A hallmark of the HIV/AIDS epidemic has been its impact on vulnerable populations. Surprisingly, one of the world’s most vulnerable populations — individuals who live with a permanent physical, sensory (deafness, blindness), intellectual, or mental health disability — has been almost entirely overlooked despite the fact that they are at equal or increased risk of exposure to all known risk factors for HIV. It is commonly assumed that individuals with disability are at low risk of HIV infection. They are incorrectly believed to be sexually inactive, unlikely to use drugs or alcohol, and at less risk of violence or rape than their non-disabled peers. Individuals with mental illness have received more attention, but a focus on this group still lags behind that for the general population.
Individuals with disability are among the most stigmatized, poorest, and least educated of all the world’s citizens. One person in ten — 600 million individuals — lives with a disability significant enough to make a difference in their daily lives; 80% live in developing countries. Although disability is often addressed solely as a medical concern, the greatest problems facing individuals with disability are social inequity, poverty, and lack of human rights protection — not simply lack of access to medical care. Indeed, as stated by the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities, one can be both disabled and healthy.
Little is known about HIV/AIDS in populations with pre-existing disabilities. The handful of prevalence studies available raise serious concerns, however. For example, a small US study found that HIV rates among deaf individuals were double those of hearing populations. Another study published in 2001 revealed that AIDS was the leading cause of mortality among women with psychiatric illness in New York. Mulindwa, using sexually transmitted infections (STIs) as a proxy for potential HIV exposure, found that 38% of women and 35% of men with disability in her Ugandan study reported having had an STI. Anecdotes from disability advocates point to significantly underreported rates of HIV/AIDS infection, disease, and death. The extent of the problem in sub-Saharan Africa prompted Johnson to state that provision of rehabilitation services to disabled populations is “no longer possible” until HIV is addressed.
This article is based on results drawn from the World Bank/Yale Global Survey on HIV/AIDS and Disability, a project at the Yale School of Public Health through the Center for Interdisciplinary Research on AIDS (CIRA) and cosponsored by the World Bank’s Office of the Advisor on Disability and Development and the World Bank’s Global HIV/AIDS Program. The survey assessed the impact of the AIDS epidemic on disabled populations, and received over 1,000 responses from 57 countries. We sought to identify issues of access to HIV/AIDS knowledge, services, and care specific to individuals with disability over and above those confronted by members of the general population in resource-poor settings. We were particularly interested in identifying where individuals with disability shared common concerns with members of the general population around issues of HIV/AIDS and where they confronted disability-specific issues and concerns. Survey results found that AIDS is a looming problem for individuals with disability worldwide – a problem that is still largely unrecognized by both the AIDS and the disability advocacy communities.
©The President and Fellows of Harvard College
