December 19, 2011

Confronting gender-based violence

Free online course will train health workers worldwide

Nancy Glass has spent the better part of two decades addressing intimate partner violence and violence against women. Glass, an associate professor of community public health nursing in the School of Nursing, has seen firsthand the devastating impacts of this growing global health crisis.

An estimated one out of three women worldwide will be physically or sexually assaulted in their lifetime, according to the World Health Organization. Roughly 50 percent of sexual assaults are committed against girls under age 16. In 2002, WHO estimated that 150 million girls and 74 million boys under the age of 18 had experienced some form of sexual violence.

“We are seeing too often that the first sexual encounter is forced, and often before the age of 15,” Glass said. “And this is not just occurring in conflict settings but areas around the globe.”

A major obstacle in the fight against gender-based violence, Glass said, is that victims are afraid to come forward.

“Women live with this silently,” she said. “They feel there is no help.”

Johns Hopkins wants to make sure that these victims have a sympathetic, and knowledgeable, ear to turn to.

In an effort to train professionals to confront this major health issue, the School of Medicine’s Center for Clinical Global Health Education, in conjunction with the School of Nursing’s Center for Global Nursing, will offer Confronting Gender-Based Violence, a distance-education course that began enrollment on Dec. 1.

The seven-week online training course is an interactive program aimed at improving clinical and psychosocial care for women and men who are survivors of and/or at risk for gender-based violence.

The program targets health care providers—physicians, nurses, psychologists, social workers and lay caregivers—in low-resource settings in Africa, Asia, Latin America and beyond.

The free course, directed by Glass, features online video lectures, scheduled Q&A sessions, examination of case studies and discussion forums where participants, spread around the globe, can talk to each other and experts from Johns Hopkins and elsewhere.

The first cohort of 50 students will begin on Jan. 13, 2012. The course has already drawn substantial inquiries from health care professionals in Ethiopia, Uganda, Kenya, Burundi, Libya, Tanzania, Kyrgyzstan and the United States.

Glass expects the course to fill up quickly. The need for immediate action, she said, is great.

Gender-based violence has numerous health consequences that extend beyond the immediate injury, Glass said, including maternal health, mental health issues, hypertension, cardiovascular disease and sexually transmitted infections.

Studies indicate that the risk of HIV among women who have experienced violence may be up to three times higher than those who have not. Realizing this, PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, has invested close to $155 million in gender-based violence initiatives the past two years, with millions more allocated to scaling up programs in the next three years.

“We have clearly demonstrated the link between violence against women and girls to HIV,” said Glass, who also serves as an associate director of the Johns Hopkins Center for Global Health, a new program that bridges the international work of the university’s schools of Nursing, Medicine and Public Health. “And [women] are dying faster than men. Research shows that the stress of the violence relates to the further compromising of the immune system.”

The root of the issue, Glass said, is that gender is not equitable in terms of power. In many places around the globe, women feel they cannot fight back, refuse their husband or partner, or insist on the use of a condom. They also fear reprisal and the stigma attached to the violence.

Even when they do come forward, Glass said, victims of violence are sometimes not believed. “I’ve worked in many countries where a woman says that she was raped, but the prevailing notion is that she made it up to get someone in trouble or simply wants a service,” she said. “The problem is ignored and not addressed.”

A chief goal of the Confronting Gender-Based Violence course is to get health care professionals to ask the right questions. Participants will be trained to spot signs of violence, conduct screening protocols, provide care in a clinical setting and refer the individuals to appropriate ongoing physical or psychosocial support. Referral training is vital, Glass said, as in many low-resource settings there are no shelters for women or hotlines to call, and the police have little to no influence.

The key, Glass said, is to make the victims feel comfortable by stressing confidentiality.

“If it’s done confidentially, they will be more willing to come forward and accept assistance,” she said. “Just asking a woman about violence is an intervention. Women often tell us that they are grateful someone has finally asked the question. They feel they are not alone, and there is someone who cares. Even women who are not abused have told us they are glad we’re asking these questions, as they know how common this issue is in their world.”

Bob Bollinger, director of the Center for Clinical Global Health Education, proposed the creation of the course, knowing both the vital need and the wealth of expertise in this area at Johns Hopkins. He spotlighted the work of Glass and Jacquelyn C. Campbell, the Anna D. Wolf Professor in the School of Nursing, who has been engaged in advocacy policy work and has conducted research in the areas of family violence and health disparities related to trauma since 1980.

Campbell has published more than 220 articles and seven books on violence against women and was a member of the congressionally appointed Department of Defense Task Force on Domestic Violence. She currently chairs the board of directors of the Family Violence Prevention Fund.

Glass’ research centers on clinical care and intervention in the areas of violence prevention and health disparities. With funding from the National Institutes of Health and the Centers for Disease Control and Prevention, Glass is currently conducting four major studies on intimate partner violence. She is a past president of the Nursing Network on Violence Against Women, International.

“With this course,” Bollinger said, “we are able to leverage the unique capacity of experts like Nancy and Jackie.”

The Center for Clinical Global Health Education, founded in 2007 to support clinical care and research training in resource-limited settings, complements and builds upon the extensive ongoing international, collaborative research and training programs at the schools of Medicine, Nursing and Public Health.

Bollinger, a professor of infectious diseases and international health at the School of Medicine, said that an important aspect of the center’s new course is that participants will be asked to improve an existing gender-based initiative or start a new one. Johns Hopkins faculty and staff will follow up on these programs to gauge their impact.

“We want to know if these programs resulted in improvements such as the prevention of violence or better treatment of victims,” he said. “We are really excited about this aspect of the program. We can see really important outcomes beyond training.”

To be eligible, individuals must present a letter of sponsorship from an employer demonstrating commitment to prevention and interventions in gender-based violence through current or planned programming.

For more information on the course and the center, go to