Delivering Integrated Care after Sexual Violence in the Democratic Republic of the Congo


Bress, Joshua, Givano Kashemwa, Christine Amisi, Jean Armas, Cindy McWhorter, Theodore Ruel, Arthur J. Ammann, Denis Mukwege, and Lisa M. Butler. 2019. "Delivering Integrated Care after Sexual Violence in the Democratic Republic of the Congo." BMJ Global Health 4. 

Authors: Joshua Bress, Givano Kashemwa, Christine Amisi, Jean Armas, Cindy McWhorter, Theodore Ruel, Arthur J. Ammann, Denis Mukwege, Lisa M. Butler


In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all survivors of GBV. A specific challenge is providing emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections to all survivors within 72 hours of violence. To address the multiple barriers to providing this time sensitive medical care, Global Strategies and Panzi Hospital implemented the Prevention Pack Program. The Prevention Pack is a prepackaged post-rape medical kit containing antiretroviral post-exposure prophylaxis, antibiotics for treatment of sexually transmitted infections and emergency contraception. The Prevention Pack Program combines community sensitisation about post-rape medical care with the provision of Prevention Packs and the implementation of a cloud-based and Global Positioning System (GPS)–enabled inventory management system. The Panzi Hospital gender-based violence team implemented the Prevention Pack Program at Panzi Hospital and 12 rural clinics in the South Kivu Province. The data manager took GPS coordinates of each site, provided an initial stock of Prevention Packs and then called all sites daily to determine demand for post-rape care and Prevention Pack consumption. Inventory data were entered into the GPS-enabled cloud-based inventory management system. Project personnel used the consumption rate, trends and geolocation of sites to guide Prevention Pack restocking strategy. Between 2013 and 2017, a total of 8206 individuals presented for care following rape at the study sites. Of the 1414 individuals who presented in the rural areas, 1211 (85.6%) did so within the first 72 hours of reported rape. Care was delivered continuously and without a single stockout of medication across all sites. The Prevention Pack Program provided timely and consistent access to emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections for rape survivors in the eastern Democratic Republic of the Congo.

Topics: Armed Conflict, Gender-Based Violence, Health, HIV/AIDS, Livelihoods, Sexual Violence, Rape, Violence Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2019

Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda


Spittal, Patricia M., Samuel S. Malamba, Martin D. Ogwang, Seggane Musisi, J. Paul Ekwaru, Nelson K. Sewankambo, Margo E. Pearce, Kate Jongbloed, Sheetal H. Patel, Achilles Katamba, Alden H. Blair, Herbert Muyinda, and Martin T. Schechter. 2018. "Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda." Journal of Acquired Immune Deficiency Syndromes 78 (3): 257-68. 

Authors: Patricia M. Spittal, Samuel S. Malamba, Martin D. Ogwang, Seggane Musisi, J. Paul Ekwaru, Nelson K. Sewankambo, Margo E. Pearce, Kate Jongbloed, Sheetal H. Patel, Achilles Katamba, Alden H. Blair, Herbert Muyinda, Martin T. Schechter


Background: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence.
Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda.
Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender.
Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, ,0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing $12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner $10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40).
Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.

Keywords: HIV/AIDS, conflict-affected people, Northern Uganda, gender, sexual violence, mental health

Topics: Armed Conflict, Conflict, Gender, Women, Health, HIV/AIDS, Mental Health, Trauma, Post-Conflict, Sexual Violence, SV against Women Regions: Africa, East Africa Countries: Uganda

Year: 2018

Women, War and Peace: The Independent Experts’ Assessment on the Impact of Armed Conflict on Women and Women’s Role in Peace-Building


Rehn, Elisabeth, and Ellen Johnson Sirleaf. 2002. "Women, War and Peace: The Independent Experts’ Assessment on the Impact of Armed Conflict on Women and Women’s Role in Peace-Building." New York: United Nations Development Fund for Women.

Authors: Elisabeth Rehn, Ellen Johnson Sirleaf


Table of Contents:
Introduction: Peace – for Whom and When?
1. Violence Against Women
2. Women Forced to Flee
3. War and the Health of Women
5. Women and Peace Operations
6. Organizing for Peace
7. Justice
8. Media Power
9. Prevention and Early Warning
10. Reconstruction

Topics: Displacement & Migration, Gender, Women, Gender-Based Violence, Media, Health, HIV/AIDS, Justice, Post-Conflict, Post-Conflict Reconstruction, Peacebuilding, Violence

Year: 2002

Resilience, Female Altruism, and Bodily Autonomy: Disaster-Induced Displacement in Post-Haiyan Philippines


Tanyag, Maria. 2018. "Resilience, Female Altruism, and Bodily Autonomy: Disaster-Induced Displacement in Post-Haiyan Philippines." Signs: Journal of Women in Culture and Society 43 (3): 563-85.

Author: Maria Tanyag


Natural disasters are increasingly causing displacements globally, and such negative impacts of climate change are expected to increase exponentially. Women and girls in particular distinctly endure long-term or gradual harms while in displacement, such as heightened risks of sexual and gender-based violence, including exposure to sexually transmitted infections and HIV/AIDS, maternal mortality, and forced or unwanted pregnancies. This article examines the Philippines as a case study to unveil the growing gendered security threats embodied by disaster-induced displacements. In the aftermath of the disaster caused by supertyphoon Haiyan, which struck in November 2013, the mantra of developing a “disaster-resilient nation” has gained currency among national and international actors in the country. Building on critical feminist political economy analysis, this article argues that the Haiyan postdisaster relief and reconstruction efforts constitute gendered processes that intimately rely on and mobilize women’s unremunerated social reproductive labor, particularly through their role as primary caregivers. Data for this research is drawn from twenty-six interviews with key informants and from secondary sources such as official reports of governmental, nongovernmental, and international humanitarian organizations. The findings underscore the importance of deploying a feminist lens to critique the material and discursive power of “resilience” through which norms of female altruism are harnessed at household and community levels while postdisaster responsibilities are increasingly diverted away from the state. In so doing, resilience discourses may serve to reinforce the structural roots of gendered vulnerability, including political, cultural, and economic barriers to accessing sexual and reproductive health services and supplies—thereby undermining bodily autonomy.

Topics: Displacement & Migration, Climate Displacement, Environment, Climate Change, Environmental Disasters, Feminisms, Feminist Political Ecology, Gender, Women, Girls, Health, HIV/AIDS, Reproductive Health, Sexual Violence, SV against Women Regions: Asia, Southeast Asia Countries: Philippines

Year: 2018

The Convergence of HIV/AIDS and Customary Tenure on Women’s Access to Land in Rural Malawi


Tschirharta, Naomi, Lucky Kabangab and Sue Nichol. 2015. “The Convergence of HIV/AIDS and Customary Tenure on Women’s Access to Land in Rural Malawi.” SAHARA-J: Journal of Social Aspects of HIV/AIDS 12 (1): 134-46.

Authors: Naomi Tschirharta, Lucky Kabangab, Sue Nichol


This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women’s land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women’s access to land. HIV/AIDS may cause the termination of a woman’s relationship with the access individual due to stigma or the individual’s death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.

Keywords: HIV/AIDS, land rights, women, customary, matrilineal, patrilineal, Droits de la terre, VIH/sida, coutumier, femmes, matrilinéaires, patrilinéaires


Topics: Gender, Women, Gendered Power Relations, Gender Hierarchies, Gender Equality/Inequality, Land Tenure, Health, HIV/AIDS, Rights, Land Rights, Property Rights Regions: Africa, Southern Africa Countries: Malawi

Year: 2015

A Gendered Perspective of Vulnerability to Multiple Stressors, including Climate Change, in the Rural Eastern Cape, South Africa


Shackleton, Sheona, Leigh Cobban, and Georgina Cundill. 2014. “A Gendered Perspective of Vulnerability to Multiple Stressors, including Climate Change, in the Rural Eastern Cape, South Africa.” Agenda 28 (3): 73-89.

Authors: Sheona Shackleton, Leigh Cobban, Georgina Cundill


Rapid global environmental change combined with other stressors is increasing the vulnerability of poor people worldwide. In South Africa, HIV/AIDS and climate variability, interacting with other localised risks are having differential impacts across communities, households and individuals. These stressors have the effect of undermining livelihood assets, decreasing adaptive capacity and constraining the ability to respond to new threats such as those expected under a changing climate. This Article considers the gendered implications of multiple stressors on livelihoods drawing on empirical data from a four-year research project in two sites in the Eastern Cape, South Africa. The research was broadly framed within a livelihoods-entitlements approach and methods included a household survey, interviews and focus group discussions. Using data from these sources, this Article explores gender-differentiated vulnerability through an analysis of household livelihoods and assets, perceptions of vulnerability and food security, and the types of responses employed when faced with shocks and stress. Our findings indicate that although women and female-headed households are generally poorer and more at risk than men and male-headed households, in some situations women may be more innovative in their individual and collective responses to stressors and may have more social capital to draw on. Furthermore, men and male-headed households also face specific gender related vulnerabilities. We comment on the need to understand the underlying causes of vulnerability and the heterogeneity that exists at the local level, and consider how such knowledge can be translated into approaches that address vulnerability now and in the future.

Keywords: gender, climate change, multiple stresss, South Africa

Topics: Environment, Climate Change, Gender, Gendered Power Relations, Health, HIV/AIDS, Livelihoods, Security, Food Security Regions: Africa, Southern Africa Countries: South Africa

Year: 2014

Food Security Aspects of the Impact of HIV/AIDS on Rural Women in Smallholder Agriculture


Matshe, Innocent. 2008. “Food Security Aspects of the Impact of HIV/AIDS on Rural Women in Smallholder Agriculture.” Agenda 22 (78): 132-43. 

Author: Innocent Matshe


This article explores the gender dimension of the impact of HIV/AIDS on agriculture, and whether the gender status of household head is important in accounting for observed differences in agricultural performance. The article quantifies this in terms of time and attempts to puts a monetary value to the costs of caring and caregiving. It indicates that rural women lose a substantial amount of time dealing with the disease and that this has a significant impact on their productivity, which directly affects their food security status. The Impact of HIV/AIDS on female-headed households was found to be compounded by external factors that interact with household characteristics. 

Keywords: food security, HIV/AIDS, Agricultural productivity, female-headed households, gender

Topics: Agriculture, Gender, Gendered Power Relations, Health, HIV/AIDS, Households, Livelihoods, Security, Food Security

Year: 2008

Seed Struggles and Food Sovereignty in Northern Malawi


Kerr, Rachel Bezner. 2013. “Seed Struggles and Food Sovereignty in Northern Malawi.” The Journal of Peasant Studies 40 (5): 867-97.

Author: Rachel Bezner Kerr


In this paper I use seeds in Malawi as both an analytical lens and an empirical focus of study to examine how food sovereignty is threatened or enhanced in a particular location and time. I argue that while food sovereignty was eroded for smallholders through neoliberal reforms to the agricultural system, community and kin practices help to maintain food sovereignty. The intersection of gender and class dynamics, combined with state policies, however, works to undermine food sovereignty for particular groups in northern Malawi. Historical processes of exclusion, dispossession and exploitation changed the division of labour and reduced time and land for diverse farming systems. State policies reduced knowledge and availability of preferred local varieties. While peasants, particularly women, have considerable knowledge of seed varieties, and seeds continue to be exchanged in agrarian communities, young women, tenant farmers, food insecure younger couples and acquired immunodeficiency syndrome (AIDS)-affected families are particularly vulnerable to reduced food sovereignty, in part due to gender inequalities, unequal land distribution and social stigma. New efforts to strengthen food sovereignty need to build on community and kin relations, while addressing social inequalities. Understanding the struggles and relations linked to seeds helps us to understand ways in which food sovereignty is undermined or strengthened.

Keywords: Malawi, food sovereignty, maize, seeds, agrobiodiversity, gender

Topics: Agriculture, Class, Gender, Health, HIV/AIDS, Households, Livelihoods, Rights, Security, Food Security Regions: Africa, Southern Africa Countries: Malawi

Year: 2013

'I Know How Stressful It Is to Lack Water!' Exploring the Lived Experiences of Household Water Insecurity among Pregnant and Postpartum Women in Western Kenya


Collins, Shalean M., Patrick Mbullo Owuor, Joshua D. Miller, Godfred O. Boateng, Pauline Wekesa, Maricianah Onono, and Sera L. Young. 2019. “‘I Know How Stressful It Is to Lack Water!’ Exploring the Lived Experiences of Household Water Insecurity among Pregnant and Postpartum Women in Western Kenya.” Global Public Health 14 (5): 649-62.

Authors: Shalean M. Collins, Patrick Mbullo Owuor, Joshua D. Miller, Godfred O. Boateng, Pauline Wekesa, Maricianah Onono, Sera L. Young


There is rapidly evolving literature on water insecurity in the general adult population, but the role of water insecurity during the vulnerable periods of pregnancy and postpartum, or in the context of HIV, has been largely overlooked. Therefore, we conducted an exploratory study, using Go Along interviews, photo-elicitation interviews, and pile sorts with 40 pregnant and postpartum Kenyan women living in an area of high HIV prevalence. We sought to (1) describe their lived experiences of water acquisition, prioritisation, and use and (2) explore the consequences of water insecurity. The results suggest that water insecurity is particularly acute in this period, and impacts women in far-reaching and unexpected ways. We propose a broader conceptualisation of water insecurity to include consideration of the consequences of water insecurity for maternal and infant psychosocial and physical health, nutrition, and economic well-being.

Keywords: HIV, water insecurity, maternal and child health, first 1000 days

Topics: Gender, Health, HIV/AIDS, Reproductive Health, Infrastructure, Water & Sanitation, Livelihoods Regions: Africa, East Africa Countries: Kenya

Year: 2019

Woman's Role in Economic Development


Boserup, Ester, Nazneen Kanji, Su Fei Tan, and Camilla Toulmin. 2007. Woman's Role in Economic Development. London: Earthscan.

Authors: Ester Boserup, Nazneen Kanji, Su Fei Tan, Camilla Toulmin


This classic text by Ester Boserup was the first investigation ever undertaken into what happens to women in the process of economic and social growth throughout the developing world, thereby serving as an international benchmark. In the context of the ongoing struggle for women's rights, massive urbanization and international efforts to reduce poverty, this book continues to be a vital text for economists, sociologists, development workers, activists and all those who take an active interest in women's social and economic circumstances and problems throughout the world. A substantial new Introduction by Nazneen Kanji, Su Fei Tan and Camilla Toulmin reflects on Boserup's legacy as a scholar and activist, and the continuing relevance of her work. This highlights the key issue of how the role of women in economic development has or has not changed over the past four decades in developing countries, and covers crucial current topics including: women and inequality, international and national migration, conflict, HIV and AIDS, markets and employment, urbanization, leadership, property rights, global processes, including the Millennium Development Goals, and barriers to change. (Summary from Taylor and Francis Group)

Table of Contents:


Part I: In the Village

1. Male and Female Farming Systems

2. The Economics of Polygamy

3. Loss of Status Under European Rule

4. The Casual Worker

Part II: In the Town

5. Women in a Men's World

6. Industry: From the Hut to the Factory

7. The Educated Woman

8. Women in the Urban Hierarchy

Part III: From Village to Town

9. The Lure of the Towns

10. Urban Job Opportunities for Women

11. The Unemployment Scare

12. The Design of Female Education

Topics: Armed Conflict, Development, Displacement & Migration, Migration, Economies, Education, Gender, Health, HIV/AIDS, Rights, Property Rights, Women's Rights

Year: 2007


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