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

Abstract

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 We searched all published or unpublished studies and national surveys reporting HIV prevalence among adults with disabilities living in Sub-Saharan Africa between 2000 and 2013.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.

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia

“…However, this does not indicate that they are free from HIV risk. There is evidence that it is a population at risk for HIV [12,28]. …”

“…A systematic review by De Beaudrap et al . found that persons with disabilities do not have a lower risk of HIV infection compared with the general population [12]. …”

Disability and HIV in Africa: Breaking the barriers to sexual health care

“…The literature often refers to the "double burden" of being female and experiencing a disability. In reviews examining the risk for HIV among people with disabilities, women were found to be significantly affected (De Beaudrap et al, 2014;Groce et al, 2013;). Women with disabilities may experience difficulties in forming secure, lasting relationships, as women with disabilities may be perceived as a burden and not valuable spouses, with the result that women may be abused and abandoned by their spouses Kiani, 2009).…”

“…This is beginning to change, with a growing awareness of the equal, if not increased risk to HIV infection for people with disabilities. Comprehensive reviews looking at the risk for HIV among people with disabilities have been published elsewhere, and will not be reviewed again here (for such reviews see Groce et al, 2013, and De Beaudrap et al, 2014. Rather, an argument is made for how mainstream HIV prevention work and research does not adequately attend to the sorts of systemic barriers that exclude people with disabilities, which a more targeted, and critical approach could.…”

A systematic review of physical activity policy recommendations and interventions for people with mental health problems in Sub-Saharan African countries

“…For example, severe mental illness has been shown to be an independent risk factor for other important non-communicable disorders such as cardio-metabolic diseases, albeit inconsistently in SSA studies [7]. Consistent associations are however reported between HIV/AIDS and poor mental health [8, 9] and chronic pain and poor mental health [10, 11]. Also the strong and often bidirectional relationships of mental disorders with substance use disorders and the associated increased risk for accidents and injuries emphasizes the critical role of a rigorous mental health policy in SSA [3].…”