"Persistent discrimination against and exclusion of people with disabilities, in particular women and girls with disabilities, increases their vulnerability, including their risk of HIV infection."
This report from the Joint United Nations Programme on HIV and AIDS (UNAIDS) highlights existing key evidence on the relationship between disability and HIV. Persons with disabilities are defined here as those who have long-term physical, mental, intellectual, or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others. It discusses the concrete steps needed for a person-centred, disability-inclusive HIV response that allows for increased participation of people with disabilities and integrates rehabilitation within the continuum of HIV care.
As noted here, the Sustainable Development Goals (SDGs) feature a strong message to "leave no one behind", including people with disabilities. Similarly, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) calls on state parties to ensure the rights of people with disabilities to participate and be included in all spheres of life. Yet, the United Nations Secretary-General's 2016 report on the Fast-Track to end the AIDS epidemic and the United Nations Political Declaration on Ending AIDS recognise that people with disabilities, in particular women and girls with disabilities, experience barriers to accessing HIV services and are left behind in HIV policy-planning, programme development, service delivery, and data collection. The UNAIDS 2016-2021 Strategy highlights the effort needed to reach the 90-90-90 targets, which calls for zero discrimination, person-centred responses, equal access to health programmes and services, including sexual and reproductive health and rights, and integration of rehabilitation into HIV care to enhance quality of life.
Specifically, the report highlights the multiple ways in which people with disabilities have been excluded and neglected in all of the sectors responding to HIV. This situaton can be attributed to factors such as stigma and discrimination in all spheres of life, including health, education, work, and the justice system. Another hindrance to access is exclusion from sexuality education: Young people with disabilities may be sexually active and may engage in behaviours that put them at risk of acquiring HIV, but they may have little knowledge about HIV and sexuality because of issues like teachers' lack of the skills and tools to accommodate people with diverse learning needs.
According to UNAIDS, including disability in the HIV response requires commitment to counteract underlying inequality and discrimination across all sectors and a shift towards integrating HIV with disability and rehabilitation services. Disability is described in the report as a cross-cutting issue in the response to HIV, calling for broader social, cultural, and economic development that is person-centred, is disability-inclusive, and addresses the barriers that people with disabilities face. Countries and organisations that have advanced the inclusion of people with disabilities across sectors often use a twin-track or three-track approach. The twin-track approach promotes two concurrent actions: disability-specific activities designed directly for people with disabilities and the mainstreaming of disability across all sector responses. This approach also includes the authentic participation and active involvement of people with disabilities in all elements of programmes. The three-track approach adds the need to include political will and funding to facilitate the inclusion of people with disabilities.
The report examines how to make equal access and participation in HIV programmes a reality, stressing the need for leadership and inclusion of people with disabilities in the following areas:
- creating disability-inclusive policies and programmes;
- including people with disabilities in other key programmatic areas;
- adjusting the workplace for people living with HIV and disability;
- disaggregating national HIV surveys via sex, age, and disability;
- assessing accessibility of HIV services through a disability audit;
- evaluating HIV and sexual and reproductive health and rights interventions for people with disabilities;
- training and supporting educators of people with disabilities to address misconceptions and strengthen access to comprehensive sexuality education;
- adapting mainstream HIV and sexual and reproductive health and rights approaches to include people with disabilities;
- developing disability- and gender-sensitive approaches to identify and report violence;
- empowering people with disabilities as agents of change by appointing them as leaders in inclusive HIV programmes;
- enabling peer education and support for people with disabilities;
- training people with disabilities to strengthen legal literacy and rights awareness;
- developing accessible information material in areas of rights protection for adults and children with disabilities, HIV information, and HIV prevention and treatment; and
- integrating sexual and reproductive health and rights and HIV services into disability-focused programmes and the work of disabled peopless organisations.
The report examines strategies for developing integrated and comprehensive HIV services - e.g., integration and use of e-health tools advancing early identification of disability, linkage to care, and learning tools - and then lays out a framework for action. As part of this framework, UNAIDS advocates for the three-track approach described above and lays out opportunities for action:
- for governments - example: ensure that people with disabilities (particularly women), their advocates, and researchers can actively participate in all stages of planning, implementation and evaluation of HIV policies and programmes. In collaboration with the disability sector, develop disability-inclusive policy frameworks by signing, ratifying, and domesticating CRPD, prohibiting all forms of discrimination based on disability and promoting equality through national legislation.
- for civil society - example: foster collaboration between women's organisations, networks of women living with HIV, and disabled people's organisations. Civil society organisations can often provide people with disabilities with opportunities to network and exchange information with diverse stakeholders, such as governments, funders, non-governmental organisations, implementers, and researchers.
- for development partners and funding agencies - example: ensure that the programmes in which they are involved are designed, implemented, monitored, reported on, and evaluated with a focus on the specific needs and priorities of women and girls with disabilities, including those living with HIV.
- for all - example: develop regional and country-specific strategies to enhance the participation of people with disabilities in key priority areas.
UNAIDS website, October 23 2017. Image credit: Rachel Chaikof