Challenges in accessing HIV and AIDS services for persons with disabilities: a review of a study carried out among persons with disabilities living with HIV and AIDS in Uganda

This review reported experiences in accessing human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) services of persons with disabilities living with HIV and AIDS in sub-Saharan Africa, Uganda. The purpose was to explore the barriers faced by persons with disabilities living with HIV, which hinder their ability to access HIV services and managing the disease. This study revealed the real-life experiences of persons with disabilities living with HIV to raise awareness among the program implementers and policy-makers about the barriers faced by them in accessing HIV services. Focus group discussions (FGDs) were conducted in 3 countries, including Ghana, Uganda, and Zambia, with a total of 76 individuals with disabilities living with HIV/AIDS interviewed. In Uganda, there were 28 persons interviewed, and out of the 28 respondents, 1 had hearing impairment, 14 had visual impairment, 12 had physical impairment, and 1 had both physical and visual impairments. Out of 14 participants from Ghana, 4 had hearing impairment, 1 had visual impairment, and 9 were physically impaired. Zambia had a total of 34 respondents with disabilities interviewed living with HIV/AIDS, and out of the 34 respondents, 8 had hearing impairment, 9 visual, and 17 were physically impaired. Study activities were conducted in capital cities of Ghana, i.e., Accra, Uganda, i.e., Kampala, and Zambia, i.e., Lusaka as well as one peri-urban/rural site for each country, i.e., Amasaman in Ghana, Jinja in Uganda, and Solwezi in Zambia. In each country, semi-structured interviews were conducted to obtain information about barriers and facilitators to access HIV services for persons with disabilities. Sign interpreters were employed for FGDs with hearing-impaired individuals, and before each discussion, data collector along with a sign interpreter for deaf participants sought informed consent from potential participants in private, and obtained a signature or fingerprint. Interviews were recorded, transcribed, and translated. Persons with disabilities living with HIV/AIDS encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most patients postponing testing until they became severely ill. Reasons for delayed testing included challenges in reaching health facilities, lack of information about HIV and testing, and HIV-and disability-related stigma. Barriers to HIV services, such as care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, providers and other patients' stigmatizing approach, lack of skills to provide tailored services to those with disabilities living with HIV, and physically inaccessible infrastructure, all of which were extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Challenges were similar across the three countries. Favorable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by nongovernmental organizations and government facilities (Uganda only). The challenges in accessing HIV and AIDS services for persons with disabilities are significant, and have major implications for HIV treatment. Deliberate efforts for necessary changes at every level should be implemented to ensure that individuals with disabilities have access to HIV services. It is crucial to improve the access to HIV and AIDS services among patients with disabilities as well as to enforce the implementation of policies to include these persons at all levels.