1. 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

2. 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 ».

3. 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

4. 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

5. 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

6. 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

7. Results: study population
Disability screening:
End: October 2015.
177 Enumeration areas, people screened ( 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%

8. Study population

9. Study population

10. Study Population: impairments

11. Social participation

12. Any sexual activity

13. 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%

14. Sexual violence
Risk of physical violence (women): OR: 1.40, 95%CI: – No difference in men
Risk of sexual violence: 4.55, 95%CI: in women compared to men

15. Knowledge on HIV

16. Knowledge on HIV transmission

17. Knowledge on HIV prevention

18. HIV infection

19. Conditional Odds Ratio 1.7 [1.03 – 2.83]
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. 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 ?

25. 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

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