1. Opportunities and Obligations for Disability Inclusion in the UNAIDS Investment Framework Dr. Jill Hanass-Hancock Health Economics and HIV and AIDS Research Division University of KwaZulu-Natal, South Africa

2. There are 1 billion people with disability in the world, which is more than those living with HIV. Phillimon Simwaba (Director DHAT, ICASA 2013)

3. What do we know? -People with disabilities are at increased risk of exposure to HIV (because they are more likely to be dependent and live in poverty, they are less likely to access education and health, are excluded from HIV prevention and sexuality education and are at increased risk of sexual abuse) -People with disabilities are members of all known at key populations and in some countries are referred to as key populations themselves. -HIV, its co-morbidities and treatment cause health conditions that lead to disability (including mental impairment). -Children living with HIV experience disability (stunting, developmental delays)

4. Why is this important? -15% of the world population (or 1 billion people) have one or more disability. We are currently missing a large part of the population in our efforts to reduce HIV risk and infections. -HIV, its co-morbidities, treatment and aging with HIV, cause health conditions that lead to and increase disability. With around 35 million people already living with HIV, we have an increased need for rehabilitation and caregiver support. -Resource poor settings cannot afford the double burden of disability and HIV and innovative social protection and rehabilitation approaches are needed.

5. How does this link to the response to HIV and AIDS? Reducing risk is not possible while excluding 15% of the population Reducing morbidity is not possible without including rehabilitation in HIV care

6. Good practice examples highlight opportunities Basic programme activities Behavioural interventions: sexuality education Treatment, care and support: health care worker sensitisation training (HEARD); specialised rehabilitation programmes (CWGAR) Key populations: peer support and peer counselling; reasonable accommodation in information material Social enablers Political commitment, advocacy, legal obligations etc.: training NAC on inclusion of disability in NSPs using CPRD principles

7. Why are we not going forward? Lack of evidence and research Lack of population-based data and analysis Lack of evaluations of interventions or of good practice Lack of understanding of disability’s economic dimension Lack of conceptualisation Lack of understanding of disability and its intersection with HIV Limitations of the human rights approach Lack of support and collaboration Lack of collaboration with and within the disability sector Lack of mainstreaming disability in the response to HIV Lack of support from international agencies driving the agenda

8. What do we need to do next? ?

9. Thank you www.heard.org.za