UMass Boston

Research team: Courtenay Sprague^1,2, Judit Senarriaga-Esteve¹, Paola Muñoz Gamboa^1, Satwika Paramasatya¹, Sebastián Hernández², Javier Armando Pineda Duque²

¹University of Massachusetts Boston, USA

²Universidad de los Andes, Colombia

Background: Intimate partner violence (IPV) comprises a significant public health problem and grave violation of women's sexual and reproductive health and rights. An estimated 27% of all women globally and 30% in Colombia have experienced IPV. Notably, research indicates IPV can be reduced and even prevented. Nonetheless, little research at the intersection of public health, violence and justice has documented state-led sustainable programs effective in addressing IPV in real-world conditions in low-and-middle-income settings, especially in Latin America. Colombia's novel, under-studied government-led ruta única de attención (single route) seeks to provide IPV-exposed women with an integrated pathway to health, legal and justice services by connecting the health system, justice, prosecution, police, family welfare, family commission, with legal-medical and psycho-social services.

Objective. We aim to map and investigate key mechanisms and limitations of the integrated response through focus on a single actor: human rights lawyers. Lawyers navigate the rut on women's behalf, thus amassing understanding of the system's functioning, mechanisms of health and justice, and limitations.

Design and Methods: In 2022-to present, we are employing purposive and snowball sampling, to conduct in-depth interviews (supplemented with debriefings) in Bogotá with government officials working across la ruta. La Universidad de los Andes ethics committee approved the study. Interviews are conducted in Spanish, then transcribed verbatim into Spanish and English.

Impact of Study/Programme: To date, little research in LMIC settings has documented state-led programs that have been effective in addressing IPV. A recent global systematic review of 104 studies found the evidence of 'what works' to prevent gender-based violence relies on randomized controlled trials with discrete study endpoints, not state-led sustainable programs implemented in the real-world. Further, only 9 studies were from Latin America. Additionally, few programs have sought to integrate justice, public health and gender, as Colombia has. Our study is positioned within that opening. The mapping of the system and the identification of key gaps in the implementation of the response according to each point of delivery assists in illuminating mechanisms for and obstacles to the government response at a more granular level. Ultimately, such research is paramount to inform research, policy and practice at national levels, particularly in LMIC settings.

Research Team: Gavin George, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal (UKZN), Z Nana Nxumalo (HEARD UKZN), Leah Junck (HEARD UKZN) and Courtenay Sprague

Themes: Gender, health and sexuality; sexual risk and HIV risk behaviors; HIV risk environment and prevention; gender as a structural health determinant.

Description: This research engages with the dynamics of transactional sex and the influence of these sexual relationships on young women's identities, which can inform subsequent HIV prevention efforts within the South African context. Transactional sex is a common practice in different regions of the African continent (Zembe et al., 2013) and refers to the practice of engaging in sex in exchange for gifts (Leclerc-Madlala, 2008). The exchange is neither explicit nor upfront and understandings over the nature of exchange fall outside local and Western notions of commercial sex work (Hunter 2002). Relationships may be characterized by large age and wealth differences or power imbalances. They influence young women and men's sexual experiences and their ability to negotiate the circumstances of those encounters (Kaufman & Stavrou, 2004). Relationships involving 'blessings' are both, material and meaningful in complex ways (Hunter 2002), and the newest types of relationships are predicated on social media that allow men to advertise for women and women to seek 'Blessers'. In this qualitative research study, we investigate the nature and extent of these relationships, and how women enact and view their own agency in such partnerships, also considering the implications for women to contract HIV in this high HIV prevalence setting.