With an infusion of funding from the Office of the U.S. Global AIDS Coordinator (OGAC), CHIP Associate Director Deborah Cornman is adding a new dimension to her HIV prevention efforts in Mozambique: she will be developing an intervention to address the gender-based violence that contributes to the spread of HIV there.
OGAC’s Gender-Based Violence Initiative (GBVI) is a multinational project taking place in Mozambique and two other African countries – the Democratic Republic of the Congo and Tanzania.
As part of her ongoing work with HIV-positive members of the military in Mozambique, Cornman has conducted extensive focus group research with men and women at military hospitals in the country.
During those focus groups, a reoccurring theme emerged: culturally-sanctioned gender roles and related gender-based violence play a significant role in the spread of HIV and other sexually transmitted infections in Mozambique, where 12.5 percent of the population is living with HIV.
“Violence and the threat of violence serve as barriers to women carrying condoms, negotiating safer sex, demanding monogamy from their partners, and disclosing their HIV status,” Cornman said.
However, Mozambique’s first domestic violence law, which passed in 2009, coupled with the multinational collaboration being funded by OGAC, has created a real opportunity for Cornman and other GBVI partners to change existing social norms surrounding gender equality and gender-based violence in the country, and ultimately to help reduce the prevalence of violence against women.
“Preventing gender-based violence is clearly becoming a priority for the government and the military in in Mozambique, because, at the very least, there is an understanding of the public health ramifications of gender-based violence,” Cornman said.
Cornman and Population Services International (PSI), which is based in Washington, D.C. and operates in 67 countries, will be addressing gender roles and gender-based violence specifically within the Mozambican Armed Defense Forces (FADM), while other GBVI partners will address the issue among the civilian population in Mozambique.
“A gender-based violence prevention intervention is especially needed in the military, which is a male-dominated organization where gender inequality tends to be normative and HIV prevalence rates are estimated to be two to three times higher than in Mozambique’s civilian population,” Cornman said.
Cornman is developing an integrated, multi-level, gender-based violence and HIV prevention intervention for male soldiers in Maputo City.
“Combining individual-, group- and structural-level approaches impacts not only individual behavior, but also peer norms and social beliefs,” Cornman said. “Shifting social norms to support sustained behavior change in a critical mass of community members, in turn, can have powerful and sustained effects that can impact neighboring communities.”
Cornman will implement the intervention on the individual level using a “train-the-trainers” approach she has used successfully with previous interventions. She will train soldiers, selected by FADM as popular opinion leaders, to serve as peer educators who will do outreach and deliver gender-based violence and HIV prevention messages and resources within the barracks.
Cornman also will develop a multi-session group workshop for male soldiers in barracks that will cover topics such as gender, communication skills, stress and anger management, and the role alcohol plays both in partner violence and in risky sexual behavior. Groups will include 10 to 15 soldiers and will be facilitated by trained fellow soldiers.
Additionally, Dr. Cornman will be creating a GBV prevention curriculum that will be used with new recruits in two military academies. Once the curriculum is developed, she will train instructors how to teach the curriculum. It is estimated that approximately 1,000 new recruits will receive education in GBV prevention in year one alone.
“If we can start educating recruits when they first enter the military and are motivated to learn, we will have a much greater chance of impacting their attitudes and behavior towards women,” Cornman said.
To affect change at the structural level, Cornman will be assisting PSI with the training of military commanders, whose role it is to provide leadership around gender equality and healthy sexual relationships. Cornman will also be working with the Ministry of Defense on a social marketing campaign in 24 barracks in Maputo City, that will disseminate GBV-related information using the military radio and the military newspaper. They will also be sponsoring a “Gender Equality Day” that will include presentations and educational dramatic enactments to encourage discussions about gender roles, gender-based violence, and healthy sexual relationships.
“It is not an easy task, but we are trying to redefine masculinity, and what it means to be a strong man, as taking care of his family rather than using violence against them. We want soldiers to understand the difference between appropriate and inappropriate use of physical force. Using physical force to defend one’s country is acceptable. Using it to control one’s wife or girlfriend is not,” Cornman said.
Cornman also plans to integrate the new gender-based violence intervention she will develop into her ongoing HIV prevention-with-positives work at three military hospitals in Mozambique, where currently about 30 peer educators, already trained by her, are influencing the sexual risk behaviors of hundreds of HIV-positive individuals.
Cornman anticipates the peer educators will impact hundreds of soldiers with individual and group work while the social marketing campaign will reach thousands of soldiers. Some soldiers will be exposed to just one aspect of the intervention, while others will be exposed to multiple levels of it, she said.
Provided the three-year demonstration project proves effective, Cornman ultimately plans to package the intervention for distribution and train a cohort of soldiers to be “master trainers” who will train soldiers throughout FADM for widespread implementation.