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Strengthening Integrated Services for Indigenous Women Affected by Hiv and Violence Boquerón, Paraguay

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Strengthening Integrated Services for Indigenous Women Affected by Hiv and Violence Boquerón, Paraguay RAPID ASSESSMENT STRENGTHENING INTEGRATED SERVICES FOR INDIGENOUS WOMEN AFFECTED BY HIV AND VIOLENCE BOQUERÓN, PARAGUAY RAPID ASSESSMENT STRENGTHENING INTEGRATED SERVICES FOR INDIGENOUS WOMEN AFFECTED BY HIV AND VIOLENCE Qualitative Research to Identify the State of the Art on Violence and HIV among Women and Girls in Boquerón, Paraguay UN WOMEN Asuncion, Paraguay, 01/10/2016 TABLE OF CONTENTS RESEARCH TEAM 6 5.3.2 Mapping of actors and services 20 5.4 Design and validation of instruments 22 LIST OF ACRONYMS AND ABBREVIATIONS 7 5.5 Fieldwork 22 1. INTRODUCTION 8 5.6 Analysis of information 23 2. OBJECTIVES OF THE STUDY 9 5.7 Structure, format and scope of data-collection instruments 24 3. REFERENCE FRAMEWORK 10 5.8 Ethical and cultural aspects 25 3.1 Geographical, economic and health context 6. SCOPE AND LIMITATIONS 26 in the Department of Boquerón 10 3.1.1 Poverty 10 7. RESULTS 27 3.1.2 Morbidity 11 7.1 The needs of indigenous women and teenagers with regard to violence and HIV 27 3.1.3 Mortality 11 7.1.1 Perceptions and attitudes about 3.1.4 Resources, services and coverage 11 violence 27 3.2 Human rights approach and indigenous peoples 13 7.1.2 Strategies to address and solve violence 31 4. LEGAL ENVIRONMENT 14 7.1.3 Beliefs, attitudes and behaviors related to exposure to HIV 35 4.1 Legal situation in relation to HIV/AIDS and 7.1.3.1 Sources of information and trust sex education 14 in them 37 4.2 Legal situation with regard to gender equality, 7.1.3.2 Attitudes towards PLWH 37 including violence against women 16 7.1.4 Access to health services and requests for 4.3 Situation of violence against indigenous support in cases of violence and exposure women of Paraguay 17 to HIV 39 7.1.4.1 Sexual and reproductive health 5. METHODOLOGICAL ASPECTS 19 services, including HIV 39 7.1.4.2 Response to violence 40 5.1 Type of Study 19 7.1.5 Expectations and needs in relation to the 5.2 Participants 19 prevention of and response to cases of violence and exposure to HIV 42 5.2.1 Focus groups in indigenous communities 19 7.1.5.1 Health services 42 5.2.2 Individual interviews with 7.1.5.2 Greater participation in representatives of institutions 20 decision-making processes 43 7.1.5.3 Services related to addressing 20 5.3 Definition of variables and indicators violence 43 5.3.1 Indigenous women’s and girls’ need for interventions on HIV and violence 20 4 strengthening integrated services for indigenous women affected by hiv and violence 7.2 Analysis of available services for HIV and 7.3.2 Response 54 the prevention of violence / care for victims of violence 45 7.4 Summary table of the context of indigenous communities and people interviewed and 7.2.1 Institutional capacities 45 the main problems identified by them 55 7.2.1.1 Activities and actions 45 7.5 Conclusions and recommendations: Gaps, 7.2.1.2 Human resources 46 good practices and opportunities for work 62 7.2.1.3 Buildings, infrastructure, material and financial resources 47 7.5.1 Conception, perception and particular 7.2.1.4 Institutional coordination 47 attitude related to the phenomenon and 7.2.1.5 Attitudes and motivation to scope of the concept of violence and aspects address violence and HIV in related to HIV as a starting point for indigenous populations, and in women’s empowerment 63 women in particular 47 7.5.2 Access to and demand for health services 7.2.2 Institutional response to violence and HIV and services related to violence by in the Department of Boquerón and in indigenous women and young people 66 indigenous populations 48 7.5.3 Strengthening and democratization of 7.2.2.1 48 Interviewee on violence formal decision-making bodies within 7.2.2.2 Interviewee on health 50 communities (leaders and councils) 69 7.3 Map of reference actors and institutions 7.5.4 Institutional response to violence and on violence and HIV in the Department HIV at Department and local level 72 of Boquerón 52 7.6 Research Team 75 7.3.1 Health sector 52 strengthening integrated services for indigenous women affected by hiv and violence 5 RESEARCH TEAM Faustina Alvarenga, Main Consultant and Researcher Martín Negrete, Methodological Consultant and Co-researcher Orlando Gómez, Interviewer (interpret of Guaraní language) Daniela Benítez, Interviewer (interprete of lengua nivacle) Maria Elena Chamorro, Interviewer 6 strengthening integrated services for indigenous women affected by hiv and violence LIST OF ACRONYMS AND ABBREVIATIONS ARV Antiretroviral NGO Non-Governmental Organization CDE Documentation and Studies Center UN United Nations Organization CEDAW Convention to eliminate all forms of UNAIDS Joint United Nations Program on HIV discrimination against women and AIDS CN National Constitution PEP Pre-Exposure Prophylaxis CODEHUPY Coordinator of Human Rights PVV Person living with HIV of Paraguay SAI Comprehensive Care Service CODENI Municipal Council for the rights of SSRR Sexual and Reproductive Health children and adolescents STP Technical Secretariat of Planning DGEEC General Directorate of Statistics, Surveys and Census TB Tuberculosis FEDAVIFA Federation of Associations for Life TM Mortality Rate and Family USF Family Health Unit FIMI International Forum of HIV Human Immunodeficiency Virus Indigenous Women UNV United Nations Volunteers SWOT Strengths, Opportunities, Weaknesses and Threats IBS Basic Health Indicators ITS Sexually Transmitted Infections MIPY Articulation of Indigenous Women of Paraguay MSPBS Ministry of Public Health and Social Welfare MDG Millennium Development Goals ODS Sustainable Development Objectives OG Government Organization ILO International Labor Organization strengthening integrated services for indigenous women affected by hiv and violence 7 1. INTRODUCTION Qualitative research to identify the status of the sit- to define strategies to overcome barriers and ensure uation of violence and HIV among women and girls that services are more effective and consistent with in Boquerón, Paraguay, is part of the Latin America the specificities and sociocultural realities of indig- and the Caribbean Regional Project to Strengthen enous peoples, by generating evidence as inputs for Integrated Services for Indigenous Women Affected advocacy at national, regional and United Nations by HIV and Violence. Cooperation Agency decision maker-levels on the urgency to respond to HIV in a comprehensive and Thus, UN Women, the Joint United Nations inclusive manner for emergent vulnerable groups. Programme on HIV/AIDS (UNAIDS) and the United Nations Volunteers programme (UNV) are working in Taking heed of lessons learned and South-South co- tandem on the issue of HIV in indigenous peoples and operation, UNV, UNAIDS and UN Women are planning exploring potential areas for more joint work in the a preliminary diagnosis of the situation of HIV and countries of Latin America. UNV, which promotes in- violence against women in indigenous peoples, and ter-agency programmes with seed funds, has shown the added value of volunteer work, in three places in interest in a proposal that seeks to reduce violence Boquerón, Paraguay. A similar study will be conduct- and vulnerability to HIV among indigenous women in ed in Alto Solimões, Brazil. These two countries were Paraguay and Brazil. The purpose of this consultancy selected because (1) they have gender diagnoses or is for the three agencies to understand the situation similar studies; (2) they have prioritized the need to of violence and HIV among indigenous women and improve data and interventions on HIV/VAW in indig- the existent current services in three locations in enous peoples; (3) there are UNAIDS and UN Women Boquerón, Paraguay. offices and/or staff in the country. These studies will contribute to strengthening the evidence base for Important antecedents to this intersectoral and in- proposals for funding to be submitted to UNV head- ter-agency coordination within the United Nations quarters, and to improve existing services. System, with the active and key participation of the indigenous women in question, have been the This qualitative study will be conducted in three plac- studies conducted in Ecuador and Guatemala in the es in Boquerón, Paraguay: previous two years, which analysed the factors that limit indigenous women’s access to comprehensive 1) Filadelfia -Uj´he Lavos: Nivaclé -A new settlement HIV care, including discrimination on grounds of gen- in the centre of Filadelfia: Ayoreo - Cacique Mayeto: der, ethnicity and socioeconomic status. In addition, Enlhet Norte the drivers that motivate indigenous women to de- mand and use comprehensive HIV services have been 2) Neuland -Cayim O Clim: Nivaclé identified. This analysis has led to progress on one of the recommendations made by the World Conference 3) Loma Plata Yalve Sanga: Nivaclé and Enlhet Norte on Indigenous Peoples in 2014 with regard to HIV, and Enxet Sur. which encourages and promotes advocacy for States 8 strengthening integrated services for indigenous women affected by hiv and violence 2. OBJECTIVES OF THE STUDY General: The overall objective is to find out about existing services to holistically address HIV and vio- the situation of violence and HIV among indigenous lence, as well as map municipal and community level women and about services available in order to be organizations working in the field of gender-based able to design appropriate interventions in locations violence and/or HIV; iii) to identify opportunities and in Boquerón, Paraguay. the value added by volunteer and South-South coop- eration work, including volunteer networks on the Specific: i) to identify indigenous women’s and girls’ ground that could be key actors. needs for interventions on HIV and violence; ii) to map strengthening integrated services for indigenous women affected by hiv and violence 9 3.
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