In Africa, people with disabilities may be at increased risk for HIV

Disabled individuals in Africa may lack access to HIV-related information, which may place them at greater risk for acquiring the infection, according to results of a recent study.

The study, conducted by Jill Hanass-Hancock, PhD of the University of KwaZulu-Natal in South Africa, was a systematic review of published literature from the last decade that dealt with associations between disability and HIV/AIDS in Africa. Data from 24 electronic databases were collected between June 2008 and December 2008 and included information up to and including findings published on Dec. 31, 2008.

Almost no studies on HIV/AIDS and disabilities in Africa were conducted before 2004.

The sample included 36 studies, 18 of which appeared in peer-reviewed journals or were presented at international conferences, and the rest of which were reports from organizations or government departments. There were 7,759 participants observed.

Results

Preliminary findings indicated that people with disabilities may be vulnerable to acquiring HIV. Disabled individuals may lack access to HIV-related information, testing and treatment.

Results of a recent study conducted in South Africa indicated that people with disabilities may have had the lowest rates of knowledge about HIV of all groups assessed. Overall analysis demonstrated that the specific areas in which people with disabilities lack information about HIV include strategies for prevention and modes of transmission.

Although many participants understood the sexual modes of transmission, many disabled individuals believed that mosquito bites, hugging or kissing can also lead to transmission. This dichotomy raised some questions. “It is debatable if the lack of HIV knowledge in relation to some modes of transmission, such as hugging, kissing and mosquito bites, can really explain the risk of exposure to HIV infection for people with disability when, at the same time, results indicate that they know about the risk through sexual transmission,” Hanass-Hancock wrote.

Hanass-Hancock also wrote that there are gaps in the research and areas of concern on this topic. She wrote that investigations have been conducted regarding vulnerability and accessibility, but that few prevalence studies or evaluations exist.

Findings have been published on the associations of deaf populations and HIV, but other disability groups have not been studied with sufficient rigor.

Exploitation of individuals with disabilities, including sexual abuse, may be a growing area of concern on which few studies or interventions have focused. On top of the risks for rape and other sexual abuse, disabled populations may not receive adequate legal protection in such instances.

As most prevention programs do not include approaches tailored to disabled individuals, those populations may not be receiving the prevention message as clearly as non disabled populations.

Beyond HIV-specific education, disabled populations may be more likely to be excluded from general education, which includes basic sexual education classes and programs.

Costs of medication and transportation to the clinic may be unaffordable for disabled individuals who are unable to find employment. Accessibility may also be a problem for such populations.

Disability-specific voluntary testing and counseling programs may not exist. Associations between counseling and violations of basic confidentiality requirements also were observed.

Disabled children may be at increased risk for HIV because parents, particularly fathers, of these children are more likely to leave the home and not return.

The double stigma of disability and HIV/AIDS may cause this population to be increasingly marginalized.

Hanass-Hancock J. J Intl AIDS Soc. 2009;12:doi:10.1186/1758-2652-12-34.