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Health Policy Plan. 2009 Sep;24(5):357-66. doi: 10.1093/heapol/czp024. Epub 2009 Jun 8.
South Africa has some of the highest levels of both HIV and gender-based violence (GBV) worldwide. The international literature has highlighted the importance of tackling GBV in the fight against AIDS. Although the link between these epidemics is acknowledged by South Africa's medical and NGO communities, government response has largely dealt with them separately. PEPFAR is South Africa's largest HIV/AIDS donor, representing significant funding potential for programmes seeking to tackle these twin epidemics. Using a combination of policy document analysis and key informant interviews at national and provincial level (Western Cape), we examined PEPFAR's response to the GBV-HIV link, the extent to which PEPFAR is aligned to national policies and the extent to which implementing agencies have felt able to work with PEPFAR funding. A number of PEPFAR-South Africa's positions (e.g. on condoms and abortion) stand in contradiction to South Africa's own laws. While PEPFAR-South Africa officials are adamant that PEPFAR addresses the GBV-HIV link, it does not form an explicit strategic goal and there are no indicators for this work. Although some agencies receiving PEPFAR funding do address the links between GBV and HIV, this appeared incidental rather than the reason for their receipt of PEPFAR funding. Not one implementing agency interviewed agreed with PEPFAR's ideological stance, perceiving it unhelpful and inappropriate in a social context defined by violence and HIV. Nevertheless, many organizations were prepared to apply for funding. Those awarded it found creative ways to work with-or around-PEPFAR's restrictions to ensure delivery of an appropriate range of much needed services to those facing the twin epidemics of HIV and GBV. The recent change in the US administration offers an important opportunity for broader links between HIV and GBV to be supported through PEPFAR. This paper makes recommendations for building a more systematic approach on the current ad hoc experience of PEPFAR in South Africa.
南非是世界上艾滋病毒和性别暴力（GBV）水平最高的国家之一。国际文献强调了在抗击艾滋病的斗争中解决性别暴力问题的重要性。尽管南非的医疗和非政府组织社区都认识到这两种流行病之间的联系，但政府的应对措施在很大程度上还是将它们分开处理。PEPFAR 是南非最大的艾滋病毒/艾滋病捐助者，为寻求解决这两种流行病的方案提供了大量资金。我们结合国家和省级（西开普省）的政策文件分析和关键知情人访谈，研究了 PEPFAR 对性别暴力与艾滋病毒关系的应对措施、PEPFAR 与国家政策的一致性程度，以及实施机构在多大程度上能够利用 PEPFAR 资金开展工作。PEPFAR-南非的一些立场（例如关于避孕套和堕胎的立场）与南非自己的法律相矛盾。尽管 PEPFAR-南非官员坚决认为 PEPFAR 解决性别暴力与艾滋病毒的联系，但这并没有成为明确的战略目标，也没有为此项工作制定指标。尽管一些接受 PEPFAR 资金的机构确实解决了性别暴力与艾滋病毒之间的联系，但这似乎是偶然的，而不是它们获得 PEPFAR 资金的原因。接受采访的没有一个实施机构同意 PEPFAR 的意识形态立场，认为在暴力和艾滋病毒盛行的社会背景下，这种立场没有帮助，也不合适。然而，许多组织都愿意申请资金。那些获得资金的组织找到了创造性的方法，与 PEPFAR 的限制合作，或绕过这些限制，以确保为面临艾滋病毒和性别暴力双重流行的人提供一系列急需的适当服务。美国政府最近的更迭为通过 PEPFAR 更广泛地支持艾滋病毒和性别暴力之间的联系提供了一个重要机会。本文为 PEPFAR 在南非目前临时经验的基础上提出了建立更系统方法的建议。
