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Women and young persons with disabilities: Guidelines for providing rights-based and gender-responsive services to address gender-based violence and sexual and reproductive health and rights

HOLOBOFF RADFORD, Anastasia
et al
November 2018

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This publications aims to provide practical and concrete guidelines for making Gender-Based Violence (GBV) and Sexual and Reproductive Health and Rights (SRHR) services more inclusive of and accessible to women and young persons with disabilities and for targeting interventions to meet their disability-specific needs.
 
Critical services for all victims and survivors of GBV include health services (e.g. first-line support, sexual assault examination and care, mental health assessment and care), justice and policing services (e.g. assessment and investigation, perpetrator accountability and reparations, safety and protection, justice sector coordination), social services (e.g. crisis counselling; help lines; legal and rights information, advice, and representation; psychosocial support and counselling), and coordination at both the national and local level.

 

Fundamental SRHR services for women and young persons—with and without disabilities— include comprehensive sexuality education; information, goods, and services for the full range of modern contraceptive methods, including emergency contraception; maternal/newborn healthcare (including antenatal care, skilled attendance at delivery, emergency obstetric care, post-partum care, and newborn care); prevention, diagnosis, and treatment for sexual and reproductive health issues (e.g. sexually transmitted infections, including HIV, syphilis, and HPV, cancers of the reproductive system and breast cancer, and infertility); safe and accessible abortion, where it is not against the law; and post-abortion care to treat complications from unsafe abortion.

 

While the primary audience of these Guidelines is GBV and SRHR service providers and support staff, these Guidelines are also intended as a valuable resource for all stakeholders—including those in government, international organizations, and non-governmental organizations—involved in designing, developing, implementing, or advocating for GBV or SRHR services for women and young persons with disabilities. 

Sexual assault advice - Booklet for Kenya

ALEY, Rob Aley - Advantage Africa
et al
November 2017

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This simple guide has been written to support victims of
sexual abuse and their families in Kenya to know their rights and
to understand what services are available to them. The
booklet is also a useful source of summary information for
duty bearers in the community (e.g. village elders, faith
groups, Assistant Chiefs and CBOs) as well as formal
service providers such as hospitals and the police.

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

Sexual Abuse of Persons with Disabilities - Research

Rob Aley
et al
November 2016

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The aim of the research was to investigate the social, cultural and institutional factors which contribute to the high incidence of sexual abuse of persons with disabilities in East Africa and to identify interventions which could change detrimental attitudes, beliefs and practices which perpetuate this high incidence. The research is framed within the United Nations Convention on the Rights of Persons with Disability (UNCRPD), particularly articles 12, 13 and 16.

The study used a qualitative participatory action research approach and worked with local partner organisations and Ugandan and Kenyan field level researchers to collect data. Survivors of sexual abuse were not interviewed but instead the research investigated the understandings, beliefs and practices of a range of service providers and key responders who are involved in the prevention of and response to sexual abuse against persons with disabilities in their communities. Groups consulted included police, teachers, health-care workers, government administrators, faith and community organisations and traditional leaders, as well as persons with disabilities and their parents. Participatory workshops were run with a reference group of people with disabilities (with a range of impairments and experiences) and relevant specialists at the initial stage and during the participatory analysis process. After initial orientation and training the field researchers undertook a total of 52 individual interviews and 9 focus group discussions with a range of stakeholders.

The overall findings show that social attitudes and understanding of disability and sexuality in general are strong influencing factors on the risks that persons with disability face in relation to sexual abuse. Participants reported a range of harmful attitudes and beliefs about disability and about the needs and rights of persons with disabilities. It is very common for cases of abuse to go unreported and to be dealt with at the family or community level, rather than being viewed as a serious criminal matter which should be taken to the formal authorities. Many barriers exist, especially at community level which mean abuse does not get reported. Lack of awareness and knowledge, stigma and exclusion and poverty were key drivers of continuing abuse and survivors of abuse seldom get proper support. Guidelines, training and clear procedures for good practice in the various professions were generally weak or absent. Key recommendations were generated for both community level interventions and in relation to policy and training at regional and national levels. The practical implementation of some recommendations was undertaken.

Sexual Abuse of Persons with Disabilities - Research

ALEY, Rob
et al
November 2016

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Abstract
The aim of the research was to investigate the social, cultural and institutional factors which contribute to the high incidence of sexual abuse of persons with disabilities in East Africa and to identify interventions which could change detrimental attitudes, beliefs and practices which perpetuate this high incidence. The research is framed within the United Nations Convention on the Rights of Persons with Disability (UNCRPD), particularly articles 12, 13 and 16.

The study used a qualitative participatory action research approach and worked with local partner organisations and Ugandan and Kenyan field level researchers to collect data. Survivors of sexual abuse were not interviewed but instead the research investigated the understandings, beliefs and practices of a range of service providers and key responders who are involved in the prevention of and response to sexual abuse against persons with disabilities in their communities. Groups consulted included police, teachers, health-care workers, government administrators, faith and community organisations and traditional leaders, as well as persons with disabilities and their parents. Participatory workshops were run with a reference group of people with disabilities (with a range of impairments and experiences) and relevant specialists at the initial stage and during the participatory analysis process. After initial orientation and training the field researchers undertook a total of 52 individual interviews and 9 focus group discussions with a range of stakeholders.

The overall findings show that social attitudes and understanding of disability and sexuality in general are strong influencing factors on the risks that persons with disability face in relation to sexual abuse. Participants reported a range of harmful attitudes and beliefs about disability and about the needs and rights of persons with disabilities. It is very common for cases of abuse to go unreported and to be dealt with at the family or community level, rather than being viewed as a serious criminal matter which should be taken to the formal authorities. Many barriers exist, especially at community level which mean abuse does not get reported. Lack of awareness and knowledge, stigma and exclusion and poverty were key drivers of continuing abuse and survivors of abuse seldom get proper support. Guidelines, training and clear procedures for good practice in the various professions were generally weak or absent. Key recommendations were generated for both community level interventions and in relation to policy and training at regional and national levels. The practical implementation of some recommendations was undertaken.

Women and health : today's evidence tomorrow's agenda

ABOUZAHR, Carla
DE ZOYSA Isabelle
GARCIA MORENO Claudia
Eds
2009

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This is a report on women and health - both women’s health needs and their contribution to the health of societies. Women’s health has long been a concern for the World Health Organization but today it has become an urgent priority. This report explains why. Using current data, it takes stock of what is known about the health of women throughout their lives and across the different regions of the world

Sexual health for people with intellectual disability

EASTGATE, Gillian
2008

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This article explores how people with intellectual disability often experience difficulties meeting their sexual needs and desires due to poor education and social isolation. However, the article highlights that people with intellectual disability are capable of safe, constructive sexual expression and healthy relationships with appropriate education and good social support. It emphasises that providing this support is an essential part of supporting people with intellectual disability
Salud Publica Mex, 50 suppl 2

Family planning : a global handbook for providers

World Health Organization Department of Reproductive Health and Research (WHO/RHR)
Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Info Project CCP
United States Agency for Inernational Development (USAID)
2007

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This is a quick-reference resource for health care workers at all levels. It reflects the family planning guidance developed by the WHO and expands on the coverage of 'The essentials of contraceptive technology' (CCP:1997) to address other needs of clients that come up during the course of family planning. Coverage includes different methods of contraception, sexually transmitted diseases, maternal and new born health, reproductive health issues, family planning provision and serving diverse groups; e.g. adolescents, men, and women near menopause . The handbook is one of the WHO's 'four cornerstones of family planning guidance'

Rwanda national policy on condoms

February 2006

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This policy is an integral part of Rwanda's overall HIV & AIDS prevention strategy for 2005 to 2009. It covers; access, behaviour change communication and condom promotion, products and quality assurance, forecasting and resource mobilisation, condom procurement, distribution and pricing, and monitoring and evaluation of the condom policy implementation

Yaari dosti : Young men redefine masculinity, a training manual

POPULATION COUNCIL
2006

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This manual was adapted from the Brazilian Program H curriculum and piloted in urban slum communities in India as part of an operations research study aimed at reducing HIV risk among young men by addressing perceptions of gender norms. The manual can be used by health educators, teachers and/or other professionals or volunteers who want to work, or are already working, with young men between 15 and 24 years old. It is divided into four subsections: gender, sexuality and reproductive health, violence, and preventing and living with HIV & AIDS, around each of which there is a series of activities

The WHO Reproductive Health Library

WORLD HEALTH ORGANIZATION (WHO). Special Programme of Research, Development & Research Training in Human Reproduction
2005

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This CD-ROM is targetted at health care professionals and assists them in understanding research evidence, making decisions about best practice, and establishing implementation procedures to assure the change. It contains editorials, articles on research, research synthesis and methodology, summaries of beneficial and harmful forms of care, systematic reviews and commentaries, implementation aids, registers of funding agencies and NGOs involved in reproductive health, and links to websites about research and research synthesis. This edition includes 13 new Cochrane Reviews (bringing the total to 101), and corresponding commentaries and practical recommendations. This issue includes a new video on 'Vacuum extraction for assisted vaginal delivery'.

Expanding contraceptive options and access for youth

SCHOLL, Ed
FINGER, William
March 2004

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In a time when young people are increasingly at risk of unintended pregnancy and sexually transmitted infections, the role of contraception in preventing these is crucial. This issue of YouthLens looks at how education, services and products can help protect youth against unintended pregnancy and sexually transmitted infections, including HIV. It stresses that young people should be targeted with appropriate messages

TB/HIV : a clinical manual

HARRIS, Anthony D
MAHER, Dermot
2004

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Developments since 1996, particularly in the TB/HIV field, have prompted a second edition of this popular manual which provides a pocket-sized guide to the clinical management of TB, particularly in patients suffering from co-infection with HIV. Designed for use by busy clinicians, the manual aims to promote the best possible diagnosis and treatment in low-income countries where the prevalence of TB and HIV infection is high, case loads are heavy, and laboratory support may be limited. With these needs in mind, the manual combines the latest scientific knowledge about TB and HIV with authoritative advice based on extensive field experience in several of the hardest hit countries. Throughout the manual, tables, flow charts, lists of do's and don'ts, questions and answers, and numerous practical tips are used to facilitate quick reference and correct decisions. Information ranges from advice on how to distinguish TB from other HIV-related pulmonary diseases to the simple reminder that in sub-Saharan Africa, anyone with TB is in a high risk group for HIV. Though primarily addressed to clinicians working at district hospitals in sub-Saharan Africa, the manual is also suitable for use in areas of Asia and South America where the problem of TB and HIV co-infection poses a growing clinical challenge

Disability and HIV & AIDS : a participatory rapid assessment of the vulnerability, impact and coping mechanisms of the disabled people on HIV/AIDS

NGANZI, Patrick
MATONHODZE, George
2004

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This study assesses the vulnerability, impact and coping mechanisms of disabled people on HIV and AIDS, and suggests strategies for developing an HIV and AIDS programme for disabled people’s organisations. Using participatory methodologies of inquiry, the study found that disabled people perceive themselves to be at higher risk of HIV infection due to their disability, regardless of their awareness levels. Their social exclusion from the mainstream HIV/AIDS services makes the situation worse. The study revealed that the many myths and misconceptions around HIV and disability increase the vulnerability of disabled people to HIV/AIDS, such as the belief that sex with a disabled person cleanses a person of HIV/AIDS. It also revealed that disabled people have limited access to HIV/AIDS information and limited use of HIV/AIDS services mainly because of the nature of their disability, the location of the facilities and the attitudes of service providers. In conclusion, the study revealed that disabled people are at a higher risk of infection by sexually transmitted infections and HIV/AIDS due to their exclusion from mainstream HIV interventions. This situation is further exacerbated by the lack of policy framework on disability and HIV and AIDS

Disability and HIV & AIDS : a participatory rapid assessment of the vulnerability, impact, and coping mechanisms of parents of disabled children on HIV & AIDS

NGANZI, Patrick
MATONHODZE, George
2004

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This study assesses the vulnerability, impact and coping mechanisms of parents of disabled children on HIV/AIDS and suggests strategies for developing an HIV and AIDS programme. Using participatory methodologies of inquiry, the study found that the parents of disabled children are at a higher risk of infection to sexually transmitted infections (STI) and/or HIV and that the risk increases as the parents try to cope with having a disabled child. Therefore, a disabled child in a family acts as one of the pre-disposing factors to the parents' infection and when an infection happens in a home, the quality of care for the very disabled child is compromised causing a vicious cycle of disability and HIV/AIDS at the household level.The study recommends that target-specific interventions should be designed and implemented for the parents of disabled children to address issues of HIV/AIDS and disability, empowerment and gender issues as well as sexual reproductive health

Reproductive health services in KwaZulu Natal Province, South Africa : a situation analysis study focusing on HIV/AIDS services

SEARLE, Catherine
et al
July 2003

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Summary of a study in KwaZulu Natal that used situation analysis methodology, first used in reproductive health research to cover important HIV & AIDS-related issues, including: the availability and quality of voluntary counselling and testing services; the extent of integration of family planning, antenatal care, and sexually transmitted infection services with HIV prevention; and the extent of condom promotion and other HIV prevention strategies

Popline

CENTER FOR COMMUNICATION PROGRAMS, JOHNS HOPKINS UNIVERSITY BLOOMBERG SCHOOL OF PUBLIC HEALTH
June 2003

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This bibliographic database on reproductive health provides more than 300,000 citations with abstracts of scientific articles, reports, books, and unpublished reports in the fields of population, family planning, and related health issues. It has numerous special features including links to free, full-text documents; the ability to limit your search to peer-reviewed journal articles; and many abstracts in French and Spanish

Basic laboratory procedures in clinical bacteriology

VANDEPITTE, J
et al
2003

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This publication brings together and updates the various guidelines produced by WHO over the years on sampling of specimens for laboratory investigation, identification of bacteria, and testing of antimicrobial resistance. It concentrates on the procedures to be followed, rather than the basic techniques of microscopy and staining, which have been described in detail in other WHO publications

Canadian youth, sexual health and HIV/AIDS study

COUNCIL OF MINISTERS OF EDUCATION, CANADA (CMEC)
2003

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This survey was undertaken to increase the understanding of the factors that contribute to the sexual health of Canadian youth. It was done by exploring the socio-cultural, socio-environmental and interpersonal determinants of adolescent sexual behaviour. A section of the survey (pp 111-114) looks specifically at disability and sexual activity

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