CHAPTER TWO
2.7 Disability and HIV/AIDS
2.7.1 Risk factors for HIV infection among people with disability
2.7.1.6 Low HIV/AIDS knowledge and risk perception
Studies show that HIV/AIDS knowledge among PWD has consistently been low (Enwereji &
Enwereji, 2008; Munthali et al., 2004; Yousafzai et al., 2005). Although there are not many comparative studies in the sector, the few available ones indicate that PWD‘s HIV/AIDS knowledge was lower than that of their non-disabled peers (Grassi, Pavanati, Cardelli, Ferri, &
Peron, 1999; Groce et al., 2007; Otte et al., 2008; Yousafzai et al., 2004).
Yousafzai et al. (2005) note that PWD‘s level of HIV/AIDS knowledge varies according to the nature and severity of their disability. For example, a communication barrier was identified among those with hearing impairment; printed materials are inaccessible to persons with visual impairment; and access to meeting places is difficult for persons with physical impairment. This finding is corroborated by Olaleye et al. (2007), who report lower knowledge of HIV/AIDS among school-going persons with hearing and speech impairments than other PWD in Nigeria.
Yousafzai et al. (2004) also reveal that PWD in their study had access to a lower range of HIV/AIDS information sources than their non-disabled counterparts. Otte et al. (2008) reports a
128 similar finding in that the visually-impaired participants reported access to HIV/AIDS information to mainly be through spoken channels, via churches and mosques, whereas the non- disabled also accessed such information from posters/billboards. Consequently, the level of HIV/AIDS knowledge of PWD was also lower than that of the non-disabled in both studies.
Moreover, PWD in these studies were more likely to report wrong HIV transmission routes such as sharing of toilets and utensils with infected persons, kissing, and inhaling in dirty places than the non-disabled. In addition, many of them were not able to differentiate between HIV and TB (Yousafzai et al., 2004). Lack of HIV transmission and prevention knowledge, as indicated above, could translate into a higher rate of exposure to HIV among PWD.
Furthermore, as demonstrated by participants in the study by Mulindwa (2003), HIV risk perception was low despite the reported sexual risk factors for infection. More females (55.0%) than males (44.0%) considered themselves at risk of HIV infection. This may reflect the socialisation of men and the perception that they are to be strong and invincible. Participants admitted that there was a risk of HIV infection due to having a history of unprotected sex and multiple partners. In contrast, most (90.0%) of the respondents in a study in Zimbabwe perceived themselves to be at high risk of HIV infection (Nganzi & Matonhodze, 2004). The gender disparity followed the same trend, whereby more females than males perceived themselves to be at high risk. The 10.0% that considered themselves to be at low risk thought so because they had never engaged in sex or else practised serial partnering instead of multiple partnering. This suggests that they were still confused about the routes of transmission of the virus, thus underrate their risk, thinking the virus cannot be transmitted through having serial partners. In addition, Wazakili et al. (2006) found that PWD and even parents often rationalised the reasons for their low HIV risk perception in the face of risky sexual behaviours, whereas a few others were ignorant or pretended to be ignorant of the sexual transmission routes of HIV.
129 2.7.1.7 Sexual abuse
Persons with disability are at higher risk of sexual abuse than the non-disabled (L.M. Mitchell &
Buchele-Ash, 2000). Women and girls with disability are particularly soft targets for sexual abuse (Kvam & Braathen, 2008). Rousso (2003) suggests that this is linked to the nature of their disability, which may make it difficult for them to assess violent situations, defend themselves and/or flee, or report abuse. On the other hand, they are perceived as sick, weak and helpless, and thus are easy prey for sexual predators. She further explains that this is exacerbated by being denied sexuality education which could equip them with the opportunities and skills to recognise and address violence.
Furthermore, a communication barrier may make it difficult for PWD to report sexual abuse to a trusted adult (L.M. Mitchell & Buchele-Ash, 2000). It is also possible for a person with intellectual disability to be declared an incompetent witness if she cannot articulate the incident (Dickman & Roux, 2005). Therefore, the case may go unreported or, if reported, may be dropped due to a lack of evidence.
Within the current HIV/AIDS pandemic, the issue of sexual abuse of PWD is increasingly important because of the misconception that a man can be cured of HIV/AIDS by having sex with a virgin (Groce & Trasi, 2004). Women and girls with disability are often considered virgins due to the myth of their asexuality. They then stand the risk of becoming HIV-infected because men may sexually violate them. In addition, such violent sexual encounters are risky because they are likely to be unprotected and, because of the force that is usually involved, there may be internal injury that further increases the chance of HIV infection.
Mulindwa (2003) reveals that 22.0% of the women respondents‘ first sexual encounters had been due to rape. Similarly, 7.0% of 1,704 persons with hearing impairment in Kenya reported rape as their first sexual encounter (Steadman Group, 2008). Additionally, most of the participants (93.0%) in the study by Philander reported being aware of sexual abuse among persons with visual impairment, which was brought about due to unequal power relations (Philander &
Swartz, 2006). Although none of these studies directly compare the rate of sexual abuse among PWD with that experienced by the non-disabled, Groce (2004b) suggests that they are up to three
130 times more at risk of sexual abuse than non-disabled persons. It could also be suggested that the vulnerability of women with disability to HIV infection is higher than with non-disabled women and men with disability considering their higher rate of exposure to rape.