The multidimensional vulnerability of people with disability to HIV infection: Results from the handiSSR study in Bujumbura, Burundi

Abstract

Background In resource-limited contexts, available data indicate that people with disability are disproportionally affected by the HIV epidemic. While disability resulting from chronic HIV infection has received some attention, few epidemiologic studies have examined the vulnerability of people with disability to HIV acquisition. The aims of the study were as follows: to estimate and compare HIV prevalence among people with and without disability living in Bujumbura, Burundi; to examine how the interaction among disability, gender and socioeconomic environment shapes vulnerability to HIV; and to identify potential pathways to higher HIV risk. Methods In this cross-sectional population-based study, 623 persons with disability (302 with disability onset ≤10 years [“early disability”]) and 609 persons without disability matched for age, sex and location were randomly selected to be tested for HIV and to participate in an interview about their life history, their social environment and their knowledge of sexual health. Findings A total of 68% of men and 75% of women with disability were affected by multidimensional poverty compared to 54% and 46% of their peers without disability ( p <0.0001). Higher HIV prevalence was observed among women with disability (12.1% [8.2–16]) than among those without (3.8% [1.7–6], OR a 3.8, p <0.0001), while it was similar among men with disability and those without ( p = 0·8). Women with disability were also at higher risk of sexual violence than were those without (OR a 2.7, p <0.0001). The vulnerability of women with early disability to HIV was higher among those who were socially isolated (HIV prevalence in this group: 19% [12–27]). In addition, education level and sexual violence mediated 53% of the association between early disability and HIV ( p = 0.001). Interpretation This study highlights how the intersection of disability, gender and social environment shapes vulnerability to HIV. It also shows that the vulnerability to HIV of women who grew up with a disability is mediated by sexual violence. Funding This research was funded by the Netherlands Organization for Scientific Research (Grant W08.560.005) and the Initiative HIV-TB-Malaria (new name of the organisation)

Understanding the vulnerability of people with disabilities to HIV: Who is at risk?

“…The latest Lancet HIV paper by Pierre De Beaudrap and colleagues illustrates why we need disability-focused research to address vulnerabilities of those who have been left behind in the response to HIV and AIDS [1].…”

“…However, in past, cross-sectional, surveys it was difficult to distinguish between women who were living with HIV and acquired disability and those women who grew up with disability and were later infected with HIV [2,3]. The methodology developed by de Beaudrap et al distinguishes between people with 'early and late disability onset' and therefore allows us to identify HIV prevalence and risk factors among people who grew up with disability ('early disability') [1]. The data shows that the prevalence of HIV is higher among women with disabilities then their peers without disabilities or men.…”

Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries

“…In a similar vein, other research has found that men with disabilities are less likely to report engaging in sexual risk behaviours, such as multiple concurrent partners [ 56 ]. Indeed research on HIV and disability has revealed that women with disabilities are at particular risk of exposure to HIV because of their exposure to sexual violence, exploitation and transactional sexual activities [ 57 , 58 ].…”

Burden of and risk factors for sexual violence among women with and without disabilities in two sub-Saharan African countries

“…For this study we used data collected through two cross-sectional studies conducted in Yaoundé, Cameroon between 2 October 2014 and 30 November 2015 (the HandiVIH study [ 12 ]) and in Bujumbura, Burundi between 20 December 2017 and 20 December 2018 (the HandiSSR study [ 13 ]). These surveys were part of a series of studies conducted on the burden of HIV infection among people with disabilities in sub-Saharan Africa.…”