Related Articles:. Home References Article citations. Journals A-Z. Journals by Subject. Publish with us. Contact us. Related Articles: Open Access. Client satisfaction with integrated community case management program in Wakiso District, Uganda, October A cross sectional survey. Health Vol. Among children under age five, HIV prevalence is 0.
Data were collected from a sample of households that are representative of the Ugandan population. The survey was conducted from February to September and interviewed 11, households, and 12, women and 9, men age The UAIS results indicate that the proportion of adults with HIV has increased slightly since the last national population-based survey in HIV prevalence is higher among women 8. Four percent of young adults age are living with HIV. HIV prevalence is highest among widowed women and men HIV prevalence varies by region, from a low of 4.
The survey shows that there has been a tremendous increase in voluntary HIV testing in Uganda over the past 6 to 7 years. The proportion of women age who have ever been tested for HIV and received their results increased fivefold, from 13 percent in to 66 percent in The increase among men has been somewhat more modest, from 11 percent in to 45 percent in The main reason for the gender difference is likely to be the high level of testing of pregnant women.
Survey results indicate that almost three in four pregnant women 72 percent were tested for HIV and received results as part of their antenatal care. The proportion of men circumcised ranges from 2 percent in Mid Northern region to 53 percent in Mid-Eastern region.
If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the Supporting Information files.
Competing interests: The authors have declared that no competing interests exist. There is a tribe of Ugandans … whose issues and needs have not been given their due and appropriate attention in the fight. By all indications, persons with disabilities have been forgotten, consciously and unconsciously. Mwesigwa Martin Babu [ 1 ] p. For example, persons with disabilities are frequently excluded from HIV education, prevention and support services due to misconceptions that they are not sexually active or do not partake in risk behaviours including drug use; healthcare services may be physically inaccessible, lack sign language facilities and other information formats such as Braille, audio or plain language; and when access to medication is limited, persons with disabilities may be treated as low priority for services [ 8 ].
As advocated by Mitra [ 18 ], a disability data revolution is needed to enable disability-inclusive development by including disability in data collection and monitoring mechanisms in international development and global health. Data collection is crucial to disability-related planning and programming. As Hanass-Hancock et al.
Further epidemiological research is required to create a more in-depth understanding of the multifaceted links between disability and HIV to assist decision-makers in prioritising interventions [ 23 ].
For example, De Beaudrap and colleagues [ 23 ] outline a protocol for a population-based survey combining qualitative and quantitative data collection methods including the Washington Group questionnaire [ 24 ], designed to understand the vulnerability of persons with disabilities to HIV in Cameroon. The authors suggested a need for standardized questions to allow comparable data collection and analyses, such as the Washington Group Short Set of Questions on Disability Washington Group Short Set [ 15 , 25 ].
The worldwide Demographic and Health Surveys Program has collected, analyzed, and disseminated accurate and representative data on population, health, HIV, and nutrition through over surveys in over 90 countries, and is primarily funded by the U.
This study utilises secondary data from the UDHS [ 26 ], the fifth and most recent in a series of nationally representative surveys, which collected information on demographic, health, and family planning status and trends in Uganda. Permission to use the data was acquired through the DHS Program website [ 27 ]. Information was also collected on the extent of disability using the Washington Group Short Set, whereby participants reported difficulties that they may have doing certain activities due to a health problem in relation to seeing; hearing; walking or climbing steps; remembering or concentrating; self-care; and communicating, on a continuum of no difficulty; some difficulty; a lot of difficulty; and cannot do at all [ 30 ].
The UDHS is a nationally representative survey of 10, households with 9, women aged 15—49 and 2, men aged 15— Notably, the UDHS reports a In the second sampling stage, households from each cluster were purposively selected from an updated complete listing of households. The Household Questionnaire was used to list all usual household members and visitors who spent the night before in the selected households. The Maternal Mortality Questionnaire was administered to all eligible women aged 15—49 in 35 additional households in of the enumeration areas.
Detailed information in relation to the survey objectives, design, survey instruments, pre-testing, training and fieldwork are available in the survey main report [ 26 ]. The current study utilises data from all four questionnaires used in the UDHS. The 10, sampled households had a total of 9, occupied households. The household member data was used for descriptive characteristics of household members by disability status.
The complete merged data for males and females resulted in a sample size of 10, individuals used in this study analyses. The first step explored the impact of the explanatory variables on the outcome variables using bivariate analysis. The second step involved multivariate analysis; ordinary least squares regressions for continuous outcome variables; and logistic regression for binary outcome variables.
All analyses included clustering at the household level to avoid downward bias in standard errors and overstating of t statistics [ 36 ]. The main explanatory variable was disability, generated from the Washington Group Short Set [ 24 , 26 , 30 ]. We looked at the Deaf population as a distinct group to see if we might identify distinct disability-specific patterns due to the asserted difference between Deaf and hearing populations in relation to HIV in much of the literature [ 37 — 40 ].
The proportion of the sample by different disability categories is shown in Table 3. As outlined in Table 3 , there were no significant differences between genders for any of the disability types.
As expected, disability was more prevalent in older individuals Fig 1. A summary of the multivariate analysis is shown in Table 4 note that empty cells represent non-significant results. Generally, persons with disabilities had fewer days since last HIV test compared to persons without a disability. For example, persons with any type of disability had 20 days fewer since the last HIV test compared to individuals without a disability. Persons with multiple disability had 27 days fewer; persons with low severity had 21 days fewer; while persons with a hearing disability had 39 days fewer since the last HIV test compared to individuals without a disability.
Also of particular note, persons with disabilities reported having a first sexual encounter at a younger age. However, the difference was minor, with a first sexual encounter generally earlier by only a few months, not years. This difference was therefore greatest for persons with multiple disabilities.
Of particular concern, persons with disabilities were more likely to have reported having a STD in the last 12 months, statistically significantly higher than for persons without a disability Table 4 , Model 2. For example, individuals with multiple disabilities and persons with a hearing disability were almost twice as likely to have reported genital sores in the last 12 months compared to persons without a disability.
Individuals with multiple disabilities and high severity disability were almost twice as likely to have reported a genital discharge in the last 12 months; while persons with high severity disability and a hearing disability were almost twice as likely to have reported a STD in the last 12 months compared to persons without a disability. This statistical significance was consistent for persons with all levels of disability assessed any disability type, single, multiple, low and high severity and disability types assessed hearing disability ; with odds greater than 1 for all disability categories compared to persons without a disability.
While we have no large baseline against which we can compare changes over time, these new figures may indicate that current outreach efforts are making progress. Accordingly, our findings are contradictory to those of earlier and more recent studies, which found that persons with disabilities are less knowledgeable than those without disabilities in Uganda [ 2 , 6 ] and elsewhere [ 9 , 10 , 31 , 43 — 45 ].
Incongruity between our findings and those of previous studies could be a result of diverse methodologies returning different results. These disability measures identify persons with disabilities in a markedly different way relative to how other studies identify persons with disabilities. As outlined in the World Report on Disability [ 31 ], operational measures of disability contrast in relation to the aim and application of the data; how disability is conceptualized; the features of disability that are assessed including impairments, restrictions on participation and environmental factors; definitions; design of questions; reporting sources; methods of data collection; and expectations of functioning.
It is also of note that while persons with and those without disabilities reported largely the same level of knowledge, several gaps in the knowledge base of persons with disabilities appear to continue, for example, misconceptions about the risk of HIV infection through mosquito bites and sharing food. One incongruous finding from this study was that as a group, persons with disabilities reported greater knowledge than those without disabilities about the need to use condoms to reduce risk of HIV AOR 1.
However, our findings also indicated a higher incidence of reported STDs for persons with disabilities. If persons with disabilities reported a higher rate of knowledge about condom usage and comparable rate of actual use, it is unclear why this group would have a higher reported rate of STDs. It is possible that some persons with disabilities may have long-term STDs and have elected, or are encouraged by partners, to use condoms, which would produce a higher knowledge level even if practices are not consistent and hence our findings indicate a higher incidence of reported STDs for persons with disabilities.
It is also possible that while persons with disabilities report a higher rate of condom knowledge relating to HIV and comparable rate of condom usage relative to persons without disabilities, they are not receiving adequate information about effective condom use. It is also possible that lack of accessible places to buy condoms, embarrassment or harassment while buying condoms or poverty associated with disabilities makes it harder for persons with disabilities to purchase condoms [ 46 ].
Furthermore, most significantly, these higher rates may point to lack of ability to negotiate safer sex practices with partners among persons with disabilities no matter what their level of knowledge [ 14 ].
Although the discrepancy was not great—months rather than years—we also found that persons with disabilities reported becoming sexually active earlier than their peers without disabilities.
Interestingly, these findings were true for both males and females. There may be a number of reasons for this finding, including targeted abuse by those without disabilities; persons with disabilities being anxious to prove that they are just like everyone else; or persons with disabilities being anxious to prove to the data collectors that they are just like everyone else and overstating their early sexual activity. Although often treated as asexual, a number of researchers and advocates have called attention to the fact that persons with disabilities may be more susceptible to being targeted for, or suffer from low self-esteem that make them at risk for, abuse and exploitation at an early age [ 13 , 14 , 47 — 50 ].
In a qualitative study by Yousafzai et al. In this study, while age at first sexual encounter was slighted earlier but comparable to peers without a disability, we did not ask the nature of this first encounter and this may also differ. Our findings, in conjunction with the findings from Mulindwa, indicate that further study on this issue is warranted.
A key finding is that persons with disabilities were as likely to be tested for HIV as the rest of the population but were significantly less likely than persons without disabilities to return to receive their test results. Persons with disabilities often, although not always, have health needs originating from their primary condition, and therefore on average may have more health needs than the majority of the population [ 15 , 52 , 53 ].
Accordingly, more inpatient and outpatient care is sought by persons with disabilities than those without disabilities [ 31 , 54 ]. Persons with disabilities are likely to be seeking healthcare.
Hence, it is unclear why our findings indicate that persons with disabilities are less likely to return to receive their HIV test results. We hypothesise several reasons for this, outlined below. Transportation to clinics may be acting as a barrier for persons with disabilities regarding their ability to return to receive test results.
A growing body of literature indicates that lack of accessible transportation and expense of transportation among a group who are routinely disproportionately poor may limit the ability of persons with disabilities to return for test results compared to their peers without disabilities [ 57 ]. Nixon et al. Physical access to clinics is often discussed as a barrier to receiving test results for persons with disabilities [ 12 , 58 , 59 ].
In a qualitative study conducted by Tun and colleagues [ 60 ], one of the most significant barriers to accessing facility-based HIV services for persons with disabilities in Uganda was related to physical accessibility to and of HIV services facilities. Presumably persons with disabilities who come for an initial test have already found the local clinical services accessible, but if results are provided someplace other than where the initial testing took place, accessibility may be an issue.
Inaccessible formats of HIV test results may be presenting as a barrier to the receiving of HIV test results by persons with disabilities. In a qualitative study of perceptions of HIV-related health services for persons with disabilities who are HIV-positive in Zambia [ 19 ], numerous participants reported stories of individuals being denied testing due to healthcare workers experiencing communication constraints. Yousafzai et al. Accordingly, simplified formats, pictures, Braille, or sign interpreters may be required [ 12 , 59 ].
Healthcare workers may place lower priority for good quality care on ensuring follow-up care for persons with disabilities when there are limited HIV services and medications available [ 12 ]. If persons with disabilities are not treated with dignity and their privacy ensured when they come for their initial tests, they may be reluctant or unwilling to return for the results. For example, in a qualitative study by Yoshida and colleagues [ 50 ] on the experiences of persons with disabilities who had contracted HIV in Zambia, participants reported discrimination in relation to a lack of expectation of persons with disabilities in HIV clinics.
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