The seventh South African AIDS Conference held in Durban, South Africa in June 2015, drew together South African and southern African researchers, academics, policy makers and programmers to discuss the state of the response to HIV in South Africa and more widely. Team members Andrew Gibbs and Smanatha Willan, from Project Empower – a WWs supported programme that works with young people to reduce their risk of contracting HIV, or of experiencing violence – presented, and provide some thoughts from the event.
A conference to bring researchers and activists together
AG: The conference was upbeat, with presentations showing a growing evidence base of ‘what works’ to prevent HIV-transmission. Dr Lucie Cluver’s presentation on cash and care highlighted the importance of broad-based cash-transfer interventions for reducing HIV-risk, specifically through child-targeted social grants. While Dr Chris Beyer spoke widely about the highly supportive evidence around Pre-Exposure Prophylaxis (Prep) from recent trials.
SW: While these discussions were happening in the plenary the Global Village was hosting some exciting discussions with civil society. Ibis Reproductive Health held a critically important and lively session on reducing unplanned teenage pregnancy, and I caught the tail-end of a session debating the washable sanitary pad and how we can bring it to every women in Africa. And as every seasoned HIV and AIDS conference go’er knows when you are exhausted head to the Global Village and the Women’s’ Networking Zone, they will have some comfortable cushions to sit on while you chat to great Feminists and re-charge for the next session – thank you women’s networking zone!!
What Works about combining approaches to prevent HIV and violence against women and girls
SW: The session we ran got off to an interesting start, first a number of our discussants got lost and then having found everyone the previous session ran over with loud debates and an impromptu march for improved health care. While we were happy to wait while the debates continued, holding a discussion session after a Treatment Action Campaign (TAC) meeting is always tricky, an impromptu march is a hard act to follow. Nonetheless we had a very exciting discussion, and following the panellists input we had good discussion with the audience, we had a teacher in the audience who shared her experiences of school based interventions, and called for greater involvement of teachers and heard from the organisation coordinating the review of South Africa’s Life Orientation in schools cirriculum.
AG: Key issues that emerged from the discussion included, the lack of a South African national strategic plan for GBV, the challenges for facilitators of having to implement interventions in settings that are often not conducive to learning and reflection, the lack of political will at multiple-levels to transform gender relationships and reduce IPV, and the ongoing challenges of implementing interventions in school settings.
While there is increasing evidence of ‘what works’ to prevent HIV-acquisition and intimate partner violence (IPV) there is often less discussion of translating this into realities, especially for young women. Dr Sinead Delany-Moretlwe – in her review of evidence on interventions to prevent HIV in young women, highlighted that while microbicide and Prep trials have been successful amongst adult women, for younger women, with highly constrained social circumstances, including experiences of gender inequalities and Intimate Partner Violence, they have been less successful. In particular the FACTS trial failed to show an effect on reducing HIV-incidence, primarily because women struggled to use the product given their highly challenging life circumstances. As Delany-Moretlwe emphasised, without tackling women’s experiences of violence, biomedical interventions are likely to always remain less than successful.
Where we need to go from here
As increasing evidence emerges from research around what works to prevent violence against women and girls there needs to be simultaneous work around understanding how interventions work, the challenges of implementing interventions and how to scale-interventions up. Moreover, there needs to be a significant focus on engaging policy makers and politicians around research programmes to ensure that positive findings are engaged with and lead to meaningful change at the national level. It will not be enough to demonstrate that interventions work, rather there needs to be as much work on ensuring that this evidence is taken up by those who have the power to influence national budgets and policies.
What Works is building evidence on how to design, implement and scale-up promising violence prevention programmes, through its Impact and Evaluations Fund. Through this fund, projects such as Stepping Stones and Creating Futures, will be assessed using RCTs. This will build a global body of evidence, on programmatic elements that could be replicated or adapted.