HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: Differential access to HIV/AIDS information and services

Abstract

Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41–0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18–1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda’s AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.

Knowledge Gaps of STIs in Africa; Systematic review

“…Fifty one included studies assessed the awareness of 1,235,811 Africans in regard to HIV in total of 35 countries, eleven studies were conducted in Nigeria [14,16,83,17,18,23,38,48,60,63,81] , nine in South Africa [24,27,29,34,37,42,46,82,84] , five in each of Ghana [19,31,65,66,68] and Ethiopia [21,73,77,78,80] , four in Uganda [13,55,72,75] , three in Mozambique [22,26,30] , two in each of Namibia [45,76] and Cameroon [59,67] , one in each of Congo [25] , Sudan [33] , Senegal [39] , Morocco [47] , Gambia [50] , Tanzania [53] , Madagascar [71] and Egypt [74] while a study provided awareness prevalence in 33 countries [8] . The conduction of the studies ranged from 2010 to 2017.…”

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

“…12 They are also more likely to report having a sexually transmitted disease than those without a disability 13 and are also at increased risk of exposure to HIV. 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.…”

“…In a qualitative study conducted by Tun and colleagues, 12 one of the most significant barriers to accessing facility-based HIV services and receiving test results by persons with disabilities in Uganda was related to physical accessibility. 13 For instance, most health centres in Uganda lack ramps and have narrow doorways that hinder the use of movement devices, such as wheelchairs. There is also a failure to consider accessibility for people with physical disabilities into sanitation facilities within health premises.…”

“…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.…”

“Even the fowl has feelings”: access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia

“…However, this continuum consistently overlooks the needs and interests of persons with disabilities (including sensory, physical and intellectual disabilities) who comprise at least 15% of the population [1]. While this omission has historically been attributed to the perception that persons with disabilities are not sexually active, this is a harmful fiction that is easily undermined by extensive empirical data (e.g., [2][3][4][5][6][7][8]).…”