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HIV/AIDS and People With Disability

By Nora Ellen Groce

June 2003

Reprinted from The Lancet, April 26, 2003

Although AIDS researchers have studied the disabling effects of HIV/AIDS on previously healthy people, little attention has been given to the risk of HIV/AIDS for individuals who have a physical, sensory, intellectual, or mental health disability before becoming infected. It is commonly assumed that disabled individuals are not at risk. They are incorrectly thought to be sexually inactive, unlikely to use drugs, and at less risk for violence or rape than their non-disabled peers. Yet a growing body of research indicates that they are actually at increased risk for every known risk factor for HIV/AIDS. For example, in a recent article, S. Blumberg and W. Dickey analyze findings from the 1999 U.S. National Health Interview Survey and show that adults with mental health disorders are more likely to report a medium or high chance of becoming infected with HIV, are more likely to be tested for HIV infection, and are more likely to expect to be tested within the next 12 months than are members of the general population.

Such findings should not be unexpected for individuals with disability. There are significant risk factors for disabled populations around the globe. For example, despite the assumption that disabled people are sexually inactive, those with disability -- and disabled women in particular -- are likely to have more sexual partners than their non-disabled peers. Extreme poverty and social sanctions against marrying a disabled person mean that they are likely to become involved in a series of unstable relationships. Disabled individuals (both male and female) around the world are more likely to be victims of sexual abuse and rape than their non-disabled peers. Factors such as increased physical vulnerability, the need for attendant care, life in institutions, and the almost universal belief that disabled people cannot be a reliable witness on their own behalf make them targets for predators. In some countries, parents of intellectually disabled children now report rape as their leading concern for their children's current and future well-being. Individuals with disability are also at increased risk of substance abuse and less likely to have access to interventions. It is estimated that 30% of all street children have some type of disability and these young people are rarely reached by safe-sex campaigns.

Furthermore, literacy rates for disabled individuals are exceptionally low (one estimate cites an adult literacy rate of only 3% globally), thus making communication of messages about HIV/AIDS all the more difficult. Sex-education programs for those with disability are rare, and almost no general campaigns about HIV/AIDS target (or include) disabled populations. Indeed, where AIDS campaigns are on radio or television, groups such as the deaf and the blind are at a distinct disadvantage.

The future for disabled individuals who become HIV-positive is equally grim. Although little is known about access to HIV/AIDS care, disabled citizens receive far fewer general health services than others. Indeed, care is not only often too expensive for impoverished disabled persons, but it can also be physically inaccessible -- e.g., clinic steps bar the way for a wheelchair user and consultation with a physician without a sign-language interpreter is meaningless for most deaf persons.

Currently, little is known about HIV/AIDS and disability. Only a few studies have estimated prevalence and no prevalence data exist for any disabled populations from sub-Saharan Africa, Asia, Europe, Central and South America, or the Caribbean. However, a growing number of stories from disability advocates worldwide point to significant unreported rates of infection, disease, and death. Over the past decade there have be a handful of articles on HIV/AIDS pilot programs and interventions for intellectually disabled adults or services for deaf adolescents. Many of these projects are innovative but almost all are small and underfunded. There is a real need to understand the issue of HIV/AIDS in disabled people in global terms and to design and implement programs and policy in a more coherent and comprehensive manner. The roughly 600 million individuals who live with a disability are among the poorest, least educated, and most marginalized of all the world's peoples. They are at serious risk of HIV/AIDS and attention needs to be focused on them.

In January 2003, the World Bank and Yale University, started a global survey on HIV/AIDS and disability that seeks to better understand variables of the current epidemic as well as to identify best-practice interventions and grassroots efforts.

Organizations that serve people with HIV and disability are invited to participate in the survey. International respondents are especially welcome.

Contact: Nora Ellen Groce, Global Health Division, Yale School of Public Health, Yale University, New Haven, CT 06520, USA; e-mail:

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