Monitoring and Evaluation for Disability-inclusive Meeting 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

Need of more data on HIV among people with disabilities “We cannot run away from from the needs of […] people with disabilities” M Sidibe 20th International AIDS Conference Opening Session—Melbourne, Australia – IAS 2014 « 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 ».

Methods Design: Population: Procedures: 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

Screening team Phase 1: + screening Phase 2 Identification of people with disabilities eligible and of their controls Screening team Phase 1: screening + Tirage aléatoire de zones de dénombrement Recensement complet des zones de dénombrement Phase 2

Interview of eligible subjects 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

Statistical methods 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

Results: study population Disability screening: End: October 2015. 177 Enumeration areas, 49 035 people screened (21 869 households) Interview of the people with disabilities and controls: End: 30th November 2015 807 persons with disabilities and 807 matched controls (+ 40 persons with disabilities begging in the street and 30 persons with disabilities members of DPO) HIV test refusal: 9%

Study population

Study population

Study Population: impairments

Social participation

Any sexual activity

Sexuality Women Men PwD Controls Sexually active 84.5 90.5 77.5 90 No of partners of the last 12 months 1 2 2.3 No of long-term relationships 2 [1 – 2] 2 [1 -2] 1 [1 – 2] 2 [1 – 3] Multiple partners 31% 33% 61% 65% Paid / transac relations 14.3% 12.8% 10.4% 10.3%

Sexual violence Risk of physical violence (women): OR: 1.40, 95%CI:1.04 - 1.90 – No difference in men Risk of sexual violence: 4.55, 95%CI:2.50 - 8.28 in women compared to men

Knowledge on HIV

Knowledge on HIV transmission

Knowledge on HIV prevention

HIV infection

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

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

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

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

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])

We did not have time to talk about Role of social environment and network Economic, family and work trajectories Role of DPO (Essomba et al. AFRAVIH 2016) Dramatic vulnerability of PwD begging (De Beaudrap et al. ICASA 2015) HandiVIH in Burkina Faso HandiVIH: what next ? https://youtu.be/VYYD_e5mJe4

Conclusions 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 => Reduced knowledge => Exposure to infection Intérêt des suggestions de l’analyse pour compléter le plan d’analyse

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