable living conditions. He immediately spoke with the 15-year-old girl’s parents, who asked him for help.
Using what he learned in his training, Julius referred her to the local social welfare officer and reported the incident to the local police station. Along with the social welfare officer, he then took her to the hospital for treatment.
The young woman’s story is one of many in the country. In Tanzania, nearly one in three girls experiences some form of sexual violence before turning 18. Almost four in 10 women have experienced physical violence, and one in five women over age 15 reports experiencing sexual violence in her lifetime, increasing her chances of contracting HIV.
To prevent and respond to violence against women and children to help end HIV, USAID’s Community Health and Social Welfare Systems Strengthening Program supports Tanzania in three ways.
1. Revitalizing community-based committees that address violence against women and children
The Government of Tanzania developed a national action plan to reinforce its commitment to eliminating violence against women and children. The plan incorporates strategies to help local authorities and police, service providers, and communities better provide prevention and response services that have the greatest potential for reducing violence against women and children.
To put the plan in action, USAID worked with the government to revitalize existing Violence against Women and Children Committees made up of members of the community — local government officials, social welfare officers, religious leaders, and police officers — and trained them to increase awareness and action in their communities.
Committees now make sure that women and girls who experience violence, especially sexual violence, get tested for HIV. If they test positive, the committees help them immediately start HIV treatment as well as support to stay on the treatment. This is a critical part of helping Tanzania reach the UNAIDS 90–90–90 goals: 90 percent of all people living with HIV will know their HIV status; 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90 percent of all people receiving antiretroviral therapy will have viral suppression.
2. Connecting victims of violence with health, social welfare, and protection services
Tanzania’s policy to end violence against women and children now includes guidance to ensure that victims of violence receive health, social welfare, and protection services. These integrated services make it easier for them to know their HIV status and bring perpetrators of violence to justice.
The policy intends to improve coordination, deliver high-quality services, implement viable prevention and response measures, and ultimately end all forms of violence against women and children. Stories like Julius’s show what the results of this integration look like on the ground and how it saves lives.
3. Empowering peer support groups to protect women and children against violence
Peer support groups tasked with protecting women and children are being revitalized and trained to more effectively identify and reach out to women and girls in their communities who have experienced physical or sexual violence.
Members of support groups for people living with HIV also help identify people at risk of violence or in vulnerable conditions, and if needed, link them to HIV testing, treatment, and other services, as well as appropriate gender-based violence response services.
Established by and for community members, peer support groups are trusted community resources and especially well-equipped to find and identify those most vulnerable to HIV. Support groups link people living with HIV to clinical services and encourage them to follow their treatment and stay on treatment.
Today, nearly 94 percent of HIV-positive adults in Tanzania are on antiretroviral treatment, and 87 percent of adults on treatment have suppressed viral loads, improving their health and significantly reducing the risk of transmitting HIV infection to others.
Reducing gender-based violence and providing services to those affected takes a broad, integrated effort. Community caseworkers like Julius are on the frontlines of this work, linking vulnerable Tanzanians to much needed care and support services for gender-based violence and HIV infection. This work is greatly contributing to Tanzania’s efforts on its development journey to reach the 90–90–90 goals.
About the Author
Aliza Hasham is the Director of Communications for USAID’s Community Health and Social Welfare Systems Strengthening activity in Tanzania, under JSI Research & Training Institute, Inc.