Exposure of Socio-demographic Risk Factors on Hiv Transmission and Use of Sexual Reproductive Health Services Among Persons With Disabilities in Rwanda
Authors: Suubi Patrick , KARANGWA Francois Xavier , Ndagijimana Olivier , Uyisabye Alexis , MUNEZERO Marie Mediatrice , REMERA Eric , MURINDABIGWI Augustin , SANGWAYIRE Beatha , Nwanna Uchechukwu Kevin 
Published: January 2023

Abstract
Introduction: Despite advances in various areas to integrate and support people with disabilities (PWD) in Rwanda, little is known about HIV prevalence among that population, their use of sexual and reproductive health services, and the implementation of inclusion principles. The purpose of this survey was to estimate the HIV prevalence among people with disabilities living in Kigali and secondary cities in Rwanda. Other critical areas investigated included sexual behaviour, HIV comprehensive knowledge, HIV testing history, male circumcision, knowledge and utilization of sexual reproductive health services, and the inclusion principle.
Methodology: The administrative sector was used as the primary sampling unit in this cross-sectional survey, which was conducted in Kigali and secondary cities. To select 30 sectors for the survey, we used a probability proportional to the number of people with disabilities registered under the sector's umbrella and associations (PWD). Then, in each sector, 16 participants were chosen at random. We conducted a life-course history interview and an HIV test on the participants after obtaining their informed consent. The prevalence of HIV among participants with disabilities was the primary outcome. Furthermore, we held a focus group discussion with PWD representatives from associations and cooperatives, CSOs working in HIV, national and bilateral organizations, and policymakers to delve deeply into HIV and sexual reproductive health issues for PWDs. The Rwanda National Ethics Committee approved the protocol (RNEC).
Result: Between October and November 2021, we recruited 443 people with disabilities from Kigali and Rwanda's secondary cities, including Muhanga, Huye, Rusizi, Rubavu, Musanze, and Nyagatare. One of our primary objectives was met when 7.0% of the respondents tested positive for HIV. 12.8% of those polled admitted to having their first sex against their will. Using a condom for the first time was higher overall (80.4%), except among people with hearing and speaking disabilities (61.5%). The survey results also revealed that people with disabilities in Rwanda have a low level of overall comprehensive correct knowledge of HIV (30.7%). Only half of the respondents said they had tested for HIV in the previous 12 months, even though 92.7% said they had been tested for HIV at some point in their lives. In terms of male circumcision, more than half (51.4%) of men with disabilities self-reported having been circumcised, with a higher prevalence of circumcision among men living in Kigali City. Finally, the survey results show that there is still a long way to go in terms of disability inclusion at the family, community, and health facility levels.
Conclusion: This study found a high prevalence of HIV among PWDs when compared to the general population. The qualitative portion of the study highlighted some factors associated with HIV acquisition, such as a lack of HIV information, sexual violence, and PWDs stigma.
Recommendation: This study recommends assessing the law for PWD inclusion implementation and conducting a bottleneck analysis.