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ࡱ>  bjbj "jjlfffffffz^C^C^C^C$CLzcZhDDDDDDDDYYYYYYY$\ ^ZfDDDDDZIffDDZIIIDfDfDYIDYIIJrPTffPDD 0z=^CdFhP8P4 3Z0cZP_dF^_PIzzffffThe International Community of Women Living with HIV/AIDS (ICW) Positive women monitoring change A monitoring tool on access to care, treatment and support sexual and reproductive health and rights and violence against women created by and for women living with HIV and AIDS May 2005 An ICW SIPAA collaboration Introduction In February 2005, the international Community of Women Living with HIV and AIDS (ICW) in collaboration with ActionAid-managed initiative Support for the International Partnership against AIDS in Africa (SIPAA), carried out workshops in Swaziland and Lesotho. The workshops aimed to examine the national response of each country to the HIV and AIDS pandemic, with particular reference to international policy commitments (in particular the GIPA principle, the Abuja Agreement of 2001, and the UNGASS Declaration of Commitment of 2001). First was an analysis of the lived experiences of the participants. An analysis of the documents was undertaken, first to see to what extent they addressed the rights, needs and concerns of women living with HIV and AIDS, and second to see whether women living with HIV and AIDS had experienced the effects of those political commitments on the ground. Further analysis was carried out into the monitoring and reporting systems used to report on progress against international policy processes, and finally, workshop participants developed their own monitoring and evaluation tool, to assess progress on issues both included and not included in the international policy documents. The resulting tool is intended for use by women living with HIV and AIDS, and other actors working in the field of HIV and AIDS with a commitment to gender, human rights and in particular the rights of women living with HIV and AIDS. It can be used for advocacy and M&E purposes. While it refers directly to the Abuja, UNGASS and GIPA commitments mentioned above, it can also be adapted easily to monitor progress against, and identify gaps in the 3x5 initiative, the Millennium Development Goals (MDGs) and the President's Emergency Plan for AIDS Relief (PEPFAR)- explain, and national strategic plans to reduce the spread and mitigate the impacts of HIV and AIDS. The workshop examined three key areas in which women living with HIV and AIDS routinely come up against barriers in accessing their rights. These are: access to care, treatment and support (ACTS), sexual and reproductive rights (SRR), and violence against women (VAW). All three areas have resonance for all women regardless of their HIV status, but hold particular concerns for women living with HIV and AIDS, who face additional barriers in accessing their rights, and for whom contravention of their rights may have disastrous or fatal consequences. Most available national and international level monitoring and reporting tools are gender blind, or at best gender neutral, but do not draw particular attention to the priorities of women or assess positive improvement in the lives of women in general, or women living with HIV and AIDS in particular. This tool intends to explore the realities of HIV-positive women's lives, including young women (aged 18-30) living with HIV and AIDS, whose voices are consistently left unheard in decision making fora, and whose rights, concerns and needs both differ from those of older women and are usually overlooked. The tool intends to provide a platform for the voices of other marginalised women too, such as disabled women and sex workers. Thus the first section of the tool looks at positive women's knowledge and awareness of rights and issues that concern them in the three areas mentioned above (ACTS, SRR and VAW), but also their lived experiences of putting or attempting to put that knowledge into practice, and the challenges that they face in doing so. The second section of the tool looks at the experiences and attitudes of service providers working in the areas of ACTS, SRR and VAW. This section explores the strengths and weaknesses of available services, and also considers the constraints and barriers service providers themselves face in providing quality care and support in resource poor, remote and under-prioritised settings. Women can use first part of tool to cross-check information they receive from service providers. The third section of the tool takes the survey to government level, where it can be used to hold governments and ministries to account on their promises, and to advocate on priority issues using evidence from both HIV-positive women and service providers, as well as monitoring the progress of government commitments. It is hoped that findings and reports can then be fed into policy making fora at local, national, regional and international level by women living with HIV and AIDS, using existing networks of positive women such as ICW, and national positive women's networks, or by establishing national chapters of ICW or other national networks of positive women. A user guide to accompany the tool is in the process of being developed. Section 1. Access to care, treatment and support (ACTS) Definition ACTS refers to HIV positive women's ability to gain consistent access to all available care, treatment and support services, including anti-retrovirals, medication for opportunistic infections, advice and treatment for side effects of medication, diagnosis and treatment for sexual and reproductive health matters including treatment of STIs, information and advice on PMTCT, healthy pregnancy and motherhood; awareness, information and treatment for gender-specific illness; pre- and post-test counselling, on-going support in the form of counselling, and where necessary financial support to meet payment for treatment or doctor's fees; home based care and other care-in-the-community programmes and initiatives; workplace policies; supportive environments at home, in the community, workplace, place of learning, public and health service institutions. ICW recognises that gender inequalities can constrain HIV positive women's access to care, treatment and support as well as their ability to use treatment, information and advise to improve the quality of their lives. We also recognise that the care, treatment and support needs of HIV positive are different to that of men. Questions for positive women: 1. Information and knowledge of rights, services and treatments What do you believe are your rights regarding access to care, treatment and support as a woman living with HIV or AIDS? Where do you get information on the following areas?Which of these do you need more information on?What is your opinion of the information you have?ARV treatment Your CD4 countOpportunistic infectionsTreatment for opportunistic infectionsadherenceSide effects of treatmentnutritionhealthy livingHepatitis CTuberculosis  What questions do have about Treatment, care and support? 2. Health seeking behaviour Under what circumstances do you go to the clinic or hospital (as soon as you get sick, or wait until really ill before seeking treatment?) What about other members of your family partner, male children, female children? As a positive woman, how do you try to stay healthy? Do you have access to good nutrition and advice that can help you to stay in good health? What barriers do you face in trying to stay healthy and accessing medication including ARVs? Have you ever shared your ARV medication with another member of your family? 3. Services (including involvement in service provision at community level) What kind of care, treatment and support do you receive (including access to ARVs, and related to opportunistic infections, side effects, etc) from:What are any of the barriers to care, treatment and support in each of these environments?What changes are needed to improve care and support services in your area?Your family:Your community:Your workplace:Health centres:Hospital:Your support group:Other (please specify): Are you involved in providing any care or support activities in your community (eg HBC, support groups, OVC, counselling other people living with HIV and AIDS, etc)? What are the problems and challenges you face in providing care in your community? Who supports you in this work and how? 4. Experience of services How far away is the place where your nearest care and treatment service? How do you get there? How comfortable are you with the different care and treatment services you have access to? How well are you treated? Are you on ARVs? (Please give details: first line / second line? What combination?) Do you have to pay for the treatment? If not who does? How long have you been on ARVs? Have you had any changes or interruptions in your treatment regime? If so why? What were the consequences for you? Have you had any experiences of being forced into treatment, or feeling scared of taking certain kinds of treatment, or being given the wrong medication. What did you do? Are there any conditions to receiving ARV treatment (such as use of certain contraceptives)? Are the medication and other things you need always available when you go to the clinic or hospital? Do you pay for other treatment and care services? If not who does? Do you feel that your experience of services is different as an older/younger woman? Please give details. 5. What needs to change How could services better suit your needs and address your concerns as an HIV positive woman? ACTS Questions for Service Providers 1. Services (including information provided, equipment and medicines and cost) What services do you provide? Who is the target group? Are they free? What are some of your objectives and goals as a service provider? What do you believe to be HIV positive women's rights in terms of access to care, treatment and support? 2. Services particularly for women / women with HIV Do you provide any service or programmes specially for women or women living with HIV or do any of your services address the specific needs of HIV positive women? How are these service adapted to make them more suitable for HIV positive women? (eg female staff, different opening times, treatment for women-only medical problems, etc) How do you ensure confidentiality for HIV positive service users? What training is there for staff on positive womens care, treatment and support issues? Do you have any data on the number of HIV positive women and men, young and older that use your services? Do women have to meet any conditions if they want to access services? (for example, do they have to have the permission of a husband or guardian; are they required to be using a certain type of contraceptive in order to access ARV treatment?) 3. Problems and challenges What problems do you encounter when treating and caring for HIV positive women, or ensuring that your services meet their needs? Do you have anyway of finding out what their needs are? Do you have the necessary technical resources and knowledge needed for treating and caring for women living with HIV and AIDS? What can women do if they are mis-diagnosed or given the wrong treatment or are unhappy with the service in general? 4. Monitoring clients and services How do you monitor how well a newly diagnosed person is understanding and coping with her status and whether they are getting the right treatment and support? How do you monitor use and success of your services, including treatment provision, diagnostic services, care, etc for positive women? How do you ensure continuity of care? 5. GIPA How are HIV+ women involved in your programmes - as target groups only, or as specialists, consultants, managers and in leadership roles? 6. Future plans/What needs to change What additional resources do you need to address the needs of HIV positive women? What are your plans to improve the services available to HIV positive women? ACTS Questions for government 1. Policy Index What policies does the government have on ACTS for positive women? Which are the departments, ministries, bodies, etc responsible for implementation of the policies? 2. Budget What is the budget for HIV+ women's access to care, treatment and support within the annual budget? 3. Programmes and resources What government supported programmes are there that support the implementation of commitments made through the Abuja agreement and UNGASS declarations of commitment and in their own national AIDS policies and strategic plans? What programmes and resources are provided that specifically address the needs of HIV positive women, including: on-going training for health service personnel concerning the needs of HIV positive women? equipment, medication, and care services for HIV positive women and/or adapted to their needs, including home-based care, ARV services? 4. Support What government support is offered to HIV positive women who affected by poverty to carry on with treatment? 5.Quality control What is the government's procurement process of drugs used to treat HIV and HIV related infections? What quality control measures are in place to ensure that drugs are not sub-standard (including those to prevent STIs, PMTCT, cervical and breast cancer, women-specific opportunistic infections)? 6. Monitoring What indicators are used to monitor commitment on ACTS including UNGASS , Abuja declarations, and national policies and strategies? 7. Promotions / awareness raising What government backed campaigns are there that raise awareness about women's rights, treatment issues which particularly affect women (for example on nutrition, prevention etc ) in the media, through poster campaigns, in schools, etc? 8. Research What policies to involve HIV positive women's groups in the design and implementation of research does the government have? What regulations and protection exist for positive women and men who take part in medical research, especially drug trials? 9. GIPA How are HIV positive women involved in policy making, implementing, monitoring, evaluation and reporting? Which issues, policies, programmes and services have HIV positive women been consulted on? What mechanisms exist to involve representatives of HIV positive women's groups in matters that affect them? What capacity building or training is offered to women and men living with HIV and AIDS to enable them to be involved in work which affects their lives? What capacity building or training is offered to government employees to enable them to engage at different levels with people living with HIV and AIDS on issues and decisions that affect their lives? 10. Future plans and commitments What government plans are there to roll out policies on ACTS to reach inaccessible communities and HIV positive women and girls? What level of civil society involvement is there in the development and sharing of these plans, including HIV positive women's groups? What plans does the government have to strengthen the distribution and computerisation of gender disaggregated data of ACTS nationwide? What resources does the government plan to provide for providers of ACTS in the coming 12 months? Section 2 Sexual and Reproductive Rights (SRR) Definition Sexual and reproductive rights cover all aspects of women's sexual and reproductive health needs and recognise the different needs that women in different circumstances may have including women living with HIV and AIDS, women living with disabilities, young women and older women. Sexual rights are: the right to treatment for sexual health problems; the right to have consensual sexual relationships, and the right to choose how and where and with whom these are carried out; the right to protected sex; right to pleasurable sex; the right to bodily integrity and freedom from sexual intimidation, coercion or force. Reproductive rights are: the right to choose whether and when to have children, how many, how to bring them up; the right to healthy motherhood including treatment, counselling and support before, during and after the pregnancy; the right to make an informed choice on whether to have a termination or sterilisation, and the right not to be forced or coerced into either; the right to safe, legal termination or sterilisation; the right to assisted conception, and a full range of contraceptive and protective technologies. Questions for positive women 1. Knowledge What do you understand to be your sexual rights? What do you understand to be your reproductive rights? Do you know what female-controlled barrier methods exist for preventing the transmission of HIV/AIDS? If you decided to have a child, what would be your main concerns? Where could you find answers to these? Where can you get information on What do you need more information on?What is your opinion of this information?healthy motherhoodplanning for conceptionpregnancyante-natal caredeliverypost partum care for mother and childSRH issues and services What questions do you have on sexual and reproductive rights? 2. Experience of rights / Decision making Sexual rights: Do you or your sexual partner(s) use a barrier method? Which one? Who decides what to use and when to use it? Are you able to choose on how, when and how often to have sex? Who usually initiates sexual activities you or your partner(s)? Do you enjoy having sex? Do(es) your partner(s) ever force you to have sex even if you don't want to? Are you able to ask him/them to use a condom? Do(es) he/ they ever refuse? Do you disclose your HIV status to your partner(s)? If no, why not? If yes, how do they react? Are you aware of your partner's(') status? If yes, how did you find out? If no, how does this affect your relationship? Reproductive rights: Are you or your partner using a contraceptive? Which one? Who decides what to use and when to use it? Have you had or are you planning to have children? (If no, go to the next section) Who decides on if to have children, when to have them, and how many? Are you likely to be stigmatised for your choice of feeding alternatives? (eg would you be forced to disclose status if you chose to bottle feed your baby to reduce risk?) 3. Access to services How far away is your nearest health clinic? How do you get there? What sexual and reproductive health services do they provide? Please tickHave you used them?If the service is not available locally how much further do you have to travel?STIs and other sexual health servicesabortionsterilisationPMTCTassisted conceptionfamily planninghealthy motherhoodpap smearsInfertility treatmentTreatment for reproductive tract infections  If PMTCT services are provided to they care for the mothers health s well as the childs? When you access PMTCT services, have you been given advice on sexual relationships, contraceptives, sexual health and STIs? What different kinds of contraception and barrier methods are available? Which of these are free? What kind does the service provider recommend? If you use a different one, please explain why. What barriers have you experienced to accessing sexual and reproductive health services? Are younger and older women able to access the same services with the same ease? What different problems do they face? 4. Experience of services How often do you have a sexual health check up, including a pap smear? (Do you know what a pap smear is?) Do the services provide continuity of care (including counselling) after pregnancy, abortion, treatment for STIs etc? Do you feel comfortable accessing the services? If not, please explain what problems have you encountered? Are there any conditions that need to qualify for services? (eg sterilisation if an abortion is sought) 5. What needs to change What changes are needed to improve sexual and reproductive health services in your area? How could services better suit your needs and address your concerns as an HIV positive woman? SRR Questions for service providers 1. What services do you provide for HIV positive women? Which of the following services do you provide on sexual and reproductive health? Is it free?Who is the target group?How are the services tailored especially for HIV positive women?STIs and other sexual health services; abortion; sterilisation; PMTCT; assisted conception; family planning; healthy motherhood; pap smears; Advice, counselling and follow-up care on each of the above; What are some of your objectives and goals as a service provider? What What do you believe are the SRRs of HIV positive women? What does your routine check up for HIV positive women involve? How often is a pap smear done for women living with HIV or AIDS? What sexual and reproductive health advice is given to women living with HIV and AIDS during a routine check-up? What barrier and contraceptive methods do you make available? Are contraceptives available to positive women? are they compulsory or not? Under your PMTCT programme, which of the following are routine procedure: Advice / counselling of positive women in planning for conception / pregnancy; monitoring and advice on health of mother during pregnancy Ante-natal classes Prevention treatment during delivery Choice of delivery methods / locations Advice on infant feeding options Post partum care for the mother and child, including regular health checks, counselling, nutrition / healthy living advice, etc. 2. Quality and appropriateness of service: What specially tailored services do you provide for young women, disabled women, women who speak different languages, older women, widows, and women's partners? How do you ensure confidentiality to HIV positive service users? How do you ensure continuity of care? What advice do you give to HIV positive women about pregnancy? How do you monitor the health of (potential) mothers prior to conception, during pregnancy and after childbirth? Is training offered to staff concerning the SRHR of HIV positive women? How are HIV+ women involved in your programmes - as target groups only, or as specialists, consultants, managers and in leadership roles? Are they paid staff or volunteers? 3. Challenges What are the main challenges your service providers face in providing services for HIV positive women? What is the procedure HIV positive women can pursue if they are unhappy with the service? In what way are HIV positive female health staff encouraged to use the services offered? 4. Future plans/What needs to change What additional resources do you need to address the needs of HIV positive women? What are your plans to improve the services for HIV positive women? What resources do you have to meet the needs of positive women (including specialised training)? Are they adequate? SRR Questions for Government 1. Policies / legislation What government policies are there on the sexual and reproductive rights and/or health of positive women or related polices, including gender policy? What are the international agreements and declarations to which the government is signatory (eg CEDAW, etc)? Which ministries, departments, bodies, etc, are responsible for making and implementing laws and policies on womens rights in general and SRHR in particular? 2. Budget questions What is the annual budget for SRH? How much is specifically allocated to the SRH of women living with HIV and AIDS? How much is specifically allocated to women of different age groups? 3. Programmes and resources: How many sexual and reproductive health centres are there in the country? How many SRH centres are specifically for women living with HIV and AIDS? How many SRH centres have youth friendly services or clinics? How often does the government updates and changes equipment provided in SRH centres? How often and what type of training is provided to service providers? What quality control measures exist to ensure standards of equipment, material, medication for SRH? What level of provision of contraceptives, barriers, medication for the treatment of STIs, etc (free of charge) is carried out? 4. Promotion / awareness raising What government backed campaigns are there that raise awareness about women's rights, sexual and reproductive health, prevention, etc in the media, through poster campaigns, in schools, etc? 5. Research What commitments to research on female controlled prevention technologies (microbicide research) are there? What policies to involve HIV positive women's groups in the design and implementation of research are there? What regulations and protection exist for positive women and men who take part in medical research, especially drug trials? 6. Monitoring What reporting procedures on national policies and legislation exist on womens sexual and reproductive health and rights? Which bodies are responsible and what methods are used for the gathering and analysis of data? What indicators are used to monitor and evaluate the accessibility of ARVs and Nevirapine to women living with HIV? 7. GIPA How are HIV positive women involved in the consultation, design and implementation of all relevant policies and legislation? What government supported programmes or services are there that address the needs and rights of positive women on which women living with HIV and AIDS were consulted? 8. Future plans / commitments What are the government's plans to develop policies and legislation on the sexual and reproductive health and rights of HIV positive women? What are the government's plans to ensure the quality, availability and appropriateness of services and treatments offered to HIV positive women? What are the government's plans to reduce the incidence of unwanted pregnancy, especially among teenage women and girls? What are the government's plans to expand PMTCT programmes, and ensure that the mother's health as well as the child's is properly monitored? What level of civil society involvement is there in the development and sharing of these plans including HIV positive women's groups? What resources the government plans to provide for sexual and reproductive health care providers of in the coming 12 months? Section 3 Violence against women (VAW) Definition Violence against women (VAW) can take many different forms including verbal, physical, sexual, emotional, financial, and psychological violence. The understanding of the term as used in the workshops in which this tool was developed, includes the following types of violence: Rape; incest; statutory rape (sexual intercourse with children or young people below the legal age of consent); marital rape; refusal to use available protective technologies to safeguard against (re-)infection or transmission of STIs including HIV; domestic violence; battery and assault; verbal violence or bullying such as cursing and use of swear words and derogatory terms; sexual violence including sexual intimidation or threats; stigma and discrimination; refusal of medical examination or treatment; withdrawal of financial support; abandonment; community violence (eg setting fire to someone's house); violation of human rights; being deprived of access to and ownership of property after the death of spouse; Questions for positive women 1. Knowledge What do you understand by the term Violence against women? In what ways do you think HIV/AIDS and Violence against Women are related? Are you familiar with any policies, legislation, or international agreements which address VAW? What impact do you think they are having? Do you think they are effective? How would you describe women's position in this society? What services are you aware of which assist women who have experienced violence including rape? Are the services free and accessible? (medication expenses, legal representation)? 2. Experience (of VAW) What forms of violence have you experienced? (If none, please go to the last section on change) Have you experienced an increase since your disclosure? Do you feel that the violence you have experienced was due to your HIV status or gender? Please give examples. Who do you go to for support as an HIV positive woman who has experienced violence? (eg family members, friends community members, police, support group, counsellor, etc) 3. Experience of services Have you ever: reported an incidence of violence to the police? Sought medical help? Sought legal advice? Had counselling related to violence? Sought support from community groups including support groups? Sought support from family and friends? How comfortable were you with these services and support? How were you treated? What were you offered? What could have made the experience easier or more comfortable? Which did you not approach and why? Please describe your experiences of accessing any of the above services and support Please describe your experience of accessing the following, when reporting violencePEPLegal advice and assistanceReferrals (medical, legal, counselling etc)CounsellingMedical examination / reportFinancial assistanceSafe houseFemale police officers / medical staffspecial room for interrogationOther 4. Barriers What barriers did you encounter in accessing any of the services and support mentioned above? 5. What needs to change What changes are needed to improve services and support for HIV positive women who experience violence in your area? How could services better suit your needs and address your concerns as an HIV positive woman? VAW Questions for service providers (This section is meant for people working in the following areas: Police, clinics, hospitals, NGO (with a VAW mandate), support groups and legal support organisations) 1. Services What do you understand by the term Violence against women? What services do you provide for women who have experienced violence against women? How are these services tailored to address the particular concerns of HIV positive women? (eg how do you create an environment in which an HIV positive woman can talk openly about her status and experience of violence?) What kinds of violence can women report here? What forms of violence are most commonly reported here? 2. Procedures and referrals: What procedure do you follow if a woman who is HIV positive comes to report an incidence of violence? Do you offer medical advice / services? If not, is a referral made on behalf of the client? Do you offer legal advice / services? If not, is a referral made on behalf of the client? Do you offer counselling services? If not, is a referral made on behalf of the client? Do you have a policy or programmes to protect the client from further violence (eg safe houses, perpetrator rehabilitation, restraining orders)? Please give details. How do you monitor the speed and effectiveness of referrals and follow-up actions? What procedure exists for a woman to make a complaint about the service? 3. Legal action How often do the cases go to court? Of these how many result in convictions? What is the average time frame from reporting the incident to sentencing a perpetrator of violence? How often do women withdraw or drop cases after they have initiated a legal process? What are the reasons for this? 4. Resources / quality of services What training on HIV and VAW do service providers receive? Do they include information and counselling on PEP? What do you do to make the experiences as comfortable as possible for the women who report incidences of violence? How do you ensure women friendly services and positive attitudes among the police, health workers, counsellors, etc? What constraints do you face in protecting the rights of HIV positive women who have experienced violence? How are HIV+ women involved in your programmes - as target groups only, or as specialists, consultants, managers and in leadership roles? Are they paid staff or volunteers? 5. Future plans/What needs to change What additional resources do you need to address the needs of HIV positive women who have experienced violence? What are your plans to improve the services for HIV positive women who have experienced violence? In what way does your service help to reduce the rate of violence against women, in particular women living with HIV and AIDS? VAW Questions for government 1. Existing policies What government policy exists on women's rights, gender, violence against women, including polices to revise customary and cultural practices, such as forced marriages, virginity testing, mourning rituals for widows, and others which violate HIV+ women's rights, or related polices, legislation and resources? What are the international agreements and declarations to which the government is signatory (eg CEDAW, etc), and related policies, legislation and resources? What are the national strategic plans addressing the rights and concerns of women living with HIV and AIDS, and mitigating the impact of the epidemic, and related polices, legislation and resources? Which ministries, departments, and bodies are responsible for making and implementing laws and policies on womens rights in general and VAW in particular? 2. Budgets What is the budget allocation for issues relating to VAW and VAWLWHA under the ministry of 1) justice, 2) home affairs 3) health ? 3. What has been done programmes, policies, support etc What government supported programmes are there to reduce VAWLWHA in the country? How many institutions address violence against women and how? 4. Promotions / awareness raising What government backed campaigns are there that raise awareness about women's rights, and violence against women, particularly in relation to HIV and AIDS, in the media, through poster campaigns, in schools, etc? What information has been produced and disseminated by the government on violence against women and women's rights? Who are the target audiences of awareness arising campaigns? 5. Monitoring What indicators and reporting procedures are used to monitor policy instruments such as CEDAW? What are the procedures for reporting on VAW to international community? What methods and mechanisms exist for measuring and disseminating national statistics relating to VAW? 6. GIPA How have women living with HIV and AIDS been involved in drafting gender policies or related policies? What mechanisms exist for ensuring the participation of women living with HIV/AIDS included in decision making that affects their lives? How are women living with HIV and AIDS involved in implementation and monitoring of international policy commitments that concern them? 7. Future plans What are the government's plans to update and implement any draft policies relating to gender, women's rights or violence against women? What are the government's plans to develop new policies, programmes and legislation on violence against women and women's rights, including the rights of HIV positive women What level of civil society involvement is there in the development and sharing of these plans including HIV positive women's groups? What resources does the government plan to provide for providers of services for HIV positive women who experience violence in the coming 12 months? 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