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BackgroundHuman immunodeficiency virus continues to challenge health care professionals even after the rollout of antiretroviral therapy. South Africa, among the worst affected countries in the world by the pandemic, has seen the effect of people living longer but facing disabling effects of both the virus and the associated impairments of the antiretroviral therapy. Rehabilitation within the evolving context of the disease has changed its focus from the impairment of the individual to the participation restriction within a person’s daily life. Offering a continuum of coordinated, multilevel, multidiscipline, evidence-based rehabilitation within health care will promote its prominence in health care structures. ObjectiveThis study aims to develop a model of care within a health care structure using a semi-rural African setting as an example. MethodsThe study will employ mixed methods using a Learning in Action Approach into the rehabilitation of people living with HIV (PLHIV) at the study setting. The Delphi technique, a multistage consensus method, will be used to obtain feedback from a number of local experts relevant for the field of rehabilitation of people living with HIV. The study will also involve various stakeholders such as the multidisciplinary health care team (doctors, physiotherapists, occupational therapists, dieticians, speech and language therapists, social workers, midlevel workers, community health care workers); department of health representative(s); site affiliated nongovernmental organization representative(s); and service users at the study setting. ResultsOnce a proposed model of care is derived, the model will be assessed for rigour and piloted at the study setting. ConclusionsThe development of a model of care in rehabilitation for PLHIV in a health care setting is aimed to provide an example of a continuum of coordinated service throughout the disease trajectory. The assumption is that the burden on the health care system will be curbed and the projected benefit for all stakeholders will promote a sort after service delivery in rehabilitation of people living with HIV.

: Introduction: Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV, and living with HIV can lead to impairments and disability. Despite this well‐established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. Methods: We used cross‐sectional data from 37 Multiple Indicator Cluster Surveys. Surveys were from six UNICEF regions, including East Asia and Pacific (n = 6), East and Central Asia (n = 7), Latin America and the Caribbean (n = 6), Middle East and North Africa (n = 4), South Asia (n = 2) and sub‐Saharan Africa (n = 12). A total of 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta‐analysis to get a pooled estimate for each sex and indicator. Results: Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother‐to‐child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]). Conclusions: Men and women with disabilities have lower overall HIV knowledge and in particular women with disabilities also indicate lower testing rates. Governments must include people with disabilities in HIV programmes by improving disability‐inclusion and accessibility to HIV‐related information, education and healthcare services., INTRODUCTION Globally, there are 1.3 billion people with disabilities [1]. There is a close relationship between HIV and disability, as research suggests that people with disabilities are at higher risk [...]

Over the past two decades, comprehensive sexuality education has increasingly been recognised as a measure that positively impacts on the sexual behaviour of young people in Africa. Despite this, and a political call to scale-up the use of comprehensive sexuality education in schools in South Africa, learners with disabilities continue to be left behind. Besides contending with negative hegemonic constructs of disabled sexualities, educators of learners with disabilities lack skills and resources to teach sexuality in accessible formats. Based on this premise, a comprehensive sexuality education approach--Breaking the Silence--was developed and piloted to assist educators of learners with disabilities to provide access to comprehensive sexuality education in KwaZulu-Natal, South Africa. This article presents results from the formative evaluation of this pilot work and discusses educators' perceptions of their learners with intellectual disabilities' sexual knowledge, agency and behaviour after implementing the approach. Although educators appeared to situate learners with intellectual disabilities as sexual agents, their implementation of the approach was dependent on the cognitive ability of learners, and discourses of culture, gender and protection from violence.

People with disabilities are at increased risk of exposure to HIV, yet they lack access to HIV prevention, treatment care and support including sexuality education. Lack of knowledge, skills and confidence of educators teaching sexuality education to learners with disabilities is related to this increased vulnerability. This study identifies possible challenges educators of learners with disabilities face when teaching sexuality and HIV education. Five focus groups were conducted in three purposely selected types of special schools representing four impairment groups in KwaZulu-Natal, South Africa. Educators recognise that teaching about sexuality is part of the South African Life Orientation curriculum and understand its importance to learners. However, they identified a number of challenges to such work, including barriers in communication and language, cultural values and expectations, learners' knowledge and behaviour, handling of sexual abuse cases and the teachers' own life experiences. Educators feel a lack of support from parents, departments of education, fellow educators and members of the community. They report the need for training and adapted HIV and sexuality education tools and resources to accommodate learners with disabilities. This training needs to provide knowledge on disability and HIV, offer guidance on disability-appropriate communication strategies, deal with sexual abuse and include educational tools for the classroom.

In the midst of a generalised HIV and AIDS epidemic in southern Africa, the argument for more coordinated and comprehensive youth sexual health interventions is intensifying. Yet the crucial question of "how best" to provide young people with these skills and knowledge remains a key challenge for policy-makers, researchers and practitioners in our region. Moreover, amongst the available literature on sex education in southern Africa, few authors have taken an applied perspective, to look at fresh approaches and tools with the potential to be implemented more broadly. This paper argues for a greater focus on concepts of masculinity and sexuality in the development of sexual health efforts in southern Africa. It aims to bridge theory and practice by advancing six promising approaches with the potential to create a suitable space and environment for participants to engage with these issues. Approaches include methods and tools currently being implemented in existing programmes, as well as ideas emerging from recent literature. Our paper is ultimately a call for further "out-of-the-box" thinking to find more effective and creative practical ways of providing the sexual health education our region's youth urgently needs. It is also a call for more applied research, to better inform future sex education programmes in southern Africa. (Contains 1 table.)

Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends. This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990–2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications. Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend. Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management. South Africa has experienced an increase in disability prevalence over time. This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services. The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%). Routine data collection and case management needs to include disability screening to identify developing functional limitations. [ABSTRACT FROM AUTHOR]

This systematic review focuses on empirical work on disability and HIV/AIDS in Africa in the past decade and considers all the literature currently accessible. The review presents data from different surveys and summarizes the findings. In this way, it convincingly reveals that people with disabilities are very vulnerable to contracting HIV, and lack access to information, testing and treatment. The review further reveals gaps in the research and areas of concern. While vulnerability and accessibility have been investigated, there are few prevalence studies or evaluations available. A certain amount of work has focused on the deaf population, but little has been done for other disability groups. A growing area of concern is sexual abuse and exploitation of people with disabilities. Only a few studies or interventions focus on this crucial area., Background The year 2008 was a special one. It was during this year that the XVII International AIDS Conference (AIDS 2008) in Mexico City, as well as the 15[sup.th] International [...]

This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of “fields” versus “a single field” because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross‐field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years., Introduction This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of “fields” versus “a single field” because of [...]

To assess recent estimates of HIV prevalence and the inclusion of persons with disabilities in the HIV response in sub-Saharan Africa. A systematic literature search was conducted of recent HIV prevalence studies among persons with disabilities in sub-Saharan Africa and National Strategic Plans from 18 countries in east and southern Africa were reviewed. Results were compared to a 2014 literature search and a 2009 National Strategic Plans review that used similar methods. Between 2013 and 2018, four published studies were identified with estimates of HIV prevalence among persons with disabilities in sub-Saharan Africa. In each study, HIV prevalence was higher among persons with disabilities than national population estimates. Fourteen of the 18 National Strategic Plans reviewed identified persons with disabilities as a vulnerable or marginalized population and thirteen National Strategic Plans proposed targeted programs for persons with disabilities. Among seven assessed disability inclusion indicators of National Strategic Plans, four showed some improvement, two showed no change, and one regressed compared to the 2009 analysis. Data on HIV prevalence among persons with disabilities is rare. In addition, inclusion of this population in National Strategic Plans in East and Southern African countries is often lacking specific detail. HIV prevalence studies in sub-Saharan Africa among persons with disabilities are rare and community studies do not disaggregate by type of disability. Estimates of HIV prevalence among persons with disabilities are greater than national averages. Government National HIV Strategic Plans often mention persons with disabilities as a vulnerable population but less often identify specific interventions or inclusive strategies for prevention or care. The integration of attention to disability in national HIV bio-behavioral surveys would allow increased understanding of HIV vulnerability and prevalence and could increase attention to persons with disabilities as a key population within National Strategic Plans. [ABSTRACT FROM AUTHOR]

Globally, years of life lost are declining, while years lived with disability are increasing. In high socio-demographic index countries, this trend has been attributed to an overall ageing population and rehabilitation services have begun to adjust to this change. In low- and middle-income countries, this trend is less well understood. Hence, the WHO's 'Rehabilitation 2030 Call for Action' and 'Rehabilitation in Health Systems Guide' call for better assessment of the situation. In order to understand trends and causes in middle income countries such as Botswana, we examine the change over time in causes and number of years lived with disability and years of life lost. We conducted a secondary analysis of the Global Burden of Disease 2017 data, exploring the change over time in Disability Adjusted Life Years per 100 000 people over the period 1990–2016. The descriptive analysis focuses on the contribution of years lived with disability towards the burden of disease within Botswana compared with the world, sub-Saharan Africa, and high-income countries. Our results show that Botswana's top causes of years of life lost are HIV and other sexually transmitted infections, cardiovascular diseases, maternal and neonatal disorders, respiratory infections and tuberculosis, and neoplasms. Years lived with disability have increased over time, which is driven by mental disorders, HIV and other sexually transmitted infections, musculoskeletal disorders, neurological disorders, and skin and subcutaneous diseases. Botswana needs better data to prepare its emerging health systems to accommodate the increased need for disability support and rehabilitation services caused by communicable and non-communicable diseases. Botswana has an increase in disability prevalence over time that requires the development of disability and rehabilitation services. The greatest contributors towards disability adjusted life years in Botswana are currently mental disorders (13.7%), HIV and other sexual transmitted diseases, (13.0%), musculoskeletal disorders (9.9%), neurological disorders (8.0%), and sense organ diseases (6.2%). This requires strengthen of services such as mental health interventions, physiotherapy, optometry and audiology as well as linkages from major disease clusters such as HIV to rehabilitation services. [ABSTRACT FROM AUTHOR]