A focus on disability is necessary to achieve HIV epidemic control

Kuper, Hannah; Heydt, Phyllis; Davey, Calum

doi:10.1016/s2352-3018(21)00345-3

Cited by 10 publications

(27 citation statements)

References 65 publications

(117 reference statements)

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“…Our rst result contradicts studies that found that persons with disability have a higher risk of HIV infection than the general population; and that HIV prevalence was often twice higher among women with disability than women without disability, with no differences between men with and without disability (5,6,11,12,13,14,15,16,17). Further, disability is more concentrated among older than younger persons, women than men, rural than urban dwellers, less educated than more educated, and poor than wealthy households, consistent with the results of our study (1,2,3,23).…”

Section: Discussioncontrasting

confidence: 98%

“…Analyzing data sets for different countries containing the HIV testing and treatment cascade and disability variables may have yielded different results. Surveys that sample more persons with disability, include data on HIV biomarkers and HIV incidence, are required to better estimate differences in HIV prevalence and care cascade between persons with and without disability, to inform disability-inclusive HIV services (5).…”

Section: Discussionmentioning

confidence: 99%

“…Persons with disability are disadvantaged in several domains of life (1,2,3,4,5,6). Globally, regardless of measurement methods used, persons with disability have lower educational attainment, employment, food security, and wealth.…”

Section: Introductionmentioning

confidence: 99%

“…These studies have shown that persons with disability often face delays and barriers in accessing HIV testing, ART and care, ranging from long distances to HIV services, negative attitudes from society and health providers, to high costs (5,6,11,12,13,14,15,16,17,18). These barriers include poor governance, leadership, nancing, and lack of appropriate data (5,6,11,16,19). However, these studies and others have also shown that sometimes persons with disability have accessed HIV testing, treatment, and care as much as persons without disability, depending on the type of disability and functional di culties (5,6,11,12,13,14,15,16,17,18).…”

Section: Introductionmentioning

confidence: 99%

“…This article uses the term "disability" rather than "disabilities" to re ect disability as a universal experience and not an intrinsic characteristic of the person. Unfortunately persons with disability are neglected in accessing life-saving HIV services (4,5,6) despite the governments, globally, making signi cant progress in achieving the UNAIDS 90-90-90 target by 2020 with the ultimate aim to end the AIDS epidemic by 2030 (8). The 90-90-90 target sought to ensure that by 2020, 90% of people living with HIV (PLHIV) would know their HIV-positive status, 90% of those knowing their status would have accessed anti-retroviral therapy (ART), and 90% of PLHIV accessing ART would have suppressed their HIV viral loads protecting their health and limiting the spread of HIV (9).…”

Section: Introductionmentioning

confidence: 99%

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Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

Chipanta

Mitra

Amo-Agyei

et al. 2023

Preprint

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Background Persons with disability may have a higher HIV prevalence and be less likely than persons without disability to know their HIV-positive status, access antiretroviral therapy (ART), and suppress their HIV viral load (HIV testing, treatment, and care cascade, also known as the 90—90—90 and the 95—95—95 targets set to be achieved by 2020 and 2025, respectively). Methods Using the Tanzania HIV Impact Survey (THIS) data collected between October 2016 and August 2017, we assessed differences in HIV prevalence and progress towards achieving the 2020 HIV testing, treatment, and care cascade target between persons with and without disability. We presented the sample characteristics by disability status and analyzed the achievement of the cascade target by disability status, and sex. We used multivariate logistic regressions, and adjusted for age, sex, rural-urban-residence, education, wealth, and region. Results The sample comprised 1,831 people living with HIV (PLHIV) with a median age of 32 years (IQR 21—45). Approximately 11.8% (95% Confidence Interval [CI]: 10.2%—13.6%, n= 212) of PLHIV in Tanzania were disabled. HIV prevalence was higher (6.2%, 95% CI: 5.3%—7.4%) among persons with disability than persons without disability (4.7%, 95% CI: 4.4% — 5.1%); Women with disability were more aware of their HIV-positive status (n = 101, 79.0%, 95% CI: 68.0%—87.0% versus n = 703, 63.0%, 95% CI: 59.1%—66.7%) and accessed ART more frequently (n = 98, 98.7%, 95% CI: 95.3%—99.7% versus n = 661, 94.7%, 95% CI: 92.6%—96.3%) than women without disability. After adjusting for socio-demographic characteristics, the odds of having HIV and of accessing ART were not statistically different between PLHIV with and without disability. However, PLHIV with disability had higher odds of being aware of their HIV-positive status (aOR 1.69, 95% 1.05—2.71) than PLHIV without disability. Men on ART with disability had lower odds (aOR = 0.23, 95% CI: 0.06—0.86) to suppress HIV viral loads than their counterparts without disability. Conclusion We found no differences in HIV prevalence and access to ART between persons with and without disability in Tanzania. Whereas PLHIV disability, women in particular, were advantaged in knowing their HIV-positive status, men on ART with disability may have been disadvantaged in having suppressed HIV viral loads. These differences are correctable by disability-inclusive HIV programming. HIV surveys in multiple countries sampling more persons with disability are required to measure differences in HIV prevalence better and in attaining the 2025 HIV testing and treatment cascade target for both persons with and without disability.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

Chipanta

Mitra

Amo-Agyei

et al. 2023

Preprint

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HIV knowledge and access to testing for people with and without disabilities in low‐ and middle‐income countries: evidence from 37 Multiple Indicator Cluster Surveys

Rotenberg,

Chen,

Hanass‐Hancock

et al. 2024

J Int AIDS Soc.

Self Cite

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IntroductionDisability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well‐established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities.MethodsWe used cross‐sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub‐Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta‐analysis to get a pooled estimate for each sex and indicator.ResultsMen and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother‐to‐child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]).ConclusionsMen and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability‐inclusion and accessibility to HIV‐related information, education and healthcare services.

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The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance

Kuper,

Heydt,

Hameed

et al. 2024

SSM - Health Systems

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A focus on disability is necessary to achieve HIV epidemic control

Cited by 10 publications

References 65 publications

Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: A cross-sectional study using population-based data

HIV knowledge and access to testing for people with and without disabilities in low‐ and middle‐income countries: evidence from 37 Multiple Indicator Cluster Surveys

The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance

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