“Even the fowl has feelings”: access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia

Abstract

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights andby denying their circumstancesleaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps ...

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

“…The findings from this study related to the multiple sources of stigma among persons with disabilities, including those living with HIV, have been reported elsewhere [26]. Briefly, the dual stigma of HIV and disability as well as the internalized stigma (i.e.…”

Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies

“…It shouldn't be seen as a stand-alone. [42] In fact, as illustrated by a number of the studies, people with different types of impairments described how they were excluded from health education campaigns or opportunities due to the initiatives only targeting the mainstream, or inclusion of disability being an afterthought [42,43,46,47,49,58]. Common examples included people with visual impairments not being able to see posters, billboards, or read informational pamphlets with health education messages, or people with hearing impairments not being able to hear messages broadcasted via radio or television programs [42,45,48,56].…”

“…Some of these barriers are disability specific, depending on the type of impairments experienced. An example here is the absence of ramps for those with certain physical impairments resulting in difficulties entering the building, or lack of sign language interpreters for people with hearing impairment [38,41,45,48,49,54,[56][57][58]. This barrier is illustrated by an example of a person with visual impairment from Kenya, discussing the shortage or lack of sign language interpreters and guidance at the health facility:…”

Determinants of knowledge, attitudes, and practices in relation to HIV/AIDS and other STIs among people with disabilities in North-Shewa zone, Ethiopia

“…Although people with disabilities require the same HIV/AIDS information, services and supports as all other members of society, they are excluded and neglected in all of the sectors responding to HIV and STI infections [ 3 ]. Remarkably, they are notably absent from equitable access and are often treated as a low priority for those services [ 8 , 9 ]. This access is hindered by several factors such as stigma and discrimination based on their disability status and/or type of disability.…”

“…There is a growing body of literature that recognizes a variety of issues that affect knowledge, attitudes, and practices in relation to HIV/AIDS and other STIs among people with disabilities. For example, a literature review from developing countries [ 10 ] and a research from Uganda [ 9 ] suggested that PWDs have very limited knowledge about HIV and other STIs because they are frequently excluded from access to HIV/AIDS and reproductive health information because of their disability status. Sociodemographic characteristics such as type of disability marital and educational level were also reported as potential predictors of knowledge and practices of PWDs in relation to HIV/AIDS because PWDs’ interest in seeking SRH-related services and information may be affected by these variables [ 5 , 11 ].…”