Disability and HIV: Vulnerability of People With Disabilities to HIV Infection in Sub-Saharan Africa
Condition: HIV; Reproductive Health; Disability
MeSH terms: HIV Infections
Study type: Observational

Summary: 
      According to the recent World Report on Disability, around 15% of the world population lives
      with a disability and 80% of people with disabilities (PWD) live in developing countries.
      More and more evidence show that PWD are more likely to be poor, vulnerable to physical and
      sexual violence, and to have less access to education. Therefore, PWD are likely to have an
      increased risk for HIV infection, potentially being a key population in regard to this
      epidemic.

      The vulnerability of PWD was recognized in 2007 by the United Nations Convention on the
      Rights of Persons with Disabilities. However, data on the extent how PWD are affected by HIV
      is still very limited. As a result, PWD are usually overlooked by National AIDS Control
      Programmes and few projects specifically targeting them have been developed.

      Recognizing the need for appropriate and reliable data to help protect the rights of PWD and
      achieve a better inclusion of disability in National AIDS Control Programmes, the Institute
      of Research for Development (IRD), the Institut de Formation et Recherche Demographique
      (IFORD) and Handicap International (HI) propose this study that aims to provide quantitative
      and qualitative data on the vulnerability of PWD to HIV infection in Cameroon and Burkina
      Faso, in order to define if this vulnerable population is also a Key Population in relation
      to the HIV epidemic. This study adopts a multidisciplinary approach (quantitative and
      qualitative methods). Quantitative data are collected only in Cameroon.

      Only the quantitative study is described here.
    

Detailed description: 
      OBJECTIVES:

      The general objective of this study is to provide information on the vulnerability of PWD to
      HIV infection.

      The objectives of the quantitative component of this study are:

      Estimation of the HIV burden among PWD:

        -  To estimate the prevalence of HIV in PWD comprehensively and for each of the following
           disabilities 1) hearing 2) visual 3) mobility 4) cognitive (intellectual)

        -  To compare the HIV prevalence between PWD and non-disabled matched controls

        -  To assess the association between PWD's social network characteristics and the risk for
           HIV

      Assessment of the knowledge, behaviour and practice toward HIV infection and sexual and
      reproductive health (including contraception) overall and for each of the impairment groups
      mentioned above:

        -  To describe and analyze the knowledge, attitude and behaviours related to HIV infection

        -  To compare the knowledge, attitude and behaviours between PWD and non-disabled matched
           controls

        -  To describe sexual and reproductive activities of PWD

        -  To describe and analyze the access and actual use of family planning methods in PWD

      Access to HIV prevention and health careglobally and for each of the impairment groups
      mentioned above:

        -  To describe and analyze the determinants of and barriers to access to prevention and
           testing services

        -  To describe and analyze the determinants of and barriers to access to care

        -  To compare the access to services between PWD and non-disabled matched controls

      Specific objectives related to disability:

        -  To describe the population of PWD in Yaoundé

        -  To describe and analyze the characteristics of the social networks of PWD

      METHODOLOGY

      Study design:

      This is a cross sectionnal study assessing HIV prevalence, HIV risk factors and sexual &
      reproductive health of PWD compared to a control group of Non-Disabled People. PWD are
      sampled from the general population using a two-step sampling method. Eligible subjects are
      proposed an HIV test and to respond to a questionnaire on their Knowledge, Attitudes and
      Practices (KAP) in relation to HIV and SRH, on their social network and on their access to
      prevention and care services. The life-grid interview method is used to collect data on
      subject's history of social participation, employment, resources, sexual partnership and
      reproductive life. Controls are selected from the PWD's neighborhood.

      Sample size:

      850 disabled subjects and 850 non-disabled controls

      Study location: Yaounde, Cameroon

      Estimated planning or Study timetable :

      Study start date: April 2014 (exploratory work) Total trial/study duration: 24 months
    

Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Community sample:

        - PWD are identified thanks to the disability screening tool developped by the Washington
        Group (WG). This tool is based on the WHO International Classification of Functionning
        (ICF).

        A stratified cluster sampling in 2 steps is used in Yaounde. The city has been divided in
        enumeration areas (EAs). First step : EAs are drawn randomly with probability proportional
        to their size in number of households. Second step: in each EA, 30 households are randomly
        drawn and each person living in these households is screened for disability with the WG
        tool, according to the inclusion and exclusion criteria.

        - For each PWD, 1 non-disabled control person is randomly chosen from the census list of
        the same enumeration area. Controls are matched on age and sex.