ETHIOPIA: Finding space for people with disabilities on HIV agenda
HIV messages and services need accessible to people with disabilities (file photo)
ADDIS ABABA, 8 March 2012 (IRIN) - Ethiopians with disabilities say they have been largely excluded from the government's national HIV programmes and are unable to access services.
"What comes first is the lack of awareness among persons with disabilities. This is mainly due to the fact that... most modes of communications the campaigners have chosen are not accessible to them and primarily target persons without disabilities," said Liya Solomon, inclusive family planning/reproductive health services project coordinator at the Ethiopian Centre for Disability and Development (ECDD). "The other challenge is inaccessibility of HIV-related services for the group.
"For those small numbers that the messages reach and who do come seeking HIV-related services, they face all sorts of challenges, starting from physical barriers in health centres that make it impossible for them to use services like VCT [voluntary HIV counselling and testing]," she added.
According to the government
, an estimated seven million Ethiopians - 10 percent of the population - are living with some kind of disability. There is a shortage of data on HIV prevalence among people with disabilities, but one 2008 study of 132 blind people in the northern region of Tigray found an HIV prevalence of 4.5 percent, higher than the national average of about 2.4 percent.
The Central Statistical Agency of Ethiopia's 2011 Demographic and Health Survey states that an estimated 97 percent of women and 99 percent of men have heard of HIV, while 56 percent of women and 82 percent of men know that consistent use of condoms prevents HIV transmission. This knowledge is significantly lower among people with disabilities.
Genet Adamu, a health service provider, recently completed a study, Accessibility and Utilization of HIV/AIDS Services among People with Hearing Disability in Addis Ababa, as part of a post-graduate degree. She found that out of 238 respondents in the capital, Addis Ababa, only 39 - about 16 percent - had comprehensive knowledge about HIV/AIDS. The study also found that more than 67 percent of respondents had poor safe sexual practices that could potentially lead to HIV infections. The study further revealed that utilization of services such as VCT was low, at just 28 percent.
According to ECDD's Liya, poor health worker attitudes further complicate disabled people's access to HIV services. "In a study... we found that some of the service providers are of the opinion that a person doesn't have a sexual need because he or she has some kind of disability," she said. "This directly or indirectly leads them not to be willing to provide counselling and other services for persons with disabilities, let alone encouraging them to access it."
ECDD has been training service providers such as VCT counsellors in sign language; the organization partnered with state organs to run a training scheme between 2009 and 2011 that reached 26 health centres and five hospitals in the capital; two major regional cities were later included as well.
"Between August 2010 and June 2011, sign language training was offered to 18 counsellors from Awassa [in Ethiopia's southern region], 21 counsellors from Addis Ababa and 20 counsellors from [the southern] Oromia region," said Retta Getachew, inclusive HIV/AIDS services project coordinator at ECDD. "The trainees have begun offering the services to clients with hearing impairments."
The challenge now is "getting the clients to come", she said, adding that they were working with disabled persons' associations to publicize the services.
"Part of our efforts has been revamping three selected hospitals, including Zewditu Hospital in Addis Ababam," said Retta. "After we overhauled Zewditu Hospital, once any person with any sort of disability reaches the gate, they can go all the way to the VCT centre to access the services without any facing any challenge. Both the facility and services are accessible."
"A much simpler solution is to make the facilities accessible to persons with disabilities right from their inception," Retta said. "According to research, there would only be a 2 percent increase in construction costs, which is much cheaper than demolishing and reconstructing later."
The Addis Ababa Health Bureau says although the small improvements are a step in the right direction, the true solution is to mainstream the disability agenda into all government policies.
"We have the model heath centres in place and have deployed trained counsellors across the major cities' health centres and hospitals; the remaining task, already being done, seems to be introducing the services to the clients. But when the flow of clients surges, it is inevitable that the existing centres will not be enough to accommodate them," said Tariku Molla, social mobilization and mainstreaming case team coordinator at the city's health bureau. "When we consider building a heath centre or draw up a policy document, we need also to consider needs of peoples with disabilities. And for that we need to be able to mainstream the agenda; that is where I think the real solution lies."