The ManicaPost
Wendy Nyakurerwa-Matinde
It never rains for Vimbai Chitikiti (not real name), it pours.
While the twenty-three year old visually impaired Buhera woman has learnt to live with her disability, curveballs are continuously thrown her way.
She dodges some of them but on several occasions she has not been so lucky.
A couple of years ago, she was home alone when an unidentified man came and raped her.
Vimbai recalls that she desperately cried for help but no one came to her rescue as her parents her gone out for some part time jobs in the community.
They came back home to find her beside herself. She could hardly contain the emotional pain.
While a police report was made, no arrests were ever made as no one had seen the intruder.
Months later, Vimbai tested positive to HIV and her journey with the virus began.
Sadly, this scenario captures the predicament of several other young women living with disabilities.
More than one billion people, which is about 15 percent of the world’s population, live with a disability.
Four out of five of these people live in low and middle-income countries, Zimbabwe included.
Disability can be physical, intellectual, a medical condition or mental illness.
Such impairments, conditions or illnesses may be permanent or otherwise.
People with disabilities often experience increased risk factors associated with acquiring HIV, including increased vulnerability to sexual violence and abuse, limited access to healthcare, and lack of access to the information and resources needed to facilitate safer sex.
Women’s Coalition of Zimbabwe (WCoZ)’s Health Cluster lead Ms Abigail Mupfawa said the situation is even worse for HIV positive young women with disabilities.
“Society judges this population and actually blames them for being positive. Society feels that they have no right to sexuality, and hence should not be exposed to HIV, and yet nothing can be further from the truth,” said Ms Mupfawa.
Intersecting vulnerabilities
HIV and AIDS, disability and gender based violence are linked in a number of ways.
Although GBV and HIV-related data on people with disabilities is extremely limited due to research oversight as well as their hesitancy to open up, growing evidence suggests disabled people are more likely to experience factors that put them at higher risk of HIV infection than people who are not disabled.
In addition, there is a misconception that people with disabilities are sexually inactive.
As a result, this constituency is often overlooked in HIV sexual and reproductive health programming and services.
Yet a number of studies have found HIV prevalence among people with disabilities to be nearly the same or even higher when compared to people without disabilities.
In 2014, the global prevalence of sexual violence against people with disabilities — irrespective of the type of disability — was found to be 1.3 times higher than in the general population, 1.39 times higher among women with disabilities and 3.86 times higher among people with mental health conditions.
Children with disabilities were found to be 3.7 times more likely than their non-disabled peers to be victims of sexual violence.
Ms Mupfawa said while most non-governmental organisations do not currently have budgets to cater for people with disabilities, WCoZ has been lobbying Government to increase funding for such programmes.
Women with disabilities and HIV
The vulnerabilities that put people with disabilities at higher risk of HIV are amplified by gender inequality.
Evidence suggests that women with disabilities fare worse than women without disabilities when it comes to vulnerability to GBV, poverty, access to education and vocational success.
Women and girls with disabilities, especially those with intellectual disabilities, are also more vulnerable to sexual violence and abuse.
In addition, they have extremely limited or non-existent access to sexual reproductive health services, leading to unwanted pregnancies, HIV and other sexually transmitted infections (STIs).
Sexual violence, abuse and intimate partner violence experienced by people with disabilities is therefore a significant public health and human rights issue that fuels this population’s vulnerability to HIV.
Stigma and discrimination
People with disabilities often experience stigma and discrimination relating to their disability.
This prevents them from feeling free to report when they are abused.
As a result, disabled people may suffer from low self-esteem and social isolation — something that leaves them even more vulnerable to violence and abuse.
Disabled people then have to face the double burden of stigma and discrimination if they are also living with HIV.
Stigma and discrimination acts as a major barrier preventing people with disabilities from accessing the HIV and sexual reproductive health services they are entitled to.
Reliance on others
People with disabilities often face multiple barriers to accessing healthcare.
Logistical barriers include being reliant on someone else for mobility or communication, support in accessing clinic-based services, or lacking the financial means to travel to a clinic, especially if it is far way.
They may also have reduced physical and emotional defences and experience communication barriers, which hamper their ability to protect themselves or report abuse and violence.
When third-party support is not available, HIV positive disabled people are forced to miss scheduled clinic appointments.
However, rather than being allowed to reschedule or given longer courses of antiretrovirals (ARVs) to reduce the number of times they need to attend the clinic, they are often labelled ‘defaulters’.
Many people with disabilities also experience a lack of confidentiality when testing for HIV because of communication barriers and the need to involve a third person for interpretation.
In addition, many health workers lack the necessary knowledge, skills and resources to provide these accessible, appropriate services.
As a result, people with disabilities may also be put-off from seeking healthcare because of the bad treatment.
Globally, more than 10 percent of women with disabilities reported not returning to seek healthcare because they were treated badly during a previous visit.
Way forward
Tackling HIV among people with disabilities therefore entails holistically tackling barriers so that wider issues such as gender inequality and violence are addressed.
In 2006, the UN Convention on the Rights of Persons with Disabilities, which has been ratified by more than 172 countries, Zimbabwe included, stated that people with disabilities should be included in all global development and health initiatives.
The Sustainable Development Goals also include people with disabilities within several targets.
Zimbabwe is one of a handful of countries in the world to implement a mainstream HIV and AIDS peer counselling training programme for people with disabilities. There is ray of hope on the horizon, after all.
