Date Published: April 13, 2017
Publisher: Public Library of Science
Author(s): Julie Abimanyi-Ochom, Hasheem Mannan, Nora Ellen Groce, Joanne McVeigh, Stefano Federici.
Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41–0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18–1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda’s AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.
There is a tribe of Ugandans … whose issues and needs have not been given their due and appropriate attention in the fight. By all indications, persons with disabilities have been forgotten, consciously and unconsciously. They represent “the forgotten tribe”. (Mwesigwa Martin Babu)  (p.30)
Table 1 provides an overview of respondents’ descriptive characteristics by disability status. On average, persons with disabilities were generally older (32 years compared to 27 years); had no formal education (16% compared to 13%); had been previously married (17% compared to 9%); reported being poorer (21% compared to 16%); and resided in a rural area (77% compared to 70%).
Our results present an evolving pattern of understanding and actions surrounding persons with disabilities and HIV and AIDS in Uganda. Comparing persons with disabilities with members of the population without a disability, we found a solid knowledge base of HIV/AIDS among a significant part of the population of persons with disabilities, which may reflect both greater AIDS outreach efforts to the general population and specific efforts to provide more information on HIV/AIDS to persons with disabilities in recent years. While we have no large baseline against which we can compare changes over time, these new figures may indicate that current outreach efforts are making progress.
Uganda has a strong history of policy and programmes that support the rights of persons with disabilities. This is evident in Uganda’s national legal framework . The Ugandan Constitution in Article 32 upholds that “the State shall take affirmative action in favour of groups marginalised on the basis of gender, age, disability or any other reason created by history, tradition or custom, for the purpose of redressing imbalances which exist against them” . Disability is also recognized in the Uganda 2010 HIV Counselling and Testing Policy, which in Article 6.2 recognizes that persons with disabilities may be at higher risk of HIV infection and also may experience difficulty in accessing services. The Article stipulates that all HIV Counselling and Testing services address the unique needs of persons with disabilities .