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Conceptualizing and managing HIV in the era of ARTThe interrelationship of disability and HIV Jill Hanass-Hancock (PhD) HEARD
“I went to one hospital, a TB hospital and then I found myself in another hospital. When I woke up I thought maybe I was somewhere else, some spiritual world. Everything was different I could not see anything. The light was spreading all over, but I could hear people talking and I was wondering where I was... Because those pills I think I took them , I reacted and that caused the blindness. ..” Ronald Ndlovu Film “Stepping into the Unknown” Nominated for the African Movie Academy Award 2011 (or African Oscar) www.heard.org.za
HIV-Prevalence of at risk populations in South AfricaSource: South African National HIV Prevalence, Incidence, Behaviour andCommunication Survey, 2008: 35 30 25 20 15 10 5 0
Interrelations of disability and HIV People with People who care for disabilities and/or PLHIV who PLHIV mental health experience disability especially young carers problems• increased risky • mental health disorders • AIDS related activity e.g. depression, limitation is associated behaviour schizophrenia, anxiety,• increased risk of with increased child substance abuse … healthcare task, less sexual abuse and less • neuro-cognitive school attendance, food access to justice disorders...• negative attitudes from insecurity and • sensory impairments educational outcomes health care staff (visual, hearing, touch)• problems with • problems with the accessing health digestive system services and education • problems with sexual• can effect adherence functions • episodic disabilities • stigma, discrimination ?
Changing the face of AIDS Barnett and Whiteside 2001
The ICF as a guiding model in the era of HIV and ART HIV as a health condition Participation Impairments e.g. Activity limitation restriction blindness caused e.g. not able to see e.g. exclusion fromthrough TB treatment and read work, stigma Environment Personal Factors no live skill or depression, gender, workplace hope … adjustment….
Current HEARD research on disability and HIV• Scoping Study on the disabling effects of HIV using the ICFframework with PLHIV• Exploratory Study using the ICF framework with health care professionals• Systematic Literature review on HIV related disability• Depression Intervention Study (using Interpersonal Therapy – IPT)• Sexuality education for youth with disabilities
Preliminary Results HIV related Disability1.ART seen as a live safer and very important2.Understanding of different disability levels3.Double stigma3.Interrelationship of impairments and mental health issues4.For impairments little hope or “nothing helps”5.Health care professionals emotional overload6.“referral system” as escape
Results from other studies which used the ICF-checklist Van As, M., et al., The International Classification of Functioning Disability and Health (ICF) in adults visiting the HIV outpatient clinic at a regional hospital in Johannesburg, South Africa. AIDS Care, 2009. 21(1): p. 50-58.
Examples from a Mental Health Study Freeman, M. et.al. 2008
Examples from a study using the Quality of Life framework Banjunirwe, F et al., 2009
Ways forward1. What is the scope of HIV-related disability in Southern Africa?2. What diagnostic tool could help to identify all the different disability levels and types (before becoming more specific)?3. What kind of rehabilitative approach will be suitable, affordable and sustainable in Southern Africa?
THANK YOUFor more information visit the HEARD disability and HIV resource centrewww.heard.org.za/african-leadership/disabilityOr the Good Practise Collection at:www.heard.org.za/african-leadership/disability/resources