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COMPARATIVE ANALYSIS OF THE INTERLINKAGES BETWEEN VIOLENCE AGAINST WOMEN AND HIV IN A PERI-URBAN AND RURAL DISTRICT IN ZIMBABWE Location: Epworth and Makoni Duration of project: 25 days Starting Date: 18 January 2016 1. Introduction The purpose of this Terms of Reference is to request proposals from institutions or individuals interested in, and capable of conducting an in in-depth study and comparative analysis of the interlinkages between violence against women (VAW) and HIV in Epworth and Makoni districts in Zimbabwe. The TOR highlights the services required as well as areas to be covered in the study. 2. Background Zimbabwe continues to be one of the few countries in the world with high HIV infection rates. 3 As of December 2014; about 1,39m Zimbabweans were estimated to be living with HIV and AIDS up from 1.1m in 2012 4. An estimated 63, 853 people die due to HIV related illnesses annually and the country has close to a million (889, 339) AIDS orphans 5. Zimbabwe has a generalized epidemic with a national prevalence of 15% (ZDHS 2010-11) which is lowest in Harare Province (13%) and highest in Matabeleland South Province (21%). Transmission is mainly through heterosexual sex and the patriarchal nature of society coupled with the biological make up of women has resulted in the epidemic being feminized. The prevalence rate among female adults aged 15 49 years is 17.7% compared to 12.3% amongst males whilst the prevalence rate among young people also exhibits the same bias against young women. Prevalence among all 15-24 year olds was estimated at 5.31%, with young women more than 1.5 times likely to be infected (6.55%) compared to young men (4.06%). 6 Gender inequalities in Zimbabwe increase the risk of women getting infected with HIV. Manifestations of gender inequalities in the country include: women and girls subordinate position in society, high prevalence of gender based violence, high poverty rates particularly for women which in turn enhances their dependence on men. Social norms permit men to have multiple sexual partners and to dominate sexual decision-making, while women s limited ability to negotiate condom use or their engagement in transactional sex increases their vulnerability to infection. The patriarchal norms of society pose a major challenge to the advancement and empowerment of women and puts them at risk. Child marriages and teen pregnancies increase the vulnerability of young women. The prevalence of child marriage is 3 In terms of new infections and numbers estimated to be living with HIV, Zimbabwe ranks 8 th globally and 4 th in the SADC region after RSA, Mozambique and Tanzania; http://www.afridev.info/sites/default/files/southern%20africa%20rshr%20%26%20uhc%20scorecard%20%282014%29- HIV%20Adult%20Prevalence-PLWHIV-%26New%20HIV%20Infections-Fin_0.pdf; accessed 11/05/15 4 NAC. 2012. State of the HIV Treatment and Care Programme Zimbabwe; http://www.nac.org.zw/about/hiv-aids-situation, accessed 07/05/15 5 Ministry of Health and Child Care (June 2014). Zimbabwe National HIV and AIDS Estimates Report 2013. AIDS and TB Programme. Online at http://www.nac.org.zw/about/hiv-aids-situation 6 Ibid 24

highest in Mashonaland Central (50%), followed by Mashonaland West (42%), Masvingo (39%) and Mashonaland East (36%). 7 The need to ensure a better future for daughters and economic gains have been cited as the underlying factors contributing to forced marriages. Reports indicate that on average, one out of three girls in Zimbabwe will be married before they are 18. In addition, a series of harmful cultural practices such as wife inheritance still take place in rural Zimbabwe further exposing adolescent girls and young women to the risk of contracting HIV. These practices are not only violations against the rights of the women and girls since most of them happen against their will and represent a clear violation of their values, they are also practices that increase the risk of contracting or transmitting HIV and STIs and contribute to maternal morbidity and mortality (Mukanangana et al; 2014). Violence against women is a key factor increasing women s risk of contracting the virus. Women are two to four times more likely to contract HIV during unprotected sex than men, because their sexual physiology places them at a higher risk of injuries and because they are more likely to be at the receiving end of violent or coercive sexual intercourse (UNAIDS 2001). A baseline study conducted on violence against women in Zimbabwe in 2013 found that a greater proportion (14%) of women survivors of intimate partner violence (IPV) had STI symptoms as compared to non-survivors (6%). 8 The ZDHS (2010/11) also found that 30% of women aged 15 49 years have experienced physical violence since age 15 whilst for 22%; the first sexual encounter was forced. Whilst violence is largely condemned, worryingly societal norms sometimes normalise this behaviour. The 2010-2011 DHS revealed that 40% of women interviewed believed that a husband is justified in beating his wife for a number of reasons including refusal to have sex (17%). Such beliefs reinforce the patriarchal social beliefs that fuel the gender based cycles of violence. As women are economically marginalized and dependent on men, many are less likely to leave these abusive relationships which further increases their vulnerability. The dependency on men also perpetuates men s dominant position in society and in turn hinders efforts to fight the pandemic. Globally efforts have been made to bring attention to the plight of women. For instance, the UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV encapsulates the key global issues and strategies for addressing the needs and rights of women and girls within the context of HIV. In addition to adapting various commitments, many efforts have also been done in country to address the specific issues facing women. 3. Justification UN Women recognises that violence against women increases their vulnerability to HIV infection. Based on that understanding, UN Women will build on its current achievements in for example the JPGBV program in Makoni to explore the interlinkages between violence against women and HIV. Although, the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) and various other policies such as the Domestic Violence Act, The Criminal Code and availability of victim friendly units exist; there is not enough evidence to show that HIV/AIDS policies and programmes are adequately addressing violence against women. This gap is accentuated by the HIV/AIDS communities continuing faith in and emphasis on the ABC prevention approach which assumes all sex is consensual. The purpose of this research therefore is not only to explore and conduct a comparative analysis of the interlinkages between VAW and HIV within a peri-urban and rural setting but also to examine the policy and programmatic responses that are in place to address gaps. The study seeks to ascertain the relevance, effectiveness and efficiency of existing programmes on HIV in addressing VAW and vice versa. This research will enable the country office to support community efforts and inform national development planning processes and efforts through understanding the socio-economic drivers of VAW and how these increase women s risk to HIV. The evidence generated will also feed 7 UNFPA.Child Marriage by Sub-National Regions. New York: UNFPA, 2011. 8 Zimbabwe Violence Against Women Baseline Study, 2013 p.62 25

into the updating of national strategies such as the Zimbabwe national Gender Based Violence Strategy (2012-2015) which will be up for review and update in 2016 and inform the roll-out and implementation of ZNASP111 (2015-2018) as well as the next Global Fund application process. Therefore, in order to build this evidence base and get a clearer and deeper understanding of the interlinkages between violence against women and HIV in two different settings; UN Women wishes to engage the services of an institution to conduct the comparative study in Epworth and Makoni districts in Zimbabwe. 4. Research aim The aim of this research is to understand the interlinkages between VAW and HIV/AIDS and examine the experiences of women survivors of violence and women living with and affected by HIV/AIDS in two different locations. In particular, their understanding of what made/makes them vulnerable to HIV, what role their setting/location plays and whether their status increases their vulnerability to violence. In addition, the study also seeks to examine the relevance, effectiveness and efficiency of existing programmes on HIV in addressing VAW and vice versa in the two districts. 5. Scope of Work Conduct a comparative analysis of the peri-urban and rural district with regards to; a. the underlying factors that put women and girls at risk of GBV and HIV b. the interlinkages between GBV and HIV c. experiences and needs of women living with HIV/AIDS; experiences of women with medico-legal mechanisms of the state in case of abuse d. the structural and community violence against women living with and affected by HIV and the impact thereof with regards to prevention, treatment, care and support services Examine the national and community response to HIV in addressing VAW and vice versa in the two districts. Specifically; a. track budget allocations and spending and assess the extent to which anti-vaw is funded in HIV/AIDS programming b. examine the relevance, effectiveness and efficiency of existing programmes on HIV in addressing VAW and vice versa. 6. Expected outputs A concise report comparatively detailing the interlinkages between VAW and HIV and the response thereof at national and local level in the two districts. Based on the findings, develop a 10 point recommendation document for priority interventions and areas for UN Women to consider, both in terms of UN Women s own work and to recommend to other stakeholders (GoZ, donors and other multi-lateral agencies). 7. Experience required An institution with gender; VAW and HIV research experience that meets the following criteria: Technical expertise of the firm Organisational experience on working within communities on gender issues, sexual and reproductive health including HIV as well as violence against women 26

Organisational understanding of gender equality, violence against women and HIV and experience of working on gender equality and women s health issues. Organisational experience on conducting gender assessments of national responses Strong organisational understanding of gender equality, human rights and rights based and VAW programming of UN agencies and government. Experience in districts at grassroots level and positive past experience working with UN agencies in Zimbabwe. Management Structure and Key Personnel Organisational management capacity and availability of experienced and qualified team leader and key team members in relation to conducting research in the HIV and health sector, gender assessments and understanding of gender equality and women s sexual reproductive health issues. Professional Qualification Key personnel should have at least a Master s degree in public health, Social Sciences, Development studies or other related field Key personnel should have extensive experience in undertaking socio-economic research focusing on the HIV, gender equality and violence against women. Other qualities Extensive Knowledge of Zimbabwe s health sector Proven experience and excellent networking and partnership skills with UN agencies, government and CSOs. Excellent communication skills, both verbal and written and strong presentation skills Cultural sensitivity 8. Timeline/Duration of project Duration of the project: The project will run for a period of 25 days 9. Reporting Arrangements The consultancy firm will be reporting to the UN Women Gender and HIV/AIDS Programme Specialist and the UN Women Deputy Country Representative SUBMISSION DETAILS Interested parties must provide the following: A brief technical proposals not more than 10 pages with the proposed research design A financial proposal Updated CV(s) of two/three key personnel to be involved in the study Deadline for submission is Monday 11 th January 2016. UN Women will acknowledge receipt of the applications through a confirmation e mail. Only those short listed shall be considered and further contacted. Proposals received after the deadline will not be considered. Proposals will be selected in accordance with the procedure set out in the UN-Women Rules and Regulations. 27

9 No deletion or modification may be made in this form. Any such deletion or modification may lead to the rejection of the Proposal. 28

10 The Proposer shall fill in this Form in accordance with the instructions. Apart from providing additional information, no alterations to its format shall be permitted and no substitutions shall be accepted. 29

11 The Proposer shall fill in this Form in accordance with the instructions. Apart from providing additional information, no alterations to its format shall be permitted and no substitutions shall be accepted. 30