Examples of good practices on disability inclusion in HIV programming

Muriel Mac-SeingHIV and AIDS/Protection Technical Advisor

Handicap International

Disability Networking Zone, International AIDS ConferenceMelbourne, July 24, 2014

Handicap International Founded in 1982, Handicap International (HI) is a

federation composed of eight national associations from France, Belgium, Switzerland, Luxembourg, Germany, UK, USA and Canada

Present in 60 countries worldwide HI works in rehabilitation, social inclusion (inclusive

education and employment), disability rights, support to DPOs, health and prevention, anti-mine action and emergency

Co-winner of the Nobel Peace Prize in 1997 as a co-founder of the International Campaign to Ban Landmines (ICBL)

Recipient of the 2011 Hilton Humanitarian Prize

HIV and AIDS at Handicap International

HI has been involved in the AIDS response since 1994 from Eastern, Western and Southern Africa to South East Asia

Is a co-founder of the African Campaign on Disability and HIV from 2007 to 2011: http://www.africacampaign.info/

Promoter of the Kampala Declaration: http://www.africacampaign.info/uploads/media/kampala_declaration_on_disability_and_hiv_aids.pdf

Since May 2014, member of the Human Rights Reference Group of the Global Fund that Fights against AIDS, Tuberculosis and Malaria

Experience on HIV and disability

AFD/EIDHR

GFUNICEF UNDPFHI360 /

PEPFAR

PSI / USAID

AFD5PC

HRSA/PEPFAR

AFD/Big

Lottery

http://www.hiproweb.org/uploads/tx_hidrtdocs/HI_Work_on_HIV_and_AIDS-EN-2013-ref.pdf

Utilisation of the twin-track approach

Handicap International and DfID, Disability, Poverty and Development, Feb, 2000, page 11.

Handicap International (2010). Access to services for persons with disabilities: Practical guide, page 19.

...Also based on HI’s guideline on access to services for people with

disabilities....

Handicap International (2012). Inclusive and integrated HIV programming: Policy Paper.

...And a disability inclusive and HIV programming integrated to SRH and

GBV....

Some facts 15% of the world’s population lives with a disability; 19%

among female population (WHO/WB, 2011) Women with disabilities and men with disabilities are

respectively 2.2 and 1.48 times more at risk to be infected by HIV than non-disabled men in Sub-Sahara Africa (De Beaudrap et.al, 2014)

The prevalence of violence against people with disabilities is 1.3 times higher than that in the general population (Hughes et al., 2012)

Children with disabilities are 3.7 times more affected by all forms of violence than their non-disabled peers (Jones et al., 2012)

PLHIV are also at risk of developing disabilities on a permanent or episodic basis as a result of their illness and/or side effects of ARV (Hanass-Hancock & Nixon, 2010; O’Brien et al, 2008)

Interrelationship between HIV and AIDS and disability

People with disabilities

Lack of access to education especially sexuality/sexual health education

Lack of access to HIV information and services

Increased risk to sexual violence and less access to justice

Negative attitudes from service providers

Stigma and discrimination (disability, gender and HIV)

People who care for PLHIV (old or

young)

AIDS related activities limitation associated with increased child healthcare task, decreased school attendance in children, food insecurity and educational outcomes

PLHIV developing epidosic and/or

chronic disabilities

Mental health disorders: depression, schizophrenia, anxiety, substance abuse

Impairments such as neurocognitive impairments, blindness,

deafness, peripheral neuropathy, etc.

Episodic disabilities

Hanass-Hancock & Nixon, 2009; HEARD 2013

In Senegal Regional project on disability inclusion also involving Mali and Burundi

(AFD/USAID Senegal; 2008-2011) National platform on HIV and disability for advocacy Seroprevalence and KAP survey among people with disabilities in

Dakar HIV prevalence almost twice more inclusion of people with disabilities in the NSP (human rights, services and budget allocation sections)

Micro-projects between DPOs and local AIDS service providers for increased accessibility

Results of first project and strong partnership with SWAA Senegal combined with support from the NAC lead to the financing of another project (2013-2016) by the Initiative 5%

Renewed collaboration with the national and regional NAC to work on the national M&E system and registries in VCT centres and treatment clinics to include disability

Referral of PLHIV to physical basic rehabilitation services

In Rwanda HIV and disability project with integration with SGBV services Implemented in 2008-2013 and funded by the Health Resources and Services

Administration/USG Organizational development of DPOs and CBOs as a result 2 DPOs

financed by the Global Funds on HIV and AIDS before the end of project Adaptation of IEC/BCC material (cross-impairments) Capacity building of disabled people to become peer educators/support Reasonable physical accommodation in VCT centres Training of health/HIV service providers in sign language and on disability

inclusion and rights Work with the MoH on disability inclusion and data disaggregation

information in VCT registries ownership and inclusion of disability in new NSP along with separate department on disability and injury

SGBV assessment of the situation of people with disabilities: http://www.hiproweb.org/uploads/tx_hidrtdocs/RwandaSDRS05.pdf

Capitalisation document of good practices on disability inclusion: http://www.hiproweb.org/uploads/tx_hidrtdocs/HILessons_Learned_Collection_Strengthening_communities_to_integrate_persons_with_disabilities.pdf

In Ethiopia Mainstreaming of disability in PEPFAR/USAID funded mainstream AIDS

organizations (PSI, PC, Intrahealth, JHU, Addis Ababa University and the National AIDS Resource Centre) this led to a successful partnership consortium with PSI to include disability into their national HIV prevention programme

Implemented in 2010-2013 and funded by World Learning/USAID Disability accessibility audit; disability focal points appointed TOT training on disability inclusion in HIV and SRH for health

professionals Disability accessibility action plan for health structures (adaptation of

IEC material, sign language for VCT counsellors, physical accessibility)

Capacity building of service providers, relevant local authorities, media, architects/engineers

Coaching and ongoing technical assistance/support to partners KAP surveys among people with disabilities in Addis Ababa Advocacy and sensitization during ICASA 2011

In Cambodia HIV prevention and sexual violence protection for people with disabilities,

especially deaf women in rural areas of Cambodia Implemented in 2008-2012 and funded by the French Development

Agency Mapping of people with different impairments in target areas Quantitative (KAP) and qualitative (vulnerability) assessment Awareness-raising and HIV/SRH/GBV education and prevention Development of a lexicon in Cambodian signs on HIV/sexual violence

with the Deaf-Development-Program (DDP) Cambodian sign language training to deaf women in their villages to

become awareness-raising facilitators Establishment of support groups for deaf women Capacity building to and work with target Commune Councils to include

disability into the commune development action plan Linkages to health care services and GBV multisectoral services

(psychosocial, medical and police/legal)

Some key challenges....

Still not enough evidence creation such as HIV prevalence studies among people with disabilities lack of comprehensive national data on HIV and AIDS and disability

Though numerous funding for “vulnerable groups” and progressive increase of funding focusing on disability, still limited donors’ prioritization on this largest world minorities

Scaling up of disability inclusive approach and initiatives in HIV/SRH programming

Limited partnership between AIDS and disability-focused organizations/DPOs

How to take advantage of provision of international tools and documents?

HEARD/HI et al. Framework on the inclusion of disability in NSPs (2011)

UNAIDS Investment Framework (2011) know your epidemic (s) people with disabilities are there!

Capitalize on the HLM on disability and development (Sept 23, 2013) and related discussions, position papers, resolutions

Human Rights Reference Group of the Global Fund to promote respect of rights of key and vulnerable populations (2013)

UNAIDS strategy review on HIV and disability (2014) UNAIDS Gap Report with people with disabilities as one of the

ten groups left behind (2014) ... And all countries which have ratified the UN CRPD!!

Opportunities and ways forwards

Support mechanisms for disability-related data collection in HIV and AIDS as part of the national M&E system (epidemiological and behavioural information)

Invest in research for evidence collection and knowledge management towards practice

Support the inclusion of disability in national AIDS strategic frameworks and plans

Assist disabled people’s organizations (DPOs) to be part of national AIDS committees

Ensure signification participation of people with disabilities in decision-making processes, implementation and M&E system

Promote gender equality and disability inclusion

Opportunities and ways forwards

Strengthen/facilitate networking/partnership between HIV and disability at international, national and grass-roots levels

Capacity building/technical assistance of mainstream AIDS organizations on disability inclusion

Bridge the gaps between academics/researchers, disability activities and ground practitioners

Support and monitoring of the application of the UN CRPD and national laws and policies

Engage the private sector in AIDS and disability

Online resources on HIV and disability

Handicap International « Ask Source » resources site: http://www.asksource.info

HEARD Resource Centre: http://www.heard.org.za/african-leadership/disability

Canadian Working Group on HIV and Rehabilitation: http://www.hivandrehab.ca/EN/index.php

UNAIDS: http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf

UN Enable: http://www.un.org/disabilities/default.asp?id=1560

Thanks!

Merci !