“We are suffering without these services:” Disability and HIV in Eastern and Southern African National Strategic Plans

Abstract

In recent years there has been substantial progress around the world towards providing universal access to HIV prevention, treatment, and care programs. However, the global HIV response has overlooked one especially vulnerable group: those with physical, mental, emotional, sensory, intellectual, and developmental disabilities. While data on the disability-HIV in Sub-Saharan Africa nexus is severely lacking, evidence does suggest that people with disabilities are at least as vulnerable to HIV, yet face multiple barriers to accessing prevention and treatment services. This thesis examines the extent to which countries in Eastern and Southern Africa have included disability in their National Strategic Plans (NSPs) for HIV, and then uses South Africa as a case study to assess barriers to implementing disability-conscious HIV policy. This thesis updates a similar review of NSPs for disability-inclusion conducted in 2009 to assess how countries’ policies have changed over the past decade, in light of greater commitments to the rights of people with disabilities (PWD) and increased international awareness of the relationships between disability and HIV. The review finds that many NSPs still fail to integrate disability issues, and there has not been substantial progress in disability-inclusion for a variety of indicators. Despite this, there are examples of good practice from which much can be learned. South Africa has consistently stood out as the region’s best example of identifying the vulnerabilities of PWD to HIV, as well as taking extensive steps toward operationalizing inclusive and disability-targeted programs. The country therefore provides an excellent case study for understanding barriers to implementing national disability-conscious policies for HIV. Fieldwork in South Africa suggests that disability-conscious policies have not always been implemented, and a wide range of barriers still exists. These barriers suggest that merely creating disability-conscious policies are not enough for governments to meet the basic human right to health for their citizens with disabilities. Rather, policy must be matched with a rights-based approach that includes people with disabilities from the start, and specific financial allocation of resources. Additionally, greater support from international actors in the HIV response, such as PEPFAR and the Global Fund, are needed to encourage prioritization of disability-inclusion and the collection of data to inform targeted, evidence-driven programs. It has become clear that if we are to end the HIV pandemic and reach 90-90-90 targets and the sustainable Development Goals, the international community cannot continue to ignore the needs of PWD. It has been suggested that disability-inclusion is the most cost-effective approach to global health development, which provides an additional incentive for countries to prioritize disability-rights within their NSPs, and to actually implement disability-inclusive HIV services. Regardless, the dignity and humanity of people with disabilities demands inclusion. HIV services must be made available to people with disabilities in full accordance with their health and human rights.