Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia
Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia
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DOI：
10.7448/ias.19.5.20829
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发表时间：
2016-07-01
影响因子：
6
通讯作者：
Moono, Grimond
中科院分区：
文献类型：
--
作者：
Tun, Waimar;Okal, Jerry;Moono, Grimond
导言：关于撒哈拉以南非洲艾滋病毒携带者中的残疾人获得艾滋病毒服务的经验的了解有限。虽然越来越多的人认识到艾滋病毒在非洲残疾人中的传播，但有必要使艾滋病毒携带者的经历和声音生动活泼，以提高方案执行者和政策制定者对他们在获得艾滋病毒服务方面的障碍的认识。本文探讨了艾滋病毒携带者所面临的障碍如何阻碍他们获得艾滋病毒相关服务和管理其疾病的能力。方法：我们对加纳、乌干达和赞比亚(2012-2013年)的76名有身体、视觉和/或听力障碍的艾滋病毒携带者(41名女性；35名男性)进行了焦点小组讨论。我们探讨了在不同级别(个人、社会心理和结构)获得艾滋病毒服务的挑战和促进者。使用框架分析方法对成绩单进行分析。结果：艾滋病毒携带者在获得艾滋病毒服务方面遇到了各种挑战。艾滋病毒检测的延迟是很常见的，大多数人等到生病时才进行检测。推迟检测的原因包括在前往卫生设施方面遇到困难，缺乏关于艾滋病毒和检测的信息，以及与艾滋病毒和残疾有关的耻辱。卫生设施中艾滋病毒相关服务，包括护理和治疗方面的障碍包括：缺乏有利于残疾的教育材料和手势翻译，提供者和其他患者的治疗被污名化，缺乏向艾滋病毒携带者提供量身定制服务的技能，以及身体上无法进入的基础设施，所有这些都使残疾人启动和坚持艾滋病毒治疗极为困难。由于与性别相关的角色，女性面临的无障碍挑战比男性更大。这三个国家面临的挑战是相似的。乌干达和赞比亚报告了在获得艾滋病毒服务方面的良好经验，非政府组织和政府设施提供了针对残疾的服务(仅限于乌干达)。结论：艾滋病毒携带者在获得艾滋病毒检测和持续护理和治疗服务方面面临许多挑战。需要在各级进行改革，以确保残疾人能够获得艾滋病毒服务。
Introduction: Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease.Methods: We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012 - 2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach.Results: Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV-and disability-related stigma. Barriers to HIVrelated services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to genderrelated roles. Challenges were similar across the three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only).Conclusions: Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities.