People coping with impairments or disabilities have enough to deal with already. Why bother them with HIV prevention measures? The answer is: because among disabled people, certain groups are more at risk of HIV infection than the average person in the street.

Attention to the problematic relationship between HIV/AIDS and disability is rare. At the International AIDS Conference in Bangkok (9-16 July 2004), for example, over 10,000 scientific papers were accepted. Only 20 of these papers (0.2 %) mentioned disability. However, about 10 % (WHO) of the world population is disabled, a percentage which is much higher amongst poorer people, and disabled persons are especially vulnerable to HIV infection. The link between HIV/AIDS and disability has several dimensions. Once infected with HIV, a person with a disability has greater problems finding help or care. Not only because he/she usually has fewer economic resources, but because for example people with physical impairments have problems, for example, with the inaccessibility of buildings and structures used by service providers. Disabled girls and women are at an increased risk of HIV infection. As women they are a marginalised group who, even in the context of their bodies and their physical rights, do not have a lot of choices. Society accords them low status, having a disability compounds that situation. On the other hand, disability and HIV/AIDS are surrounded by a lot of myths and misconceptions: by stigma and discrimination. Children with disabilities are more vulnerable to sexual violence and HIV infection. 

This article focuses on HIV prevention messages and measures for disabled people in developing countries. 

Governments and NGOs in the fight against AIDS completely ignore disabled people, not recognising that they are equally sexual active, or even more vulnerable to sexual abuse. Thus exposure to HIV is at least as high as in the general public. 
Many HIV prevention campaigns focus on raising public awareness through newspapers and written materials which are inaccessible to many poor people. The majority of disabled people belong to the poor and illiterate sections of society in developing countries (World Bank estimates say 17 %). In addition, hardly any HIV prevention messages are available for blind or deaf people. Intellectually disabled young people usually do not receive any sex education and thus also no HIV prevention messages. Research amongst deaf communities in Kenya and Nigeria for instance, reveals that a high proportion of deaf people have an alcohol or drugs problem. Promiscuity, bisexuality and gay relationships score highly too within the somewhat secluded deaf community. The Nairobi deaf community was amongst the first to recognise the danger of HIV circulating amongst their members and of the urgent need to develop sign language and HIV prevention messages. In any home, boarding school or place where people are institutionalised for longer periods, secret sexual relationships and also sexual abuse is frequently encountered. Disabled young people are proportionally more often placed in vulnerable situations.

Disabled people and chronically ill people take more injections in their lifetime than others and, especially in developing countries, this puts them more at risk of HIV and Hepatitis infections. 
Many children with disabilities are frequently exposed to medical services and also to traditional healers by their parents, who are often expressing in this action, their feelings of guilt, desperation and over-protection. The children receive many kinds of injections (painkillers, energisers and stimulants, vitamins, or just fake medicine) and are prone to incisions with a ritual meaning or to a series of surgery. In most developing countries there is no systematic inspection of the needles and razor blades used in sterilisation procedures and sometimes the sterilisation equipment itself is not even in place. Recurrent use of needles and razor blades is common practice. This is a sure way of spreading Hepatitis B, Hepatitis C and/or HIV.

Disabled people not only lack access to information about how to prevent HIV-infection, but they lack HIV-counselling, and they have less access to HIV-testing, which is a necessity for the diagnosis and for access to the treatment which is currently available and often life-saving (though not a complete cure).
Gradually the public in most developing countries is becoming aware that sex education for young people does not trigger promiscuity amongst them. In fact most young people can be protected against sexual abuse and unwanted pregnancies by teaching them the negotiation skills needed for safe sex or no sex, by helping them to recognise and avoid situations in which one could be sexually assaulted, by explaining the risks of Sexually Transmitted Diseases and HIV and promoting the use of condoms. However, there are hardly any such programmes specifically targeted at young people with disabilities. In the event that one becomes uncertain about one’s HIV status, so-called Hotlines (special telephone lines) and HIV-testing centres are advertised. This information barely reaches people with disabilities. The counsellors are usually inexperienced in dealing with disabled people and thus deny such people any counselling at all. The whole chain of events builds risk upon risk: once a person with a disability is at risk of exposure to HIV, he/she may not be aware of the HIV risk or any means of HIV prevention, he/she may not go for HIV testing or HIV-counselling, he/she may not get access to treatment and thus he/she may unknowingly go on to transmit HIV to others. This argument justifies prioritizing the problematic relationship between HIV/AIDS and disability. HIV prevention and education should be made accessible and available to people with disabilities by organisations working with HIV/Aids. Disability networks should ensure access to adequate HIV information for their members, also through advocacy with the government (equal rights to health education and prevention) and through collaboration with AIDS organisations. Stop Aids Now (SAN!) Netherlands is of the opinion that service-providing organisations should offer accessible services to disabled people and that HIV/Aids-interventions targeting people with disabilities should inco-operate disability-specific measures. SAN! also argues that Dutch international NGOs who work with HIV/Aids could be addressed with this specific issue by, for example, testing interventions on the accessibility of disabled people, and integration of problems of people with disabilities in counseling. 

source: http://www.dcdd.nl