1. HIV/AIDS AND DISABILITY
IN JAMAICA
By Marigold J. Thorburn, MD
29/12/2018
Presentation for World AIDS Day

2. HIV/AIDS AND DISABILITY IN JAMAICA
THE CURRENT SITUATION
IN THE COUNTRY
29/12/2018
Presentation for World AIDS Day

3. HIV/AIDS IN JAMAICA Courtesy of Dr Peter Figueroa
Sero-prevalence among adults 1.5%
Estimated No. with HIV/AIDS ,000
No. of persons in need of ARV 6,000
No. of persons currently on ARV ,500
29/12/2018
Presentation for World AIDS Day

4. HIV/AIDS IN JAMAICA Challenges
Achieving behaviour change – safe sex
Access to anti-retroviral drugs
Continued discrimination and stigma
Widespread complacency & inertia in the society concerning AIDS
Need to strengthen leadership at all levels
29/12/2018
Presentation for World AIDS Day

5. Presentation for World AIDS Day
HIV/AIDS IN JAMAICA
Most of the persons living with HIV do not know that they are infected
We need to significantly increase both provider and client initiated HIV testing:
29/12/2018
Presentation for World AIDS Day

6. HIV/AIDS AND DISABILITY
No special facilities or programmes for persons with disabilities
In theory they have access to any health facility
29/12/2018
Presentation for World AIDS Day

7. HIV/AIDS AND DISABILITY
Since 2004 there has been a programme supported by the EU and UNFPA for improvements in sexual and reproductive health for adolescents with disabilities
This is part of a national programme being conducted by the National Family Planning Board in four areas
29/12/2018
Presentation for World AIDS Day

8. HIV/AIDS AND DISABILITY
SAFE MOTHERHOOD
FAMILY PLANNING
REDUCTION OF INCIDENCE OF STDs
REDUCING HIV/AIDS
Background and Introduction
The EC/UNFPA Project in Reproductive Health in Jamaica is part of a wider project agreement between the European Commission (EC) and the UNFPA that seeks to address certain issues on reproductive health in selected countries of the African, Caribbean and Pacific (ACP) regions.
The project is consistent with global sexual reproductive health (SRH) objectives endorsed by the International Conference on Population and Development (ICPD) programme of action where international donor organizations such as UNFPA and the EC have collaborated with government, NGO’s, community groups and civil societies to achieve certain population policy objectives. Subsequently the project is also consistent with a number of strategic policy directions being undertaken by the government of Jamaica.
Jamaica was selected to “provide comparative cases to assess best practices”, due to challenges that the country faces in relation to economics and sexual reproductive health (SRH). The target groups are men, adolescents and adolescents with disabilities
29/12/2018
Presentation for World AIDS Day

9. HIV/AIDS AND DISABILITY
BARRIERS FOR PERSONS WITH DISABILITIES
Independent SRH learning
Assisted SRH learning
Effective SRH service delivery
Adolescents- adolescent pregnancy, low contraceptive use among adolescents, early sexual initiation, high-risk sexual behaviour, gaps between adolescents’ perceived and actual risk, high levels of gender-based violence.
Persons with Disabilities- barriers to independent SRH learning, barriers to assisted SRH learning, barriers to effective SRH service delivery.
Males- sexual behaviour in all sexual lifestyles (heterosexual, homosexual, bisexual), cultural beliefs and expectations, high-risk behaviour.
29/12/2018
Presentation for World AIDS Day

10. HIV/AIDS AND DISABILITY
There are no prevalence figures specifically for HIV/AIDS in persons with disabilities
29/12/2018
Presentation for World AIDS Day

11. HIV/AIDS AND DISABILITY
Development of materials on SRH appropriate for use with persons with disabilities.
Sensitization of health service providers, social workers and the general public on SRH needs for persons with disabilities.
Strengthening the capacity of parents of adolescents with disabilities and community members to support the SRH needs of their children
ROLE OF DISABILTIES SECTOR
Activities focussing on persons with disabilities will be implemented by:
The Jamaica Association for the Deaf,
The Jamaican Association on Mental Retardation and
McCam Child Development Centre.
These sub projects are:
Development or adaptation of printed IEC materials on Sexuality and Reproductive Health, appropriate for use with persons with disabilities.
Development or adaptation of audiovisual IEC materials on Sexuality and Reproductive Health, appropriate for use with persons with disabilities.
Development and delivery of sensitization to health service providers, social workers and the general public on SRH needs for persons with disabilities.
Strengthening the capacity of parents of adolescents with disabilities and community members to support the SRH needs of their children
Disabilities Sector Target Group
Although adolescents with disabilities represent the focus of the disabilities sector, parents/care providers, health care providers, social workers and Guidance Counsellors have been identified as secondary target groups given their significant influence in adolescent SRH development. A recent study estimated that 8.6% of Jamaican women and 9.9% of men in the reproductive age group years have disabilities. Given recent research on Early Sexual Activity among Adolescents by K Kempadoo, Ph.D. and Leith Dunn, Ph. D (2001), attention will be given to children with disabilities at the primary school level. The disparity between chronological and developmental age among this special population will also necessitate extension of the age range at the upper end to include young persons up to age 21.
29/12/2018
Presentation for World AIDS Day

12. HIV/AIDS AND DISABILITY
SRH PROJECT FOR ADOLESCENTS WITH DISABILITIES:
Completed so far:
KVAP qualitative study on 4 disability groups
Materials for parents and AWDs
Findings of the study indicate that girls are better informed than boys and had high self esteem.
They are not that different from adolescents with disabilities
There is a lot of material for adolescents because of the 5 year USAID funded programme Youth.now which finished last year.
Adolescents with Disabilities (AWD) were placed in two age groups and years for the focus group discussions. Using a guide, information was obtained on their knowledge, values, attitudes and practices in relation to the reproductive anatomy, physical attractiveness and self esteem, personal hygiene, physiological development, sex, sexuality and sexual practices, family planning and pregnancy, STIs and HIV/AIDS and sexual and reproductive rights and services. The sources of this information were also obtained.
29/12/2018
Presentation for World AIDS Day

13. HIV/AIDS AND DISABILITY
MAIN KVAP FINDINGS ON STDs
Girls more knowledgeable than boys
Aware of importance of HIV/AIDS but range of knowledge poor
Condoms identified as the best means of prevention
Agreed with voluntary HIV testing
Aware of where to get services
Not much difference between different disability groups.
While this may seem good, these adolescents came from special schools and there fore had access to information. It is likely that AWDs not in special schools would be different
29/12/2018
Presentation for World AIDS Day

14. HIV/AIDS AND DISABILITY
This initiative should lead the way to the SRH needs of persons with disabilities being met better through the regular health programmes.
This combined with the increasing resources being put into HIV/AIDS should have benefits for PWDs
Adolescents across all disability groups demonstrated high levels of self esteem and confidence and were accepting of their disability. They had some knowledge of the sexual and reproductive health issues that were investigated but it was uneven across the groups with important gender differences as females tended to be more knowledgeable than males. Overall, except for the knowledge and practice of personal hygiene there were appreciable gaps in knowledge and understanding about aspects of adolescent physiological development, contraceptives, some sexual practices and sexual and reproductive rights. The main sources of reproductive health information were parents, school, mass media and health professionals.
Adolescents had positive values and attitudes to contraceptive use (even though they encountered barriers) and their rights to sexual intercourse and childbearing while recognising that these may be constrained in relation to disability and capacity. Adolescents acknowledged the assistance provided by their parents but reported that many did not discuss sexual matters with them. They also reported acts of discrimination by health care providers when they sought to access contraceptives. They clearly indicated their need for more reproductive health information from traditional and non-traditional sources, friendlier and more sensitive services to access contraceptives and the provision of sexual and reproductive services specially targeted to each disability group.
Parents are supportive of their disabled children and they seek to teach them coping skills appropriate to their disability despite the challenges to provide adequate care. They are aware of their children’s sexual feelings and in some cases advised and counselled them to avoid pregnancy and STIs including HIV. However, many parents admitted to a lack of information and skills on reproductive health and so refrained from discussing such issues with their children. Issues of contraceptive use, abortion and homosexuality are very controversial among parents with respect to their AWDs with mainly strong positions against them. However, important factors that were recognised were the severity of the disability, its impact on capacity should an AWD become pregnant and the associated responsibility and also that the AWD if able, could exercise their personal choice in these matters which may be contrary to that of the parent.
29/12/2018
Presentation for World AIDS Day

15. HIV/AIDS AND DISABILITY
Continued cooperation and coordination between
The National Family Planning Board and
Organisations in the disability sector
However, it should not be necessary to have disability NGOs always involved, because PWDs shoul be able to feel comfortable enough to be able to access regular services.
There is access to information but there is no specific disability related in formation in the public sector other than what I have described.
29/12/2018
Presentation for World AIDS Day

16. HIV/AIDS AND DISABILITY
BARRIERS TO INCLUDING PWDs IN REGULAR AIDS PROGRAMMES
Myths about the sexuality of PWDs
Attitudes of health care workers including pharmacists about providing contraceptives and other advice
Reluctance of parents and personnel to talk about the subject
Without knowing the prevalence rate of HIV in PWDs it would be hard to assess the impact of this intervention. I don’t really feel that the impact on disability would be that great.
Although there is a tendency to regard AIDS as a disability, it would be difficult to incorporate AIDS patients into disability programmes because most of them are NGOs and very under-funded. It would require a lot of additional resource development.
29/12/2018
Presentation for World AIDS Day

17. HIV/AIDS AND DISABILITY
NEXT STEPS
Implementation of educational programmes in the special education services for AWDs and parents
Encouraging and funding the Combined Disabilities Association to develop educational programmes to reach all PWDs
The resources presently available are those that are being developed in the SRH programme for adolescents with disabilities already described. These will span the Ministry of Health AIDS programme as well as the NGOs. I do not see separate programmes for PWDs with AIDS run by disability NGOs or the setting up of special services by the Ministry of Health.
Another resource tbhat should be developed is the Combined Disabilities Association’s capacity to reach older PWDs with educational programmes.
29/12/2018
Presentation for World AIDS Day