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Women with disabilities, HIV and sexual violence: Data tell us they are still left behind

HUMANITY & INCLUSION (HI)
July 2018

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This leaflet intends to underline the existence of intersectional factors of vulnerability amongst Women with Disabilities with respect to HIV/AIDS and sexual violence in Burkina Faso and Guinea Bissau. The figures presented here are taken from two studies carried out in Burkina Faso and Guinea Bissau in 2017. In Burkina Faso, 28,667 people were interviewed in total, among whom 978 identified themselves as persons with disabilities (using the Washington Group Short Set of Questions). For the biobehavioral study in Guinea Bissau, 17,110 people were interviewed in total, among whom 1,147 identified themselves as persons with disabilities

Disability and HIV

UNAIDS
August 2017

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This report highlights existing key evidence on the relationship between disability and HIV. It discusses the concrete steps needed for a person-centred, disability-inclusive HIV response that allows for increased participation of people with disabilities and integrates rehabilitation within the continuum of HIV care. Globally, it is estimated that 1 billion people (15% of the world’s population) have a disability. Of those aged over 15 years, approximately 110–190 million (2.2–3.8%) experience significant disabilities. Disability is increasing in prevalence due to ageing populations, trauma, accidents and the increase in chronic health conditions, including HIV. Persistent discrimination against and exclusion of people with disabilities, in particular women and girls with disabilities, increases their vulnerability, including their risk of HIV infection.
 

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

ABIMANYI-OCHOM, Juie
MANNAN, Hasheem
GROCE, Nora
McVEIGH, Joanne
April 2017

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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.

PLoS ONE 12(4): e0174877
https://doi.org/10.1371/journal.pone.0174877

HIV & AIDS and rehabilitation. Factsheet.

HANDICAP INTERNATIONAL
March 2017

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The Human Immunodeficiency Virus (HIV) is a virus that makes the immune system collapse, making a person totally defenceless to infections. A person living with HIV may experience episodic and/or chronic impairments. These may result from illness and/or from treatment side effects, in particular: general fatigue and weight loss; neurological disorders; mental and cognitive disorders such as dementia; and joint and muscle problems. Different examples of rehabilitation across the care cycle are given. A case study in India is provided.
 

Disability and HIV

UNAIDS
January 2017

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This report highlights existing key evidence on the relationship between disability and HIV. It discusses the concrete steps needed for a person-centred, disability-inclusive HIV response that allows for increased participation of people with disabilities and integrates rehabilitation within the continuum of HIV care.

Prevalence of HIV infection among people with disabilities : a population-based observational study in Yaounde, Cameroon (HandiVIH)

DE BEAUDROP, Pierre
et al
January 2017

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In the HandiVIH study, an estimation and a comparison of HIV prevalence and associated risk factors between people with and without disabilities. In this cross-sectional, population-based, observational study, two-phase random sampling was used to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. The Washington Group Short Set of Questions on Disability was used to identify people with disabilities. An HIV test was administrated and a life-course history interview carried out with participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. The study took place in Yaoundé, Cameroon, between Oct 2, 2014, and Nov 30, 2015. 

The Lancet HIV · January 2017 

DOI: 10.1016/S2352-3018(16)30209-0

Integration of childhood tuberculosis into maternal and child health, HIV and nutrition services: A case study from Uganda

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Uganda case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The methodology for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and iCCM benchmarks"

Chap. 2: Intervention Cost-Effectiveness: Overview of Main Messages

DT, Jamison
JG, Breman
AR, Measham
et al
September 2016

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"Although efficient spending on health has always been a desirable goal, it is particularly critical in the face of recent threats, such as HIV/AIDS and drug-resistant bacteria, as well as the problems presented by increasing prevalence of chronic diseases, such as diabetes and cardiovascular disease (CVD), that threaten to roll back the significant health gains achieved in the past two decades. This book is an opportunity to assess anew the costs associated with and the health gains attainable from specific interventions and thereby better inform the allocation of new health funding." 

Integration of childhood TB into maternal and child health, HIV and nutrition services. A case study from Malawi.

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi in order to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Malawi case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The method for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and benchmarks for integrated community case management (iCCM)"

For every child, a fair chance : the promise of equity

UNITED NATIONS CHILDREN’S FUND (UNICEF)
November 2015

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“UNICEF’s commitment to equity – giving a fair chance in life to every child, everywhere, especially the most disadvantaged – is built on the conviction that it is right in principle and evidence that it is right in practice. This report makes the case for closing persistent gaps in equity…” The report identifies a number of persistent gaps in equity for children, ranging from health to nutrition, to social inclusion. The report concludes by making recommendations to close gaps in equity worldwide as well as projecting progress in achieving equity by 2030

Knowledge and perceptions of HIV-infected patients regarding HIV transmission and treatment in Ho Chi Minh City, Vietnam

Hoang, Dong
Dinh, An T
Groce, Nora
Sullivan, Lynn
March 2015

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Patient education concerning HIV and antiretroviral (ARV) medications is important for optimal outcomes. The authors assessed the knowledge and perceptions of HIV-infected patients in an ARV education program in Ho Chi Minh City, Vietnam. The study population’s knowledge of HIV/AIDS and ARV medications, perceived stigmatization, and areas of knowledge deficits underscore the need for effective patient education programs addressing poorly understood issues around HIV/AIDS.

The relationship between HIV and prevalence of disabilities in sub-Saharan Africa : systematic review

BANKS, Lena Morgon
et al
January 2015

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“This article systematically reviews the evidence on the prevalence and risk of disabilities among children and adults living with HIV in sub-Saharan Africa. The article concludes that HIV is widespread in sub-Saharan Africa and the evidence suggests that it is linked to disabilities, affecting a range of body structures and functions. More research is needed to better understand the implications of HIV-related disability for individuals and their families as well as those working in the fields of disability and HIV so that appropriate interventions can be developed”

Tropical Medicine & International Health

2015 global reference list of 100 core health indicators

WORLD HEALTH ORGANIZATION (WHO)
2015

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“The Global Reference List of 100 Core Health Indicators is a standard set of 100 indicators prioritized by the global community to provide concise information on the health situation and trends, including responses at national and global levels. It contains indicators of relevance to country, regional and global reporting across the spectrum of global health priorities relating to the post-2015 health goals of the Sustainable Development Goals (SDGs). These include the Millennium Development Goals (MDGs) agenda, new and emerging priorities such as noncommunicable diseases, universal health coverage and other issues in the post-2015 development agenda.”

Including disability in HIV policy and programming : good practices drawn from country-based evidence

MAC-SEING, Muriel
December 2014

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The purpose of this document is to share good practices and processes concerning the inclusion of disability issues in HIV policy and programming, drawing on specific experiences in Senegal, Ethiopia, Kenya, Rwanda and Cambodia and on lessons learned at international AIDS conferences. More specifically, it is intended to 1) provide a clear indication to HIV and AIDS practitioners that disability mainstreaming in HIV and AIDS is indeed possible and workable in various contexts and by implementing specific steps/initiatives; 2) transfer concrete knowledge and practices to disability stakeholders, including disabled people's organisations, on how to work in HIV and AIDS; and 3) persuade HIV-related development partners that more investment is needed to develop this knowledge base in order to bring about practical changes at micro, meso and macro levels, as well as among the population. The good practices are also intended to inspire and motivate other organisations and agencies to use and replicate them in other contexts and countries, if/when they are adapted to the needs and situations of people with disabilities and communities

LL 07

Including disability in HIV policy and programming : good practices drawn from country-based evidence : brief

MAC-SEING, Muriel
December 2014

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This brief is an introduction to the lessons learned document on good practices about the inclusion of disability in HIV policy and programming. Good practices and processes concerning the inclusion of disability issues in HIV policy and programming are highlighted, drawing on specific experiences in Senegal, Ethiopia, Kenya, Rwanda and Cambodia and on lessons learned at international AIDS conferences

LL No 7 Brief 

The gap report

THE JOINT UNITED NATIONS PROGRAMME ON HIV AND AIDS (UNAIDS)
July 2014

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The goal of this report is to provide the best possible data on the global AIDS epidemic, with a particular focus on information and analysis on the people left behind. The report highlights these gaps firstly in regional terms, providing “Regional Snapshots” and then explores issues faced by the following 12 populations that have been left behind by the AIDS response: people living with HIV, adolescent girls and young women, prisoners, migrants, people who inject drugs, sex workers, gay men and other men who have sex with men, transgender people, children and pregnant women living with HIV, displaced persons, people with disabilities and people aged 50 years and older

"We are also dying of AIDS” : barriers to HIV services and treatment for persons with disabilities in Zambia

CHOPRA, Rashmi
July 2014

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This report documents the obstacles faced by people with disabilities in both the community and healthcare settings. These include pervasive stigma and discrimination, lack of access to inclusive HIV prevention education, obstacles to accessing voluntary testing and HIV treatment, and lack of appropriate support for adherence to antiretroviral treatment. The report also describes the sexual and intimate partner violence women and girls with disabilities face, and the need for the government and international donors to do more to ensure inclusive and accessible HIV services

 

Note : Accessible and easy read versions are available from the link above

Disability and HIV : a systematic review and a meta-analysis of the risk of HIV infection among adults with disabilities in Sub-Saharan Africa

DE BEAUDRAP, Pierre
MAC-SEING, Muriel
PASQUIER, Estelle
July 2014

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"More than one billion people worldwide are estimated to be living with a disability. A significant proportion of them lives in Sub-Saharan Africa where they are reported to be at increased risk of HIV. However, quantitative evidence on this remains scarce. A systematic review and a meta-analysis of the risk of HIV infection among people with disabilities living in Sub-Saharan Africa were undertaken. We searched all published or unpublished studies and national surveys reporting HIV prevalence among adults with disabilities living in Sub-Saharan Africa between 2000 and 2013. The risk ratio (RR) of HIV infection in people with disabilities versus people without disabilities was estimated through a random-effects meta-analysis. Of the 12,252 references screened, 13 studies were selected. HIV prevalence varied widely across studies from 1.1% to 29%. Pooled RRs of HIV infection in people with disabilities compared to the general population were 1.31 (1.02–1.69) overall; 1.16 (0.71–1.87) among people with mental illness or intellectual disabilities and 1.07 (0.58–1.95) among people with hearing disabilities. This meta-analysis provides evidence that people with disabilities do not have a lower risk of HIV when compared to the general population, and that women with disabilities are especially affected. A clear increasing gradient in the risk of HIV according to gender and disability status was also observed. The important heterogeneity across studies and their varying quality warrant a closer look at the intersection between disability and HIV. Additional studies with more systematic approaches and with higher-quality methodologies are required to further address this knowledge gap"

 

AIDS Care : Psychological and Socio-medical Aspects of HIV/AIDS, Volume 26, Issue 12

DOI: 10.1080/09540121.2014.936820

 

Predictors of voluntary HIV counselling and testing services utilization among people with disabilities in Addis Ababa, Ethiopia

ADEREMI, Toyin Janet
et al
June 2014

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“The study investigated HIV testing prevalence and factors associated with the utilization of voluntary HIV counselling and testing (VCT) services among individuals with disabilities in Addis Ababa. The analysis was based on a survey of 209 men and 203 women with disabilities, aged 15–49, who had ever heard about HIV and AIDS in four sub-cities in Addis Ababa. HIV testing prevalence was 53.2%, with no significant difference between males and females. Comprehensive HIV knowledge, living with spouse, and religious affiliations positively predicted utilization of VCT services among participants. Living with both parents and having physical or mental/intellectual disabilities were negative predictors of VCT services utilization. More research on the predictors of utilization of VCT services by gender and urban/rural divides are needed among people with disabilities”

AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, Vol 26, Issue 10

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