Monitoring and Evaluation for Disability-inclusive Meeting

1. Disability and HIV: an appraisal of the vulnerability of people with disabilities to HIV infection in Yaoundé, Cameroon (HandiVIH - ANRS 12302) Monitoring and Evaluation for Disability-inclusive Meeting

2. Need of more data on HIV among people with disabilities « One of the more hidden communities struggling with HIV is people with disabilities. Few programmes exist to enable their access to HIV prevention and treatment services […] because of a lack of data ». “We cannot run away from from the needs of […] people with disabilities” M Sidibe 20th International AIDS Conference Opening Session—Melbourne, Australia – IAS 2014

3. Methods • Design: • Population based study (Yaoundé, Cameroon) • Cross-sectional and comparative (control group) • Population: • People with disabilities: • Age: 15 to 49 years • Washington Group questionnaire: ≥ 1 major difficulty or 2 minor difficulties (>1 year) • Visual, hearing, physical, intellectual / mental limitations considered • Controls matched on age, sex and residential area • Procedures: • Two stages sampling • Face to face interviews (including interviewers with disabilities) • On site HIV testing using to rapid tests

4. Identification of people with disabilities eligible and of their controls Screening team Phase 1: screening + Phase 2

5. Identification of people with disabilities eligible and of their controls Screening team Phase 1: screening + Phase 2: Interview of eligible subjects HIV test • Interviews about • Disability and social participation • Life-course history • KBP HIV and FP • Reproductive Health • Access to services and health care

6. Statisticalmethods • Conditional logistic regression • Sub-group analysis: • Physical, visual, hearing intellectual / mental impairment • Impairment severity • Age of disability onset (<> 10 year) • Restriction of social participation? • Problem of the mediating factors (education, socio-economic level) • Sensitivity of results to test refusal

7. Results: study population • Disability screening: • End: October2015. • 177 Enumeration areas, 49 035 people screened (21 869households) • Interview of the people withdisabilities and controls: • End: 30th November 2015 • 807 personswithdisabilities and 807 matchedcontrols • (+ 40 personswithdisabilitiesbegging in the street and 30 personswithdisabilitiesmembers of DPO) • HIV test refusal: 9%

8. Study population

9. Study population

10. Study Population: impairments

11. Social participation

12. Anysexualactivity

13. Sexuality

14. Sexual violence

15. Knowledge on HIV

16. Knowledge on HIV transmission

17. Knowledge on HIV prevention

18. HIV infection

19. HIV infection Conditional Odds Ratio 1.7 [1.03 – 2.83]

20. Risk of HIV infection ORcond = 1.7 [1.03 – 2.83]

21. Risk of HIV infection ORcond = 1.7 [1.03 – 2.83]

22. Risk of HIV infection ORcond = 1.7 [1.03 – 2.83]

23. Acces to health care • Access to care reduced in PwD: • 17.5% vs 8% of women, 38% vs 25% of men (OR = 2.8, p<0.001) • 68% vs 76% of women who gave birth • More common difficulties (OR: 2.3 [1.80 – 2.94])

24. Wedid not have time to talk about • Role of social environment and network • Economic, family and worktrajectories • Role of DPO (Essomba et al. AFRAVIH 2016) • Dramaticvulnerability of PwDbegging(De Beaudrap et al. ICASA 2015) • HandiVIHin Burkina Faso • HandiVIH: whatnext ? • https://youtu.be/VYYD_e5mJe4

25. Conclusions • => Reduced knowledge • => Exposure to infection • HIV infection is more common among people with disabilities • Various risk factors: • Lack of information • Lack of access to education • Economic constraints • Sexual violences • Less access to care • Relation between HIV and disability is two-sided

26. Acknowledments Handicap International IFORD FOCAP ANRS Initiative 5% du Fonds Mondial Service de Coopération et d’Action Culturelle Sidaction IRD DPO of Yaoundé Sight Savers ACMS All people with disabilities and participants to this study HIV Outpatient services