1. Customizing HIV Intervention Modalities for Persons with Disabilities for Persons with Disabilities Phillimon Simwaba Harare, Zimbabwe Motto: Creating an Inclusive Society

2. Structure of Presentation  Introduction  Disability Risk Factors  Vulnerability  Reaching Populations of Persons with Disabilities  Focused and Customized Approaches  Practical experiences from Zambia  Strategies of Customized  Some Recommended Customized strategies  Conclusion

3. Disability Risk Factors The risk factors associated with disability are:  Extreme poverty  Social stigma and marginalization  high rates of unemployment  Lack of access to education and health care  No attention to impact of the AIDS epidemic on persons with disabilities  Misconceptions that persons with disabilities are asexual  Subjected to myths (sex with person with disability cures AIDS)  Challenges in communication and Access to HIV/AIDS services

4. Vulnerability  Individuals with disability are at equal to significantly greater risk for all HIV/AIDS risk factors, and as such, must begin to be included in all AIDS outreach efforts.  Sub-groups within disabled populations (e.g. women with disabilities, disabled adolescents, members of ethnic and minority populations with disabilities), are at even greater risk (World Bank: 2004; Yousafzai and Edwards 2004, Groce: 2005)

5. Persons with Disabilities are identified as a vulnerable group and calls for HIVAIDS Interventions that are customized and focused on such vulnerable groups. The disability population is subdivided into various disability categories and sub-groups and further calls for targeted interventions for each of the categories and subgroups. Vulnerability

6. Gaps in Reaching Populations of Persons with Disabilities Gaps in Reaching Populations of Persons with Disabilities The tragedy of disability and HIV and AIDS raises a lot question that services providers have not been able to answer adequately and effectively.  Balancing costs of outreach to Persons with Disabilities versus outreach to able-bodied peers.  Assumed prejudice that persons with disabilities are asexual and do not require any targeted HIV /AIDS responses  Persons with disabilities have low levels of education and mostly are accustomed to charity and not as equal partners in responding to HIV and AIDS interventions

7. Focused and Customized Approaches  Customize interventions for optimum effectiveness modalities, as appropriate communication need for visually and hearing impaired  Rights of equality of access to information is the most effective argument for customized and focused approaches to reach out to persons with disabilities  Focused and Customized approaches must be implemented with the confines of disability inclusive HIV/AIDS programming  No potential response addressing issues for persons with disabilities is able to work for all categories of disability

8.  Diverse intervention strategies contribute in similar diverse and significant ways for specific categories of disability  Different disability groups encounter varied challenges in the response to HIV and AIDS (such access to ART, access to education materials, access to VCT and Social Support services) Focused and Customized Approaches

9. Practical experiences from Zambia “...I’m a hearing impaired person. Now in these hospitals, there’re no sign language interpreters, and say, the attitude of some of the nurses is very negative. They can yell at you, uh, I’m sick, and then how am I going to be helped because there’s a communication barrier.” People whose disabilities are longstanding describe heightened experiences of disability-related stigma upon acquiring HIV (e.g., people with visible disabilities describe being stared at the added burden they had “created” by becoming HIV +. (Sepo study Report, Zambia)

10. Strategies of Customized  Organizations implementing HIV/AIDS interventions for persons with disabilities can use a combination of approaches that can be used to address issues of persons with disabilities. For example adopting a twin track approach of including in the mainstream while also targeting the disability sector  Plans must be put in place on how services will be accessible and appropriate to people who are deaf, hard-of- hearing, visually impaired, intellectual disabilities, psychosocial disabilities and disabled, or physical disabilities

11. Some Recommended Customized strategies  Disability-specific interventions addressing needs of groups within the persons with disabilities population; who are potentially not reached through HIV/AIDS outreach campaigns addressed to mainstream population because of disability-specific limitations  Include and train persons with varied disabilities as HIV peer educators to support other persons with disabilities on HIV education. These must work with/in both in Mainstream HIV interventions and as well as in disability sector  Some selected disability specific organizations must be identified and be trained as lead agencies to peer disability organizations and to support HIV education to other disability organizations and persons with disabilities

12.  Within the mainstream counseling and testing centres, models of disability inclusive programming must be developed and implemented. These should address challenges of accessibility, information access, stigma and discrimination and other negative issues that persons with disabilities encounter Some Recommended Customized strategies

13. Conclusion  Disability constitutes various categories whose needs are diverse  Within these categories are subgroups of women and youths and other minority groups that must have customized approaches in order that they be reached  Customized approaches must be used in order to effectively address issues of each category  Inclusion into mainstream disability interventions are must be ensured in order to allay issues of stigma and discrimination

14. The End and Thanks