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Rotenberg S, Chen S, Hanass‐Hancock J, Davey C, Banks LM, Kuper H. HIV knowledge and access to testing for people with and without disabilities in low- and middle-income countries: evidence from 37 Multiple Indicator Cluster Surveys. J Int AIDS Soc 2024; 27:e26239. [PMID: 38566480 PMCID: PMC10988115 DOI: 10.1002/jia2.26239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. METHODS We used cross-sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub-Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta-analysis to get a pooled estimate for each sex and indicator. RESULTS Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother-to-child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]). CONCLUSIONS Men and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability-inclusion and accessibility to HIV-related information, education and healthcare services.
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Affiliation(s)
- Sara Rotenberg
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Shanquan Chen
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Jill Hanass‐Hancock
- South African Medical Research Council, Gender and Health Research UnitDurbanSouth Africa
- School of Health Science, University of KwaZulu‐NatalDurbanSouth Africa
| | - Calum Davey
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Lena Morgon Banks
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
| | - Hannah Kuper
- International Center for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
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Casebolt T. The HIV epidemic in Haiti: is disability a factor? AIDS Care 2024:1-8. [PMID: 38381850 DOI: 10.1080/09540121.2024.2318241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
People with disabilities (PWD) are thought to be low risk for HIV because of social norms regarding disability and sex. However, qualitative studies indicate they are at risk and are not being reached by HIV programs. The Demographic and Health Survey (DHS) conducted in Haiti in 2016 included HIV biomarker data and disability status. Crude and adjusted odds ratios were calculated using a disability severity indicator as the independent variable and HIV infection as the dependent variable. Covariates were selected based on theory and previous studies. Individuals reporting milder disabilities had a higher odds of HIV infection in the crude model (OR:1.65; CI: 1.16-2.34) and those adjusted for demographics (OR:1.73; CI:1.19-2.51) and sexual activity (OR:1.60; CI:1.06-2.42). Those with moderate and more severe disabilities have the same odds of HIV infection as the general population. PWD are HIV-positive and at risk of HIV infection. Based on this, it is essential that HIV education, testing, and treatment programs are inclusive of PWD. Accessible HIV education materials need to be created. HIV testing programs should involve PWD in planning and implementation. Providers of HIV care must be trained regarding the needs of PWD for reproductive healthcare.
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Affiliation(s)
- Tara Casebolt
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
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Mathabela B, Madiba S, Modjadji P. Exploring Barriers to Accessing Sexual and Reproductive Health Services among Adolescents and Young People with Physical Disabilities in South Africa. Int J Environ Res Public Health 2024; 21:199. [PMID: 38397689 PMCID: PMC10887722 DOI: 10.3390/ijerph21020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Despite South Africa having a progressive and liberal sexual and reproductive health (SRH) policy framework, adolescents and young people with disabilities (AYPWDs) are less likely to receive sexual and reproductive healthcare, being consequently predisposed to a long-term detrimental impact on their health. Our study explored the barriers to accessing sexual and reproductive health services (SRHSs) in clinics among AYPWDs in Mpumalanga, South Africa. We conducted a descriptive qualitative study with twenty-seven AYPWDs in four focus group discussions using semi-structured interviews, audiotaped and transcribed verbatim, and then applied a thematic analysis of the data. Employing a socio-ecological model, the findings show a poor socioeconomic status, lack of information on SRH, and the attitudes of AYPWDs as barriers at the individual level, hindering AYPWDs from accessing SRHSs in clinics. AYPWDs also faced difficulties to talk about SRH with parents, a lack of support to seek SRHSs, improper care from family/parents, and negative attitudes of friends, at the interpersonal level. They further expressed barriers at the community/societal level as negative attitudes of non-disabled community members and poor infrastructure for wheelchair use. At the organization level, their access to SRHSs was negatively affected by HCWs' maltreatment, described in the forms of negative attitudes, being judgmental using verbal abuse, discrimination, and bullying. Furthermore, AYPWDs described difficulties in communication with HCWs, as well as violating their confidentiality and misconceived ideas on their sexuality. Intensified efforts to strengthen public health strategies are needed to improve access to SRHSs by AYPWDs in South Africa, as well as enhancing the proficiency and communication skills of HCWs and educating AYPWDs, parents, and non-disabled community members on SRH.
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Affiliation(s)
- Bheki Mathabela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa;
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg 1709, South Africa
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Qi W, Li H, Lian Q, Zuo X, Yu C, Lou C, Tu X. Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study. Reprod Health 2023; 20:84. [PMID: 37280677 DOI: 10.1186/s12978-023-01625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. METHODS A cross-sectional survey was carried out among 473 unmarried youth aged 15-24 with visual, hearing, physical disabilities in both urban and rural areas in China. RESULTS Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. CONCLUSION Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities.
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Affiliation(s)
- Wenjuan Qi
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
- Shanghai Municipal Center for Disease Control & Prevention, 1380 West Zhongshan Road, Shanghai, 200336, China
| | - Hongyan Li
- UNESCO Beijing Office, 5-153 Jianguomenwai DRC, Beijing, 100600, China
| | - Qiguo Lian
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Xiayun Zuo
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Chunyan Yu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Chaohua Lou
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
| | - Xiaowen Tu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China.
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Ouedraogo HG, Balde B, Zida S, Cissé K, Lougué S, Tieba M, Bagnoa C, Tangara A, Soumana HS, Grema MSM, Kouanda S. Low prevalence of HIV infection among persons with disabilities in Niger: findings from a household-based cross-sectional study in 2018. AIDS Care 2022; 34:60-64. [PMID: 35291900 DOI: 10.1080/09540121.2022.2050177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this work was to report for the first time the prevalence of HIV infection among people with disabilities (PWDs) in Niger. The Washington Group Short questionnaire was used to identify people with disabilities during a household survey. Blood samples for HIV testing were collected using the Dried Blood Sampling (DBS) method. HIV testing was performed according to the Niger national HIV testing guideline. A total of 21,979 persons aged 15-69 years were screened, of them 2237 (10.17%) had disabilities and 949 participants (4.32%) had severe disabilities (level 3 or 4). Finally, 821 participants agreed to participate in the HIV testing. Female persons with disabilities accounted for the majority (52.25%). People with physical impairment were mostly represented (39.27%) followed by those with visual impairment (38.66%). At least one-third had multiple impairs (36.91%). HIV prevalence among person with disabilities was 0.66% (95% CI: 0.33-1.30). There is no difference between HIV prevalence and type of disabilities or socio-demographic characteristics. Hence, there is a need to consider them in the development and implementation of an effective HIV strategy.
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Affiliation(s)
- Henri Gautier Ouedraogo
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Boubacar Balde
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Sylvie Zida
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Kadari Cissé
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Siaka Lougué
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Millogo Tieba
- Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Clement Bagnoa
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | | | - Maïna Sani Malam Grema
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2022; 6:61. [PMID: 35299711 PMCID: PMC8902259.2 DOI: 10.12688/wellcomeopenres.16593.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches. Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020)
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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Asa GA, Fauk NK, Mwanri L, Ward PR. Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia. Int J Environ Res Public Health 2021; 18:ijerph182111546. [PMID: 34770060 PMCID: PMC8583444 DOI: 10.3390/ijerph182111546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a qualitative study exploring impacts of caring for CWD on mothers or female caregivers and their coping strategies, this paper describes barriers for access to healthcare and rehabilitation services for CWD in Belu district, Indonesia. One-on-one, in-depth interviews were conducted with 22 mothers or female caregivers of CWD. Participants were recruited using a combination of purposive and snowball sampling techniques. These were supplemented with interviews with two staff of disability rehabilitation centers in Belu to understand any additional barriers. Data analysis was guided by a qualitative data analysis framework. Our analysis identified that lack of affordability of healthcare services (high costs and low financial capacity of mothers) was the key barrier for access to healthcare and rehabilitation services CWD. Religious or faith-based factors, such as being a non-Catholic (Belu is predominantly Catholic), converting from Catholic to other religions, and the belief in children’s disability condition as “God’s will”, were also influencing factors for lack of access to the services. Shortage of staff, distrust in the therapy skills of staff at rehabilitation centers, and unavailability of appropriately trained healthcare professionals were structural or system-related barriers. The findings indicate the need for government-owned and run disability rehabilitation centers (not faith-based), the provision of fully subsidised health insurance to provide free services, and the provision of qualified therapists and healthcare professionals (to build trust) in Belu and other similar settings in Indonesia.
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Affiliation(s)
| | - Nelsensius Klau Fauk
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
- Institute of Resource Governance and Social Change, Kupang 85221, Indonesia
- Correspondence:
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
| | - Paul Russell Ward
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide 5001, Australia; (L.M.); (P.R.W.)
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2021; 6:61. [PMID: 35299711 PMCID: PMC8902259 DOI: 10.12688/wellcomeopenres.16593.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies. Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020)
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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Ganle JK, Baatiema L, Quansah R, Danso-Appiah A. Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: A systematic review. PLoS One 2020; 15:e0238585. [PMID: 33044966 PMCID: PMC7549766 DOI: 10.1371/journal.pone.0238585] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/19/2020] [Indexed: 01/10/2023] Open
Abstract
Background There is evidence that persons with disabilities often encounter grave barriers when accessing sexual and reproductive health services. To the best of our knowledge, however, no systematic review has been conducted to pull together these pieces of research evidence for us to understand the nature, magnitude and extent of these barriers in different settings in sub-Saharan Africa. We do not yet have a good understanding of the strength/quality of the evidence that exist on the barriers persons with disabilities face when accessing sexual and reproductive health services in sub-Saharan Africa. We therefore conducted a systematic review to examine the barriers persons with disabilities face in accessing sexual and reproductive health services in sub-Saharan Africa. Methods A systematic review was conducted using PRISMA guidelines (PROSPEROO protocol registration number: CRD42017074843). An electronic search was conducted in Medline, EMBASE, CINAHL, PsycINFO, and Web of Science from 2001 to 2020. Manual search of reference list was also conducted. Studies were included if they reported on barriers persons with disability face in accessing sexual and reproductive health services. The Critical Appraisal Skills Programme and Centre for Evidence Based Management (CEBMa) appraisal tools were used to assess methodological quality of eligible studies. Findings A total of 1061 studies were identified. Only 26 studies covering 12 sub-Saharan African countries were eligible for analysis. A total of 33 specific barriers including inaccessible physical health infrastructure and stigma and discrimination were identified. These barriers were further categorised into five levels: broader national level barriers; healthcare system/institutional barriers; individual level barriers; community level barriers; and economic barriers. Conclusion Persons with disabilities face a myriad of demand and supply side barriers to accessing sexual and reproductive healthcare in sub-Saharan Africa. Multilevel interventions are urgently needed to address these barriers.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
- Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa
- * E-mail:
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Reginald Quansah
- Department of Biological, Environmental and Occupational Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
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Hashemi G, Wickenden M, Bright T, Kuper H. Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies. Disabil Rehabil 2020; 44:1207-1220. [PMID: 32956610 DOI: 10.1080/09638288.2020.1817984] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
METHODS Six electronic databases were searched for relevant studies from 2000 to 2019. Forty-one eligible studies were identified. RESULTS Findings suggest that the people with disabilities' choice to seek healthcare services or not, as well as the quality of intervention provided by primary healthcare providers, are influenced by three types of barriers: cultural beliefs or attitudinal barriers, informational barriers, and practical or logistical barriers. CONCLUSION In order to achieve full health coverage at acceptable quality for people with disabilities, it is necessary not only to consider the different barriers, but also their combined effect on people with disabilities and their households. It is only then that more nuanced and effective interventions to improve access to primary healthcare, systematically addressing barriers, can be designed and implemented.IMPLICATIONS FOR REHABILITATIONPeople with disabilities in both high income and low- and middle-income country settings are more likely to experience poorer general health than people without disabilities.Barriers to accessing primary healthcare services for people with disabilities result from a complex and dynamic interacting system between attitudinal and belief system barriers, informational barriers, and practical and logistical barriers.Given primary healthcare is often the initial point of contact for referral to specialty care and rehabilitation services, it is crucial for people with disabilities to access primary healthcare services in order to get appropriate referrals for such services, specifically rehabilitation as appropriate.To achieve full health coverage at acceptable quality for people with disabilities, starting with primary healthcare, it is necessary for healthcare stakeholders, including rehabilitation professionals, to consider the combined and cumulative effects of the various barriers to healthcare on people with disabilities and their families and develop an understanding of how healthcare decisions are made by people with disabilities at the personal and the household level.
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Affiliation(s)
- Goli Hashemi
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.,Department of Occupational Therapy, Samuel Merritt University, Oakland, CA, USA
| | - Mary Wickenden
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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Adugna MB, Nabbouh F, Shehata S, Ghahari S. Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: a scoping review. BMC Health Serv Res 2020; 20:15. [PMID: 31906927 PMCID: PMC6945633 DOI: 10.1186/s12913-019-4822-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background Children with disabilities (CwDs) make up around 150 million of the billion people with disabilities in the world. The Sub-Saharan African countries have a large number of CwDs who have limited access to healthcare and rehabilitation care. This, combined with chronic poverty, low education, and inadequately trained healthcare professionals, substantially lowers these children’s quality of life. The main objective of this scoping review was to discover the barriers and facilitators to healthcare access for CwDs in selected low to middle income Sub-Saharan African countries. As African countries significantly vary in socioeconomic status, we only focused on countries in Sub-Saharan Africa who allocated less than $50/person to healthcare. Methods A broad and iterative search strategy using multiple sources and databases including CINAHL, Medline, Global Health, and Embase were utilized. Using a comprehensive search strategy, 704 articles were generated. After removal of the duplicates, 466 of them were screened based on the study inclusion and exclusion criteria. After iterative reading and screening of these articles, a final 15 articles were included in this review. Results This scoping review shows that CwDs in the selected Sub-Saharan African countries face major barriers including stigma and negative attitudes, poverty and insufficient resources, inadequate policy implementations, physical inaccessibility, lack of transportation, lack of privacy, and inadequately trained healthcare professionals to deal with disability. Emotional and social support, including peer support for CwDs and caregivers, were identified as facilitators for better access to health services. Conclusions There is limited access to healthcare services in the low and middle income Sub-Saharan African countries due to poverty, low education, inadequate healthcare systems, and shortage of healthcare professionals. It is evident that there are socioeconomic, cultural, and physical related impediments that affect CwDs’ and their caregivers’ access to the required healthcare services. Policy development, improved physical accessibility, public disability awareness, and parental support are some of the key facilitators to access healthcare services. The study highlights the importance of revisions to childhood disability and healthcare provisions policy and practice as well as sustainable rehabilitation programs. Further research is required to explore ways to improve experience of accessing health services.
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Affiliation(s)
- Molalign B Adugna
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Fatima Nabbouh
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Selvia Shehata
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
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12
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Manoj MP, Suja MK. Correction to: Sexuality and Reproductive Health in Young People with Disability: A Systematic Review of Issues and Challenges. Sex Disabil 2018. [DOI: 10.1007/s11195-018-9523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Mekonnen M, Behailu T, Wakgari N. Knowledge, Attitude, and Practice regarding HIV/AIDS among People with Disability in Hawassa City, Southern Ethiopia. Advances in Public Health 2018; 2018:1-7. [DOI: 10.1155/2018/9649610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. People with disabilities are vulnerable group to be infected with HIV/AIDS and are challenged to utilize HIV/AIDS services. Hence, this study assessed knowledge, attitude, and practice about HIV/AIDS among disabled people in Hawassa city. Methods. A community-based cross-sectional study was conducted among 250 disabled people. All disabled people residing in Hawassa city during the study period were included. Pretested and structured questionnaire was used for data collection. Logistic regression analyses were used to identify the associated factors. Results. A high percentage (197 (79.8%)) of disabled people were knowledgeable about HIV/AIDS. Similarly, 190 (76%) of the respondents had a favorable attitude towards HIV/AIDS. In addition, being married (AOR = 2.20; 95% CI: 1.14, 4.27) and being employed (AOR = 2.85; 95% CI: 1.19, 6.81) were positively associated with knowledge about HIV/AIDS. Moreover, being a male (AOR = 2.83; 95% CI: 1.61, 2.90) and being married (AOR = 2.13; 95% CI: 2.25, 3.26) were also positively associated with having a favorable attitude towards HIV/AIDS. Conclusions. Significant numbers of disabled people were knowledgeable and had a favorable attitude towards HIV/AIDS.
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14
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Manoj MP, Suja MK. Sexuality and Reproductive Health in Young People with Disability: A Systematic Review of Issues and Challenges. Sex Disabil 2017; 35:507-16. [DOI: 10.1007/s11195-017-9505-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Winters N, Langer L, Geniets A. Physical, psychological, sexual, and systemic abuse of children with disabilities in East Africa: Mapping the evidence. PLoS One 2017; 12:e0184541. [PMID: 28892508 DOI: 10.1371/journal.pone.0184541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
Abstract
Children with disabilities (CWDs) are at a higher risk of being maltreated than are typical children. The evidence base on the abuse of children with disabilities living in low- and middle-income countries is extremely limited but the problem is particularly acute in East Africa. We don't know the types of evidence that exist on this topic. This problem is compounded by the fact that key indicators of disability, such as reliable prevalence rates, are not available currently. This paper addresses this serious problem by mapping the existing evidence-base to document the coverage, patterns, and gaps in existing research on the abuse of children with disabilities in East Africa. An evidence map, following systematic review guidelines, was conducted and included a systematic search, transparent and structured data extraction, and critical appraisal. Health and social science databases (Medline, EMBASE, PsychInfo, Taylor&Francis, Web of Science, and SAGE) were systematically searched for relevant studies. A substantive grey literature search was also conducted. All empirical research on the abuse of CWDs in East Africa was eligible for inclusion: Data on abuse was systematically extracted and the research evidence, following critical appraisal, mapped according to the type of abuse and disability condition, highlighting gaps and patterns in the evidence-base. 6005 studies were identified and screened, of which 177 received a full-text assessment. Of these, 41 studies matched the inclusion criteria. By mapping the available data and reports and systematically assessing their trustworthiness and relevance, we highlight significant gaps in the available evidence base. Clear patterns emerge that show a major data gap and lack of research on sexual abuse of children with disabilities and an identifiable lack of methodological quality in many relevant studies. These make the development of a concerted and targeted research effort to tackle the abuse of children with disabilities in East Africa extremely difficult. This needs to be addressed urgently if the abuse of children with disabilities is to be prioritised by the global health community.
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Abimanyi-Ochom J, Mannan H, Groce NE, McVeigh J. HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: Differential access to HIV/AIDS information and services. PLoS One 2017; 12:e0174877. [PMID: 28406929 PMCID: PMC5390986 DOI: 10.1371/journal.pone.0174877] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022] Open
Abstract
Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41-0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18-1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda's AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.
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Affiliation(s)
- Julie Abimanyi-Ochom
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Hasheem Mannan
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Nora Ellen Groce
- Leonard Cheshire Disability and Inclusive Development Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Joanne McVeigh
- Centre for Global Health and School of Psychology, Trinity College Dublin, Dublin, Ireland
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17
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De Beaudrap P, Beninguisse G, Pasquier E, Tchoumkeu A, Touko A, Essomba F, Brus A, Aderemi TJ, Hanass-Hancock J, Eide AH, Mac-Seing M, Mont D. Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH). Lancet HIV 2017; 4:e161-e168. [PMID: 28126484 DOI: 10.1016/s2352-3018(16)30209-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. METHODS In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. FINDINGS Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women. INTERPRETATION The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. FUNDING Agence nationale de recherches sur le sida et les hépatites virales (ANRS-Inserm) and the 5% Initiative.
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Affiliation(s)
- Pierre De Beaudrap
- IRD, CEPED, UMR 196, INSERM U1244, Université Paris Descartes-Institut de Recherche pour le Développement, Paris, France.
| | - Gervais Beninguisse
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Estelle Pasquier
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon; Initiative 5% Sida, Tuberculose, Paludisme/Expertise France, Paris, France
| | - Alice Tchoumkeu
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Adonis Touko
- Forum Camerounais de Psychologie, Yaoundé, Cameroon
| | - Frida Essomba
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Aude Brus
- Handicap International, Lyon, France
| | | | - Jill Hanass-Hancock
- Medical Research Council & University of KwaZulu-Natal, Durban, South Africa
| | | | - Muriel Mac-Seing
- Handicap International, Lyon, France; School of Public Health, University of Montreal, London, UK
| | - Daniel Mont
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK
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18
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Tun W, Okal J, Schenk K, Esantsi S, Mutale F, Kyeremaa RK, Ngirabakunzi E, Asiah H, McClain-Nhlapo C, Moono G. Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia. J Int AIDS Soc 2016; 19:20829. [PMID: 27443266 PMCID: PMC4956734 DOI: 10.7448/ias.19.5.20829] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/01/2016] [Accepted: 05/02/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. METHODS We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012-2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. RESULTS Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only). CONCLUSIONS Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities.
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Affiliation(s)
- Waimar Tun
- HIV and AIDS Program, Population Council, Washington, DC, USA;
| | - Jerry Okal
- HIV and AIDS Program, Population Council, Nairobi, Kenya
| | - Katie Schenk
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Selina Esantsi
- Reproductive Health Program, Population Council, Accra, Ghana
| | - Felix Mutale
- Development Consultant, Formerly with Zambia Agency for Persons with Disabilities, Lusaka, Zambia
| | | | | | - Hilary Asiah
- Reproductive Health Program, Population Council, Accra, Ghana
| | | | - Grimond Moono
- HIV and AIDS Program, Population Council, Lusaka, Zambia
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19
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Rutenberg N, Tun W. Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016; 19:21261. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Three decades into the HIV pandemic, the issues affecting people with disabilities remain less known. Increasing attention has been given to this overlooked population when it comes to HIV prevention, treatment and care. This is related to the significant unmet sexual and reproductive healthcare needs facing people with disabilities worldwide. This article discusses the barriers to sexual health for people with disabilities in Africa and presents an argument about how mainstream HIV prevention work and research do not adequately attend to the sorts of systemic barriers that exclude people with disabilities, which a more targeted and critical approach could.
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Kassa TA, Luck T, Bekele A, Riedel-Heller SG. Sexual and reproductive health of young people with disability in Ethiopia: a study on knowledge, attitude and practice: a cross-sectional study. Global Health 2016; 12:5. [PMID: 26864115 PMCID: PMC4750354 DOI: 10.1186/s12992-016-0142-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As is common in developing countries, in Ethiopia young people with disabilities (YPWD) are more likely than the general population to be illiterate, unemployed and impoverished. They often lack equal access to information and education for reasons ranging from barriers regarding physical access to services to varied special learning needs. Very little is known about knowledge, attitude and practice (KAP) of YPWD regarding sexual and reproductive health (SRH) related issues. We, therefore, aimed to assess the KAP of 426 YPWD in Addis Ababa, Ethiopia. METHODS A cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire covering socio-demographic information, as well as information on KAP regarding SRH. RESULTS Only 64.6% of YPWD were aware of SRH services. Radio and TV were mentioned as the main sources of information by 62.2% of the participants. 77.9% had never had a discussion about SRH topics with their parents. Even though 96.7% of the respondents had heard about HIV, 88% had poor knowledge about ways of preventing HIV. Perception of the risk of getting infected with HIV was found to be generally low in YPWD; only 21.6% believed that they were at risk of acquiring HIV. CONCLUSIONS Our study, in general, demonstrated that there is a lack of comprehensive knowledge, appropriate practice and favorable attitude of YPWD regarding different SRH-related issues. Our findings thus clearly indicate the need for strategies and programs to raise SRH-related awareness and to help YPWD to develop the appropriate skills and attitudes needed for a healthy reproductive life.
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Affiliation(s)
- Tigist Alemu Kassa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.
| | - Assegedech Bekele
- Gondar College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
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De Beaudrap P, Pasquier E, Tchoumkeu A, Touko A, Essomba F, Brus A, Desgrées du Loû A, Aderemi TJ, Hanass-Hancock J, Eide AH, Mont D, Mac-Seing M, Beninguisse G. HandiVIH--A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations. BMJ Open 2016; 6:e008934. [PMID: 26846895 PMCID: PMC4746454 DOI: 10.1136/bmjopen-2015-008934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. METHODS AND ANALYSIS The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents' life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people's organisations is collected separately. ETHICS AND DISSEMINATION This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. TRIAL REGISTRATION NUMBER NCT02192658.
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Affiliation(s)
- Pierre De Beaudrap
- IRD, CEPED, UMR 196, Université Paris Descartes—Institut de Recherche pour le Développement (IRD), Paris, France
| | - Estelle Pasquier
- Initiative 5% Sida, Tuberculose, Paludisme/Expertise France, Paris, France
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Alice Tchoumkeu
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Adonis Touko
- Forum Camerounais de Psychologie, Yaoundé, Cameroon
| | - Frida Essomba
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Aude Brus
- Handicap International, Lyon, France
| | - Annabel Desgrées du Loû
- IRD, CEPED, UMR 196, Université Paris Descartes—Institut de Recherche pour le Développement (IRD), Paris, France
| | | | | | | | - Daniel Mont
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK
| | | | - Gervais Beninguisse
- Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
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Julien H, Fourie I. Reflections of affect in studies of information behavior in HIV/AIDS contexts: An exploratory quantitative content analysis. Library & Information Science Research 2015. [DOI: 10.1016/j.lisr.2014.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Affiliation(s)
| | - Hasheem Mannan
- Nossal Institute for Global Health, The University of Melbourne, Australia
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25
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Chappell P. How Zulu-speaking youth with physical and visual disabilities understand love and relationships in constructing their sexual identities. Cult Health Sex 2014; 16:1156-1168. [PMID: 25036419 DOI: 10.1080/13691058.2014.933878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Popular socio-medical discourses surrounding the sexuality of disabled people have tended to subjugate young people with disabilities as de-gendered and asexual. As a result, very little attention has been given to how young people with disabilities in the African context construct their sexual identities. Based on findings from a participatory research study conducted amongst Zulu-speaking youth with physical and visual disabilities in KwaZulu-Natal, this paper argues that young people with disabilities are similar to other non-disabled youth in the way they construct their sexual identities. Using a post-structural framework, it outlines how the young participants construct discursive truths surrounding disability, culture and gender through their discussions of love and relationships. In this context, it is argued that the sexual identities' of young people with physical and visual disabilities actually emerges within the intersectionality of identity discourses.
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Affiliation(s)
- Paul Chappell
- a Department of Anthropology and Development Studies , University of Johannesburg , Johannesburg , South Africa
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Aderemi TJ. Teachers’ Perspectives on Sexuality and Sexuality Education of Learners with Intellectual Disabilities in Nigeria. Sex Disabil 2014; 32:247-58. [DOI: 10.1007/s11195-013-9307-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Groce NE, Rohleder P, Eide AH, MacLachlan M, Mall S, Swartz L. HIV issues and people with disabilities: A review and agenda for research. Soc Sci Med 2013; 77:31-40. [DOI: 10.1016/j.socscimed.2012.10.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/21/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022]
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Saulo B, Walakira E, Darj E. Access to healthcare for disabled persons. How are blind people reached by HIV services? Sexual & Reproductive Healthcare 2012; 3:49-53. [DOI: 10.1016/j.srhc.2011.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 12/04/2011] [Accepted: 12/19/2011] [Indexed: 11/25/2022]
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Rohleder P, Swartz L, Schneider M, Eide AH. Challenges to providing HIV prevention education to youth with disabilities in South Africa. Disabil Rehabil 2011; 34:619-24. [DOI: 10.3109/09638288.2011.613512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eide AH, Schür C, Ranchod C, Rohleder P, Swartz L, Schneider M. Disabled persons’ knowledge of HIV prevention and access to health care prevention services in South Africa. AIDS Care 2011; 23:1595-601. [DOI: 10.1080/09540121.2011.575119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Clare Schür
- b Human Sciences Research Council , Pretoria , South Africa
| | - Chitra Ranchod
- b Human Sciences Research Council , Pretoria , South Africa
| | - Poul Rohleder
- c Department of Psychology , Anglika Ruskin University , Cambridge , UK
- d Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Leslie Swartz
- d Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Marguerite Schneider
- d Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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Chireshe R, Rutondoki EN, Ojwang P. Perceptions of the availability and effectiveness of HIV/AIDS awareness and intervention programmes by people with disabilities in Uganda. SAHARA J 2010; 7:17-23. [DOI: 10.1080/17290376.2010.9724973] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
PURPOSE Disabled people in South Africa have been included, for the first time, in policy documents on HIV prevention. However, little is known about how persons with disabilities in South Africa may be at risk, or not. For policy to be implemented in effective practice, we need to know what the risk issues are for disabled people in South Africa. METHODS This study draws on qualitative findings from a survey and interview study exploring organisational responses to the HIV epidemic for disabled people. Qualitative data were analysed using thematic and discourse analysis. RESULTS An analysis of comments made about risk factors for HIV, identified sexual abuse as a key risk. Furthermore, findings suggest that disability stigma may be a key factor on increasing disabled people's vulnerability in engaging in unsafe sex. CONCLUSION The findings provide much needed exploratory findings, in an area in which little is known; useful for considering issues for HIV prevention. However, caution needs to be taken that these findings are not the perspectives of disabled people themselves, and may reproduce accepted discursive truths.
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Affiliation(s)
- Poul Rohleder
- Department of Psychology,Anglia Ruskin University, Cambridge, CB11PT, UK.
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Affiliation(s)
- Poul Rohleder
- a Department of Psychology , Anglia Ruskin University , Cambridge , UK
- b Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Leslie Swartz
- b Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
- c Human Sciences Research Council , Pretoria , South Africa
| | | | - Nora Groce
- d Department of Epidemiology and Public Health , University College , London , UK
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Abstract
This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years.
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Affiliation(s)
- Jill Hanass-Hancock
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
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Taegtmeyer M, Hightower A, Opiyo W, Mwachiro L, Henderson K, Angala P, Ngare C, Marum E. A peer-led HIV counselling and testing programme for the deaf in Kenya. Disabil Rehabil 2009; 31:508-14. [DOI: 10.1080/09638280802133115] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa. AIDS 2008; 22 Suppl 4:S73-86. [PMID: 19033757 DOI: 10.1097/01.aids.0000341778.73038.86] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.
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Morrow M, Arunkumar MC, Pearce E, Dawson HE. Fostering disability-inclusive HIV/AIDS programs in northeast India: a participatory study. BMC Public Health 2007; 7:125. [PMID: 17594502 PMCID: PMC1924853 DOI: 10.1186/1471-2458-7-125] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 06/26/2007] [Indexed: 11/24/2022] Open
Abstract
Background Manipur and Nagaland in northeast India are among the Indian states with the highest prevalence of HIV. Most prevention and care programs focus on identified "high risk" groups, but recent data suggest the epidemic is increasing among the general population, primarily through heterosexual sex. People with disability (PWD) in India are more likely than the general population to be illiterate, unemployed and impoverished, but little is known of their HIV risk. Methods This project aimed to enable HIV programs in Manipur and Nagaland to be more disability-inclusive. The objectives were to: explore HIV risk and risk perception in relation to PWD among HIV and disability programmers, and PWD themselves; identify HIV-related education and service needs and preferences of PWD; and utilise findings and stakeholder consultation to draft practical guidelines for inclusion of disability into HIV programming. Data were collected through a survey and several qualitative tools. Results The findings revealed that participants believe PWD in these states are potentially vulnerable to HIV transmission due to social exclusion and poverty, lack of knowledge, gender norms and obstacles to accessing HIV programs. Neither HIV nor disability organisations currently address the risks, needs and preferences of PWD. Conclusion The Guidelines produced in the project and disseminated to stakeholders emphasise opportunities for taking action with minimal cost and resources, such as using the networks and expertise of both HIV and disability sectors, producing HIV material in a variety of formats, and promoting accessibility to mainstream HIV education and services. The human rights obligations and public health benefits of modifying national and state policies and programs to assist this highly disadvantaged population are also highlighted.
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Affiliation(s)
- Martha Morrow
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Vic 3010, Australia
| | - MC Arunkumar
- Department of Anthropology, Manipur University, Imphal, Manipur, India
| | - Emma Pearce
- School of Population Health, University of Melbourne, Melbourne, Vic 3010, Australia
| | - Heather E Dawson
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Vic 3010, Australia
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