As has become the norm in mainstream national interventions, disability has been sidelined once again in the Global fund 2014 -2016 round to combat HIV and AIDS, tuberculosis and malaria, cementing a disability-exclusion trend that started in 2002 with the inception of the Global Fund intervention in Zimbabwe.
The Executive Director of the National Association of Societies for the Care of the Handicapped, (NASCOH), Farai Mukuta, says that despite NASCOH winning the Auxillia Chimusoro award in 2007 for advocating for HIV and AIDS as an issue of real concern among people with disabilities (PWDs), the prevailing view in society is that PWDs are not sexually active and do not warrant inclusion in HIV and AIDS interventions. Consequently, there have been no there have been no deliberate efforts to address the issue of AIDS among people with disabilities and to incorporate them within the rubric of the national response.
“There is an erroneous assumption in society that people with disabilities. On the contrary, people with disabilities are just as sexually active as the rest of the society and the lack of provision of HIV and AIDS information in disability-friendly formats makes them even more vulnerable to the pandemic. It is unfortunate that they continue to be systematically excluded in national HIV and AIDS interventions.
A Disability and HIV and AIDS situation analysis commissioned by NASCOH in 2003 revealed that people with disabilities are particularly vulnerable to AIDS due to their low literacy levels, little access to health care, high vulnerability to sexual abuse, lack of information on AIDS especially for the visually impaired and hearing impaired, and consequent lack of inclusion in AIDS intervention programmes. Stigma, fear and ignorance results in the majority of PWDs refraining from accessing available services such as VTC, Antiretroviral therapy, home based care and counseling. Such is the impact of stigma, discrimination and social exclusion among people with disabilities that those who contract HIV go to extra lengths to hide their status, for fear of compounding this stigma, discrimination and social exclusion. The peculiar situation of people with disabilities calls for urgent, target-specific interventions aimed at mitigating the impact of AIDS in the disability sector.
Just as people with disabilities are a forgotten and invisible group in society, they are also forgotten in planning for HIV/AIDS programmes. In the majority of cases, people have found it convenient to wink at the issue of AIDS among people with disabilities, to find solace in the erroneous assumption that PWDs do not engage in sexual activity, or to just regard the problem as inconsequential. The reality, however, is that disabled people are just as sexually active as the rest of the society and are even more at risk of infection because of the obvious barriers that they encounter in accessing vital information on HIV/AIDS, not to mention access to health care. In addition to the attendant factors that have been documented by research as heightening or ameliorating the prevalence of HIV/AIDS in any society, on a general level, the prevalence of AIDS among people with disabilities is further compounded by the following special considerations, again documented by research:
- Hearing and visually impaired people registered lower scores on the HIV/AIDS Knowledge Index than hearing people, thus indicating low levels of awareness of AIDS issues.
- The incidence of alcohol abuse within the hearing impaired community is estimated to be at 35% compared to 12-14% incidence among the general population.
- It is estimated that 1 in 7 hearing-impaired persons has substance abuse problems, compared with 1 in 10 in the hearing population.
- People with serious mental illnesses have a lower level of self-efficacy where taking protective measures is concerned. This observation obtains even where knowledge and awareness of AIDS issues is present.
- People with learning disabilities have difficulties in negotiating safe sex. Incidences of homosexuality are also noticeably higher among this group
- A strong connection between increased risk taking behaviour and risk of contracting HIV has been documented among adolescents hospitalised for emotional behaviour.
- Compliance and adherence to TB medication is very low for the mentally ill, and homeless.
- Access to information and treatment, and issues of social status has been noted to be issues of real concern for women with disabilities.
Although the issue of HIV and AIDS has been addressed comprehensively in the wider society in Zimbabwe, as evidenced by the reported fall of the country’s HIV and AIDS prevalence rate from 26% in 2000, 18.1% in 2005, and 15% in 2011, this success story does not, regrettably, include people with disabilities (PWDs), who have been systematically sidelined from all HIV and AIDS intervention programmes in the country, on the erroneous assumption that they are not sexually active. AIDS constitutes nature’s greatest threat to mankind, and any intervention that fails into account a sizeable proportion of the country’s population (1 950 000 people or 15% of Zimbabwe’s total), is ineffectual and falls short of the mark. Fundamentally, it can be likened to
pouring water into a bucket riddled with holes at the bottom, as it ignores the potentially devastating effects occasioned by the crucial dynamics of sexual interaction between PWDs and the able bodied populace and among PWDs themselves.
The social exclusion of PWDs is not limited to the HIV and AIDS arena, but extends to the Millennium Development Goals (MDGs). Although the MDGs are an international blueprint for development that hold a lot of scope for committing governments to “making the right to development a reality for everyone and to freeing the entire human race from want”, disability is not mentioned in any of the 8 MDGs, the 18 targets set for achieving these goals and the 48 indicators for measuring the achievement of these targets, effectively leaving out people with disabilities out of the development loop. By excluding a large part of society, the MDGs have ensured that PWDs are mostly unable to benefit from the achievements made in attaining the MDGs, including in the area of HIV and AIDS impact mitigation.