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Chipanta D, Estill J, Stöckl H, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Keiser O. Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study. PLoS One 2024; 19:e0302182. [PMID: 38843144 PMCID: PMC11156379 DOI: 10.1371/journal.pone.0302182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia
- Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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De Beaudrap P, Mouté C, Pasquier E, Tchoumkeu A, Temgoua CD, Zerbo A, Mac-Seing M, Beninguisse G. Burden of and risk factors for sexual violence among women with and without disabilities in two sub-Saharan African countries. Glob Health Action 2022; 15:2077904. [PMID: 35775278 PMCID: PMC9255210 DOI: 10.1080/16549716.2022.2077904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Available data suggest that women with disabilities have an increased risk of sexual violence, but little is known about the situation of those women living in resource-limited settings. Objectives To assess the burden and examine the drivers of sexual violence among women with disabilities. Methods This is a pooled analysis of two population-based surveys conducted in Cameroon and Burundi. Adults with and without disabilities were randomly recruited from the general population. Structured interviews were conducted at both sites to collect data on participants’ functional limitations, life-course history of sexual violence, education, employment, and resources. Only women with disabilities whose impairments started before the age of 10 years (n = 359) and women without disabilities (n = 720) are included in this analysis. The age-adjusted prevalence of violence was computed, and risk factors were assessed using a discrete survival regression and mediation analysis. Results At both sites, the participants with disabilities had a lower education level and had an increased risk of food insecurity. The pooled age-adjusted prevalence of lifetime sexual violence was 19.8% (95%CI:15.3–24.3) among women with disabilities and 11.7% (95%CI:9.3–14.1) among those without disabilities (ORap: 2.0, 95%CI:1.4–2.8). Women with cognitive limitations and those with visual impairments had the highest risk of sexual violence (ORap: 3.5 (95%CI:2.0–6.3) and 2.7 (95%CI:1.4–5.0), respectively). Over the life course, the risk of sexual violence was especially high among women with disabilities who had lived with an intimate partner before the age of 25 years (p < 0.001). Education level mediated approximately one-third of the total association between disability and sexual violence (p = 0.001). There was no evidence of an indirect effect through food insecurity. Conclusion This study provides evidence of the high burden of sexual violence among women with disabilities who live in urban African contexts. The social environment and access to education may be key contributors to this vulnerability.
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Affiliation(s)
- Pierre De Beaudrap
- CEPED, Institut de Recherche pour le Développement, Université Paris Cité, INSERM, Paris, France
| | - Charles Mouté
- CEPED, Institut de Recherche pour le Développement, Université Paris Cité, INSERM, Paris, France.,Direction de la Recherche, de la Coopération et de l'Appui Technique, Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon.,Bureau Central des Recensements et des Etudes de Population (BUCREP), Yaoundé, Cameroon
| | - Estelle Pasquier
- Health Department, Initiative HIV/AIDS, Tuberculosis, Malaria, Paris, France.,Department of Public Health and Primary Care, Ghent University, Gent, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alice Tchoumkeu
- CEPED, Institut de Recherche pour le Développement, Université Paris Cité, INSERM, Paris, France.,Direction de la Recherche, de la Coopération et de l'Appui Technique, Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Carole Dongmo Temgoua
- Direction de la Recherche, de la Coopération et de l'Appui Technique, Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
| | - Aida Zerbo
- Health Department, Initiative HIV/AIDS, Tuberculosis, Malaria, Paris, France
| | - Muriel Mac-Seing
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gervais Beninguisse
- Direction de la Recherche, de la Coopération et de l'Appui Technique, Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon
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Chipanta D, Stöckl H, Toska E, Amo-Agyei S, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Thiabaud A, Keiser O, Estill J. Women with disabilities in hearing: the last mile in the elimination of mother-to-child transmission of HIV - a cross-sectional study from Zambia. AIDS Care 2022; 34:1203-1211. [PMID: 34789032 DOI: 10.1080/09540121.2021.1998313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article explored the differences in HIV testing in the elimination of mother-to-child transmission of HIV (EMTCT) between women with and without disabilities aged 16-55 years, reported being pregnant and receiving the social cash transfers (SCT) social safety nets in Luapula province, Zambia. We tested for associations between HIV testing in EMTCT and disability using logistic regression analyses. We calculated a functional score for each woman to determine if they had mild, moderate or severe difficulties and controlled for age, intimate partner sexual violence, and the SCT receipt. Of 1692 women, 29.8% (504) reported a disability, 724 (42.8%) mild, 203 (12.0%) moderate, and 83 (4.9%) severe functional difficulties (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI] 1.04-1.70). Women with moderate (aOR 2.04; 95% CI 1.44-2.88) or mild difficulties (aOR 1.66; 95% CI 1.32-2.08) or with a disability in cognition (aOR 1.67 95% CI 1.22-2.29) reported testing more for HIV than women without disabilities; Women with a disability in hearing (aOR 0.36 CI 0.16-0.80) reported testing less for HIV. Disability is common among women receiving the SCT in the study area accessing HIV testing in the EMTCT setting. HIV testing in EMTCT is challenging for women with disabilities in hearing.
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Affiliation(s)
- David Chipanta
- Institute of global Health, University of Geneva, Geneva, Switzerland.,Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Heidi Stöckl
- Medical Faculty, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians University, München, Germany
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Silas Amo-Agyei
- Department of Economics Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, Internatgonal Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia.,Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Amaury Thiabaud
- Institute of global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of global Health, University of Geneva, Geneva, Switzerland
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Cissé K, Ouedraogo HG, Lougué S, Zoungrana C, Clement B, Kouanda S. Predicting factors of sexual behaviours at risk of HIV infection among people living with disabilities: a generalized structural equation model. AIDS Care 2022; 34:35-45. [PMID: 35373673 DOI: 10.1080/09540121.2022.2051422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Many studies have shown the HIV vulnerability of people with disabilities (PWD). This vulnerability is supported by risky sexual behaviours, which need to be well described. The objective of this study is to identify predictors of sexual behaviours at risk of HIV infection among PWD in Burkina Faso. We conducted a population-based cross-sectional study on disability and HIV in four regions in Burkina Faso. PWD were selected through a probabilistic method. The Washington Group Short questionnaire was used to identify PWD. Five sexual risk behaviours were considered in this analysis (having multiple sex partners, starting sex at an early age, having had sex with a nonregular partner, sex in return for payment and condomless sex). A composite variable was created and called "risky sexual behaviour (RSB)", which was defined in three categories (low risk, moderate risk and high risk) based on the co-occurrence of the individual sexual risk behaviours. Generalized structural equation was used to identify the predictors of RSB withincome possession as a mediator. A total of 973 PWD were included in this study. The proportion of PWD who were engaged in at least two risky sexual behaviours was 9.5% (95%CI: 6.5-13.8), those with one risky sexual behaviour represented 42.8% (95%CI: 39.4-46.3) and less than half ( 47.7% (95%CI: 43.3-52.1)) werenot engaged in risky sexual behaviour. The prevalence of HIV increased with the level of risky sexual behaviour. Age, education level and type of disability have a significant direct effect on RSB. Indeed, the oddof engaging in sexual risk behaviour was low among PWD who attended at least secondary school compared to those who were not schooled (adjusted odds ratio (aOR): 0.62 (95%CI: 0.41-0.92). The indirect effect of sex on RSB mediating by income possession was significant. Indeed, women with income have a low oddof engaging in RSB compared to men (aOR: 0.83 [95%CI: 0.71-0.98]). Our results confirm a certain ambivalence in the sexuality of people with disabilities. Hence, there is a need for a particular focus on risky sexual behaviour to enable the development of an effective HIV strategy in this group.
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Affiliation(s)
- Kadari Cissé
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Henri Gautier Ouedraogo
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Siaka Lougué
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Clement Zoungrana
- Sexual and reproductive health specialist, Humanity & Inclusion, Ouagadougou, Burkina Faso
| | - Bagnoa Clement
- Sexual and reproductive health specialist, Humanity & Inclusion, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
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Kuper H, Heydt P, Davey C. A focus on disability is necessary to achieve HIV epidemic control. THE LANCET HIV 2022; 9:e293-e298. [DOI: 10.1016/s2352-3018(21)00345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 10/18/2022]
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Kett M, Cole E, Beato L, Carew M, Ngafuan R, Konneh S, Colbourn T. The Ebola crisis and people with disabilities' access to healthcare and government services in Liberia. Int J Equity Health 2021; 20:247. [PMID: 34819095 PMCID: PMC8611399 DOI: 10.1186/s12939-021-01580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There has been little research on the impact of the 2014-2015 West African Ebola crisis on people with disabilities. This paper outlines the way in which the Ebola Virus Disease (EVD) outbreak in Liberia in 2015 highlighted existing inequalities and exclusion of people with disabilities and their households. METHODS The results presented here are part of a larger ESRC/DFID-funded mixed methods research project in Liberia (2014-2017) which included a quantitative household survey undertaken in five counties, complemented by qualitative focus group discussions and interviews with people with disabilities and other key stakeholders. Uniquely, this research gathered information about people with disabilities' experience of the EVD outbreak, as well as additional socioeconomic and inclusion data, that compared their experience with non-disabled community members. RESULTS Reflections by people with disabilities themselves show knowledge, preparation, and responses to the EVD epidemic was often markedly different among people with disabilities due to limited resources, lack of inclusion by many mainstream public health and medical interventions and pre-existing discrimination, marginalisation and exclusion. Interviews with other key stakeholder revealed a lack of awareness of disability issues or sufficient training to include this population systematically in both Ebola response activities and general health services. Key findings include the need to understand and mitigate direct and indirect health consequences of unequal responses to the epidemic, as well as the limited capacity of healthcare and social services to respond to people with disabilities. CONCLUSION There are lessons to be learned from Ebola outbreak around inclusion of people with disabilities, relevant to the current COVID-19 pandemic. Now is the time to undertake measures to ensure that people with disabilities do not continue to be marginalised and excluded during global public health emergencies.
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Affiliation(s)
- Maria Kett
- UCL Institute of Epidemiology and Healthcare, London, UK.
| | - Ellie Cole
- UCL Institute of Epidemiology and Healthcare, London, UK
| | - Lucila Beato
- University of Witwatersrand, Johannesburg, South Africa
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