HandiVIH—A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations

Abstract

IntroductionIn resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities.Methods and analysisThe HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents’ life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people's organisations is collected separately.Ethics and disseminationThis study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities.Trial registration numberNCT02192658.

Young women with disabilities and access to HIV/AIDS interventions in Uganda

“…For young women with disabilities, this elevated risk is compounded by additional risks associated with gender and age, making them particularly susceptible to HIV infection. 14 The predominant view of women with disabilities as a sexually inactive homogeneous group, who do not conform to cultural and commercial images of feminine beauty, fosters a negative self-image among young women with disabilities that erodes their self-confidence for initiating and maintaining safe sexual relationships. 15 Ugandan adolescents with disabilities have reported low self-esteem and self-efficacy, which impacted on control over safe sexual relationships and rendered them more susceptible to targeted abuse, rape and exploitation at an early age.…”

“…As a result, poor education, poverty and social isolation as well as inaccessibility of health information make young women with disabilities less likely than other young people to be informed about HIV and to access necessary prevention and treatment interventions. 13,14 Misconceptions that persons with disabilities are not sexually active frequently lead to their exclusion from HIV education, prevention and support services. They are confronted by high levels of stigma and discrimination which leave scant room for the full enjoyment of their rights to information and services as well as attention to the risk of HIV.…”

Ineffectiveness of information and access to health services: vulnerability to human papillomavirus

“…Such dynamics depends on each individual, access to means of communication, educational levels, availability of material resources and qualified professionals in the transmission of this information (De Beaudrap et al. ).…”

Determinants of knowledge, attitudes, and practices in relation to HIV/AIDS and other STIs among people with disabilities in North-Shewa zone, Ethiopia

“…Human immune virus (HIV) and other sexually transmitted infections (STIs) and disability are linked in several ways [ 5 ]. Although HIV-related data on PWDs are limited, growing evidence suggests PWDs are more likely to encounter factors that put them at higher risk of HIV and other STI infection than people without disabilities [ 6 ].…”

“…Persistent discrimination against and exclusion of PWDs increase their vulnerability of HIV infections [ 7 ]. Furthermore, there is a misconception that PWDs are sexually inactive and they are frequently overlooked in HIV prevention and AIDS (acquired immune deficiency syndrome) programs [ 3 , 5 ]. They are highly vulnerable to sexual abuse and experience social marginalization, which places PWDs at increased risk of HIV and STI infection [ 7 , 8 ].…”