In southern Africa , discussing sex and sexual issues among the disabled is taboo, as it is widely, and wrongly believed that they do not engage in sexual activity. As a result, informing them of the risks of Sexually Transmitted Infections (STIs) and HIV has long been thought to be unnecessary, often to the detriment of this marginalised group. This group can be divided into various sub-categories based on the type of disability and its severity, as well as on the basis of gender. The triple stigma and discrimination that disabled women living with HIV face is immense for not only do they encounter the negative attitudes and actions related to their respective disabilities – they also experience similar reactions to their being women, and HIV positive.
What are the different types of disabilities?
Disabilities differ in their nature and severity, ranging from being sensory (deafness, blindness), physical, and intellectual to mental. Social factors can also influence the severity of a disability. For instance, in the developed world, those who are visually impaired can get spectacles to rectify their problem, whereas in the developing world, these simple solutions might not be accessible for all.
What are the links between disability and HIV, particularly in women?
Because many disabilities leave individuals vulnerable and in need of constant care and support, women with disabilities experience a high incidence of abuse – physical, emotional, psychological and verbal – the implications of which include forced sex and possible infection with HIV. Myths about sleeping with a disabled person to cure HIV have also been identified as contributing factors.
Women are biologically more susceptible to infection from HIV than men, in any given heterosexual encounter. Violence increases a woman's susceptibility to acquiring the virus further, due to tears and lacerations resulting from the use of force.
Disabled women may also acquire the virus through consensual sex. Women living with disabilities are also often unemployed or poorly paid and may therefore find themselves having to use transactional sex in order to survive, Visual impairments such as blindness can mean that a woman can be ‘tricked' into having unprotected sex with a man under the false impression that he is wearing a condom.
What proportion of the world's population is living with a disability?
According to the World Health Organization (WHO), 10% of the world's population is made up of people living with a disability significant enough to make a difference to their daily lives. Eighty percent of these live in the developing world, with a larger proportion in rural rather than urban areas.
What obstacles stand in the way of disabled people's personal and social growth?
In poor societies, it is generally recognised that those living with a disability are the poorest. This is because they are often not granted the same access to education as their able-bodied peers due to a number of factors, including the fact that educational institutions and materials that suit their special disabilities are virtually non-existent (books in braille, or centres for handicapped and deaf learners).
Disability condemns many to unemployment thus contributing to poor nutrition and lack of access to health services, or to safe living and working conditions.
What are the implications of this in terms of accessing information on HIV and AIDS?
Low levels of formal education among the disabled mean that they may experience illiteracy as a major impediment to reading and comprehending messages on HIV and AIDS. In 1998, the global literacy rate for adults with disability was 3%, and as low as 1% for women. Disabled women are therefore harder to reach with health messages as they are much more likely to be illiterate than their able-bodied counterparts.
People with intellectual and mental disabilities usually face the inherent disadvantage of being slow learners. This puts them in a worse predicament when it comes to understanding even basic information on HIV prevention, treatment, care and support. Where a disabled person partners with an able bodied and knowledgeable person, the knowledgeable partner has the power to withhold or disseminate HIV information at will. Should the disabled person require treatment there are further challenges in how they will understand the importance of adhering to medication, which could result in the creation of drug-resistant strains of HIV which are more expensive to treat.
As mentioned above, very few HIV materials in braille and information disseminated through sign language audio-visuals are available and d ifferent adaptations of materials are necessary to accommodate different types of disabilities.
Can disabled people be reached by HIV prevention and care services?
There are unique challenges involved in reaching disabled people with HIV prevention and care services, due to low literacy rates and the limited access to education previously mentioned.
Disabled individuals also report being turned away at HIV testing centers or AIDS clinics. Interventions such as ramps for those with physical impairments, sign language interpreters for those who are deaf and simplified HIV and AIDS messages for those with intellectual impairments are still lacking. Where AIDS treatment is scarce and where services and support for individuals with HIV or AIDS are limited, individuals with pre-existing disabilities are often placed last on the list of those entitled to care.
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