Janel Smith, MPH, RN Clinical Care for Sexual A ssault S urvivors S pecialist

1. Multimedia training to strengthen clinical care capacities for sexual assault survivors and HIV/AIDS prevention in humanitarian settings Janel Smith, MPH, RN Clinical Care for Sexual Assault Survivors Specialist International Rescue Committee

2. Background • Worldwide, an estimated 1 in 3 women will be physically or sexually abused, and1 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

5. 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

6. Compassionate care: patient rights Before we thought they would not understand…now we give them the information…the patient has the right to accept or refuse interventions. Doctor, Kenya Now 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

7. Compassionate care: attitudes 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

8. Competent care: HIV PEP

9. Competent care: follow-up 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

10. 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

11. 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

12. Thank you Training materials in English and French: clinicalcare.rhrc.org Contact: Janel.smith@rescue.org