Good Practice: SRH Services

BANGLADESH

WISH2ACTION: Ensuring Safe and Clean Home Delivery in Ulipur Cluster through Flood and COVID-19 Response[1]

In 2020, three floods occurred in Ulipur Cluster amidst the COVID-19 crisis. HI’s WISH2ACTION project team identified that pregnant women with disabilities were suffering from gaps in SRH services as health and family planning centres became inaccessible for antenatal care or delivery. The WISH2ACTION project team arranged meetings with cluster management committees (CMC), seeking their suggestions to improve the situation. The CMC suggested family welfare centres to update the list of pregnant women and skilled birth attendants (SBA) in their respective areas. SBAs were unable to ensure clean and safe delivery at home due to unavailability of safe delivery kits. Through WISH2ACTION, HI provided family planning centres in 11 sub districts (used by the SBAs) with safe delivery kits containing sterile stitch, blade, rubber sheet, gloves and clamp materials. Additionally, district health and family planning authorities, local administration played a great role in facilitating the implementation of the initiative, which led to safe and clean home deliveries and a decrease in maternal mortality and morbidity.

WISH2ACTION: Inclusive SRH Services in Different Health Facilities to Help Persons with Disabilities Make Right Decisions[2]

HI's data collection from beneficiaries, follow-up visits, referral activities, courtyard, and one- on-one awareness sessions through WISH2ACTION found that most persons with disabilities were unaware of their SRH rights, availability of services and health centres, and depended on private health facilities. In response, the WISH2ACTION project team disseminated accurate information on available SRH services and centres, such as Union Health and Family Welfare Centres, Community Clinics, and Upazila Health Complex. As a result, the number of persons with disabilities seeking SRH and family planning services from government facilities, which are free of cost, increased.

Disability Inclusion in HIV and AIDS Response

Evidence suggests that persons with disabilities are at equal, if not increased, risk of exposure to HIV. While data is scarce, a 2014 analysis of data from Sub-Saharan African countries showed that persons with disabilities are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities[3]. In addition, evidence suggests that persons living with HIV or those with AIDS are also at risk of developing disabilities due to illness or related treatments[4].

Yet, UNAIDS has found that persons with disabilities “represent one of the largest and most underserved populations” when it comes to health and HIV services[5]. Barriers faced by persons with disabilities in this regard are similar to those faced in relation to access to health services generally, including lack of accessible information or education regarding HIV prevention, treatment, care and other matters and the inaccessibility of HIV testing and treatment centres due to physical barriers, poor coordination of health services and lack of accessible transport. For individuals with disabilities who are HIV-infected, poverty and barriers such as lack of transport to medical treatment centres hamper effective access to care and treatment, including antiretroviral and other medications for related infections. Persons with disabilities also experience disproportionately high levels of poverty, further limiting access to HIV prevention, treatment, care and support.

Obstacles to Inclusive HIV and AIDS Care

Lack of Availability: HIV-related facilities, goods, and services, including HIV prevention, treatment, care and support are often not available to persons with disabilities; health care providers are not qualified in sufficient numbers to provide disability-specific support and accommodation in HIV prevention, treatment, care and support services.

Barriers to Accessibility: Accessibility requires attention to discriminatory attitudes as well as to physical, economic and informational barriers.

Discrimination: Stigma and discrimination create barriers to HIV prevention, treatment, care and support for persons with disabilities.
Physical inaccessibility: HIV and AIDS prevention, treatment, care and support are often inaccessible to persons with disabilities, including HIV testing and treatment centres, because of physical barriers, poor coordination of health services or lack of accessible transport.
Economic inaccessibility: Consumers with disabilities often live in poverty, which limits their access to HIV prevention, treatment, care and support; persons with disabilities may not enjoy equal access to health facilities, goods and services, including medicines and supportive devices.
Information inaccessibility: Information relating to HIV prevention, treatment, care and other matters, is inaccessible to persons with disabilities; and persons with disabilities are often wrongly judged to lack the capacity to make or participate in decisions about their treatment and care.

Unacceptable HIV and AIDS facilities, goods, and services: Persons with disabilities often experience disrespectful treatment in the context of HIV and AIDS; informed consent procedures are often not respected for persons with disabilities; confidentiality and privacy of persons with disabilities is often breached.

Poor quality HIV and AIDS facilities, goods and services: Persons with disabilities are entitled to quality facilities, goods and services.

Source: One Billion Strong, HIV/AIDS, Disability and Discrimination: A Thematic Guide to Law, Policy and Programming (2012).

Important

Just as disability should be mainstreamed across health services generally, the rights and needs of persons with disabilities should be mainstreamed in national responses to HIV and AIDS, including national strategic plans. In many countries, this has not been done.

Good Practice Examples

Persons with disabilities – and the organizations they form – can meaningfully and fully engage in HIV and AIDS programming. The forms of engagement include the following types of intervention:

educating persons about HIV;
providing HIV prevention commodities, services, and treatment;
providing protection from discrimination and sexual violence; and
empowering persons to participate in the HIV response.

Disability, HIV, and AIDS Trust (DHAT)

The Disability, HIV and AIDS Trust (DHAT) promotes the rights and capacity-building of Persons with Disabilities with cervical cancer, TB, HIV and AIDS-related infections; and aims at achieving inclusion and full participation of Persons with Disabilities in the context of disability rights, cervical cancer, tuberculosis, sexual reproductive health rights (SRHR), HIV and AIDS interventions.

The Disability HIV and AIDS Trust (DHAT) is a non-profit regional organization, registered in Harare, Zimbabwe.
Website: www.DHATRegional.org

[1] Exerpted from: STEP TOWARDS DISABILITY INCLUSIVE SEXUAL REPRODUCTIVE HEALTH: LEARNINGS FROM WISH2ACTION PROJECT

[2] Ibid.

[3] UN IRIN news, Heightened HIV risk for people with disabilities, available at: http://www.irinnews.org/report/100414/heightened-hiv-risk-for-people-with-disabilities

[4] Dr. Jill Hanass-Hancock (HEARD, IDDC), Dr. Paul Chappell (University of Johannesburg, IDDC) and Leandri Pretorius (HEARD), Discussion Paper of UNAIDS Strategy Brief for Integrating Disability into AIDS Programming (2014).

[5] UNAIDS, The Gap Report: People with Disabilities (2014).