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People with physical, sensorial and intellectual disabilities are among the most vulnerable to the impact of HIV and AIDS
HIV is a significant and almost wholly unrecognised problem among disabled people worldwide. According to the Global Survey on HIV/AIDS and Disability (1), individuals with disabilities are at equal or higher risk of HIV infection, compared to people without disabilities. Disabled people are more likely to have several sexual partners in a series of unstable relationships because they are less likely to marry (2). They are also more likely to be victims of sexual abuse and rape in cultures where HIV-positive people believe they can be “cleansed” of the virus by having sex with virgins, because disabled people are often assumed not to be sexually active (3). Physical dependence, life in institutions, and “the almost universal belief that disabled people cannot be a reliable witness on their own behalf”, also make them particularly vulnerable to abuse and infection (4).

Low literacy rates among disabled people and difficulty to access radio and television messages for the deaf and the blind, present real challenges to information outreach. Sex education programs for disabled people persons are rare. Access to general healthcare services is also poor for a variety of reasons, including social and economical obstacles and problems to physically access the health facilities. Disabled people living with HIV in Africa often face multiple discriminations from being disabled, poor and HIV-positive.

What is Handicap International’s approach to communities affected by HIV and AIDS?
Handicap International uses community development for the inclusion and social inclusion of people living with the virus. Our approach relies on the involvement of people living with HIV and has four components: primary prevention, healthcare, social and economic inclusion and rights and policy. These goals and outcomes will be achieved over time by working with consortium of organisations and well-established networks.

Handicap International puts its emphasis on social and economic inclusion by reducing discrimination in the communities, schools, health system and workplace as well as by providing opportunities for inclusion.

We have a strong history of community-based healthcare programmes. Through training of healthcare providers, establishment of community pharmacies or involvement in home based care initiatives, we seek to empower local people to improve their own healthcare at community level, while lobbying and promoting change at higher levels of government.

Current activities and future directions
Over the last 5 years, Handicap International has been active in the fight against HIV and AIDS in the following field programmes:

• Prevention and public awareness activities are heavily emphasised in projects in Mozambique, Kenya and Burundi. In Laos, Cambodia and Morocco, our teams involved with community health education have included HIV prevention messages through a variety of means, including village awareness-raising sessions, school magazines, theatre and school plays, among others.
• HIV testing is part of the Kenya programme, both in Kitale and Garissa, with plans to regionalize activities to Somaliland, Djibouti and Ethiopia.
• Healthcare is a major component of activities in Burundi and Kitale, Kenya. With the assignment of an HIV/AIDS Medical Advisor to the East Africa region, training of health care workers in the management of opportunistic infections, referral networks and support for district-level hospitals in rural zones for the eventual arrival of antiretrovirals have been greatly enhance. 
• Activities toward the economic inclusion of people living with HIV and AIDS have been an important part of the programmes in Burundi, Kenya and Burkina Faso. In Mozambique we have been working toward the social inclusion of AIDS orphans since 2002.
• Access to HIV information and services for disabled people is a current focus for a large umbrella project in Kenya. Ethiopia is poised to launch a project for access to legal and health services for disabled victims of sexual abuse. Handicap International's programme in France has a solid experience through a project addressing sexuality among intellectually disabled persons living in institutions in France.

In addition to further development of these ongoing activities, Handicap International aims to expand its involvement in three areas. 

• Social and economic inclusion of people living with HIV and AIDS and their families: the Southeast Asia Regional Planning Seminar for the Social and Economic Integration of People living with HIV/AIDS (November 2004) launched this initiative in programs in Thailand, Cambodia, Laos and Vietnam. Programmes in Mozambique, Kenya and Russia are also considering this focus.
• HIV and Disability: obtaining equal access to HIV information and services for disabled people is a preoccupation in programmes most affected by the AIDS epidemic. We aim to increase its support to partners in developing countries to address the particular vulnerability of disabled people. In addition, an inter-Africa network among organizations and individuals interested in the prevention of HIV among the physically and intellectually disabled will be piloted through our Nairobi office. Program Togo recently hosted an exploratory visit to design a strategy to introduce HIV prevention information into our rehabilitation projects and with our partners in order to reduce vulnerability as well as stigma.
• Human Rights and Mainstreaming: through participation in networks and keeping current with global trends for access to essential medicines and other human rights, we will increase its visibility and voice in the fight against inequalities linked to HIV and AIDS. Handicap International is currently devising its internal HIV workplace policy which includes medical coverage for HIV care. Beginning January 2006, all programmes will be required to adapt the policy to the local context. Programs in countries where the impact of HIV is heavy will be encouraged to mainstream HIV considerations into all projects and all activities.

External link: Africa Campaign on Disability and HIV & AIDS

(1) Groce N. Global Survey on HIV/AIDS and Disability. The World Bank/Yale University. April 2004,  http://circa.med.yale.edu/globalsurvey

(2) Economic and Social Commission for Asia and the Pacific. Hidden sisters: women and girls with disabilities in the Asian Pacific region. New York: United Nations, 1995.

(3) Jewkes R, Martin L, Loveday P. The virgin cleansing myth: cases of child rape are not exotic. Lancet 2002; 359: 711.

(4) Nosek MA, Howland CA, Hughes RB. The investigation of abuse and women with disabilities: going beyond assumptions. Violence Against Women 2001; 7:477-99.