A survey of over half a million people in low- and middle-income countries found that men and women with disabilities were 25% less likely to have comprehensive knowledge about HIV prevention than people without disabilities. They were also less likely to know where to get tested for HIV. In addition, women with disabilities were less likely to know how to prevent vertical transmission and to have been tested for HIV than women without disabilities.
In Samoa, none of the women with disabilities studied had comprehensive knowledge of HIV prevention. In Ghana, men with disabilities were 54 percent less likely to know about HIV prevention than men without disabilities. In Kyrgyzstan and Sierra Leone, women with disabilities were 40 percent less likely to know about vertical transmission than women without disabilities.
The analysis focused on 37 countries with available HIV and disability data for women and a subset of 29 countries that provided data for men. Of these, 12 countries were in sub-Saharan Africa, 7 in East and Central Asia, 6 in Latin and Central America, 6 in East Asia and the Pacific, 4 in the Middle East and North Africa, and 2 in South Asia.
background
There are 1.3 billion people with disabilities worldwide. There is a strong link between HIV and disability, as people with disabilities are at higher risk of contracting HIV due to exclusion and discrimination. Efforts to improve access to HIV prevention, testing and treatment have often overlooked the needs of people with disabilities and those living with HIV who develop disabilities.
Therefore, researchers from the London School of Hygiene and Tropical Medicine compared knowledge about HIV and access to testing between people with and without disabilities aged 15 to 49. They used data from Multiple Indicator Cluster Surveys conducted in 37 low- and middle-income countries.
Multiple Indicator Cluster Surveys use a multi-stage sampling procedure to select clusters of households from a previous national sampling frame (such as a census) to generate nationally representative data on indicators related to sustainable development goals and health and development.
The study involved 513,252 participants from 37 countries, of whom 5% (24,695 people) had a disability. Most participants were female (80%) and 60% were from rural areas. All men and women aged 18-49 were eligible to participate, while participants aged 15-17 were selected if they were among children aged 5-17 randomly selected from the household list.
For adults, disability was defined as those who responded that they “cannot do anything at all” or have “great difficulty” with activities such as seeing, hearing, walking, concentrating, self-care and communicating. For 15- to 17-year-olds, the list of activities also included making friends, accepting change, learning and anxiety.
The researchers compared the following indicators in people with and without disabilities: comprehensive knowledge of HIV prevention, knowledge of where to get tested for HIV, knowledge of mother-to-child transmission, having been tested for HIV before and knowing the result, and having been tested in the last year.
Comprehensive knowledge of HIV prevention was defined as knowledge of the two primary methods of HIV prevention (having only one monogamous, HIV-negative partner and always using condoms), understanding that healthy-looking people can also be HIV-positive, and rejecting the two most common country-specific misconceptions about HIV transmission.
Results
- Comprehensive knowledge of HIV prevention: Both women and men with disabilities had significantly lower knowledge about HIV prevention than women and men without disabilities (adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.69, 0.93) and (aRR: 0.74, 95% CI: 0.67, 0.81), respectively. This difference was most pronounced in Ghana (aRR: 0.46, 95% CI: 0.27, 0.78) and Chad (aRR: 0.53, 95% CI: 0.33, 0.84).
- Knowledge about mother-to-child transmission: Women with disabilities had less knowledge about vertical transmission than women without disabilities (aRR: 0.87, 95% CI: 0.81, 0.93). Countries with marked differences include Palestine (aRR: 0.39, 95% CI: 0.21, 0.72), Kyrgyzstan (aRR: 0.60, 95% CI: 0.44, 0.82) and Sierra Leone (aRR: 0.59, 95% CI: 0.46, 0.77).
- Know where to get tested for HIV: Women and men with disabilities were less likely than people without disabilities to know where to get tested for HIV (aRR: 0.94, 95% CI: 0.92, 0.97) and (aRR: 0.95, 95% CI: 0.92, 0.99), respectively. This difference was most evident in Turkmenistan (aRR: 0.59, 95% CI: 0.42, 0.82).
- People who have already been tested for HIV and knew the result: Women with disabilities were tested less frequently than women without disabilities (aRR: 0.90, 95% CI: 0.85, 0.94). This difference was most evident in Guinea-Bissau (aRR: 0.62, 95% CI: 0.49, 0.79). Among men, there was no difference in testing rates between men with and without disabilities in most countries, with the exception of Fiji (aRR: 0.20, 95% CI: 0.06, 0.65) and Georgia (aRR: 0.57, 95% CI: 0.34, 0.95).
- People who were tested for HIV in the last 12 months and knew the results: Women with disabilities were less likely to have been recently tested for HIV than women without disabilities (aRR: 0.95, 95% CI: 0.90-1.02). There were no differences between men with and without disabilities (aRR: 1.02, 95% CI: 0.87-1.20).
Although men and women with disabilities had lower overall knowledge about HIV and lower testing rates, there were countries where the number of people with disabilities was higher than that of people without disabilities.
- In Tuvalu, women with disabilities knew more about HIV prevention than women without disabilities (aRR: 1.62, 95% CI: 1.05–2.49).
- In Madagascar, women with disabilities were more likely to know about vertical transmission (aRR: 1.31, 95% CI: 1.16–1.47).
- In Tunisia, women with disabilities were more likely to have ever been tested for HIV (aRR: 1.57, 95% CI: 1.07–2.26). Men with disabilities were also more likely to have been tested for HIV than men without disabilities (aRR: 2.81, 95% CI: 1.17–6.72).
- In both Suriname and Togo, men with disabilities were more likely to have been tested in the past 12 months than men without disabilities (aRR: 1.74, 95% CI: 1.28–2.36) and (aRR: 1.59, 95% CI: 1.02–2.47), respectively.
“Efforts should focus on improving the accessibility of sexuality education and HIV services for people with disabilities by ensuring physical and communication access to facilities and information materials,” the researchers write. “Training health workers on disability (including destigmatizing disability and sexual activity) and ensuring that public health and patient information about HIV is available in accessible formats can further improve the quality of these services.”
“Finally, more comparable data on disability need to be available in routine HIV surveys and other national and household-level surveys that address HIV prevalence, knowledge and testing,” they conclude.
