In a recent global survey of disability advocates, 87 percent of the organizations surveyed reported that HIV/AIDS is of immediate concern to the disabled populations that they serve. Our advisor on disability and AIDS discusses the issues faced by disabled populations with HIV in conflict situations in northern Uganda.

Today Northern Uganda is slowly emerging from a war that has ravaged the region for the past twenty years. This conflict has caused over 1.7 million people to be displaced from their homes many forced into IDP – internally displaced peoples – camps. Residents of these IDP camps experience crowded conditions and mounting frustration. There are high levels of alcoholism, sexual violence and unraveling of social and cultural norms. This region is also host to one of the highest HIV prevalence rates in Uganda.

Due to the violence of the conflict, poverty and lack of adequate health care facilities and services there is also a very high incidence of disability in the region.

There are numerous governmental and non-governmental relief and development initiatives targeting this region but none are looking specifically at the intersection between disability and HIV/AIDS issues. We, at AIDS-Free World, feel that this is a shameful oversight with often deadly consequences. There are creative innovations taking place on the ground but we need a response from the international community to support these initiatives and allow them to grow.    

Let me first outline the issues contributing to particular challenges when disability, AIDS and conflict intersect.

Earlier this year, the Women’s Commission on Refugee Women and Children published a landmark report addressing disabilities amongst refugees and other conflict affected populations, including IDPs. This is the first study of its kind and I highly recommend that each one of you read it, as soon as you have a chance. This report highlights the fact that displaced peoples often suffer serious injuries resulting in a variety of impairments. When essential treatment is lacking because of the conflict or disaster, such injuries can easily lead to permanent disabilities. Likewise, people with existing impairments do not receive necessary treatment and their conditions can worsen.

It is also important to remember the range of disabilities affecting people in conflict settings. They are not limited to those disabilities newly acquired due to violence. Often, we see that programmes that are set up to support people with disabilities focus exclusively on those people newly acquired disabilities, landmine victims for example, but fail to engage in a deeper analysis of disability rights that could benefit all people with disabilities including those disabled from birth or through diseases like polio.
 
Furthermore, in post-conflict situations – like the one we are currently witnessing in Northern Uganda -  where communities previously living in IDP camps are re-settling into villages and rural communities, the transition is often most difficult for people with disabilities, regardless of how their disability was acquired. People with disabilities displaced in Kitgum District, in Northern Uganda, have shared their worries about the transition back to their home communities: they will have longer distances to travel to find food, fetch water, access medical care and other essential services. The family support systems that may have been their previously have often been eroded by the last 20 years of conflict.

There is evidence suggesting that post-conflict periods, with renewed movement of people and reconstruction, carry the biggest risk for increased rates of HIV transmission. Any “protective elements” that might have been in place during conflict due to restricted movements fall away, and yet the increased vulnerability due to financial constraints and increased physical and sexual violence remain. In addition to an increased risk of infection, a significant proportion of people living with HIV and AIDS – between 8% and 10% -  are affected by conflict, humanitarian crisis and/or displacement.

Though the actual relationship between HIV prevalence and conflict is quite complex, it is recognized that HIV/AIDS information, treatment and care services can effectively be delivered in conflict situations.  Most International NGOs active in Northern Uganda incorporate some elements of AIDS service delivery into their programmes. But, we have yet to see the active integration of people with disabilities into any of these programmes.

Around the world people with disabilities remain among the most stigmatized, poorest, and least educated citizens.  All of the risk factors associated with HIV are increased for individuals with disability:  poverty, severely limited access to education and health care, lack of information and resources to ensure ‘safer sex,’ lack of legal protection, increased risk of violence and rape, vulnerability to substance abuse, and stigma. These heightened risk factors demonstrate that the danger of the further and faster spread of the pandemic among people with disabilities is real.

Gender inequality is not only driving the feminization of the AIDS pandemic, but also leaving women and girls more vulnerable to and affected by physical and mental disabilities. Females currently comprise 74 percent of people with disabilities in low and middle-income countries, yet they receive only 20 percent of the rehabilitation assistance worldwide. Similarly, conflict situations disproportionately increase girls and womens vulnerability to HIV. This is largely due to increased risks of physical and sexual violence, but also lack of access to health care, loss of livelihoods and situations forcing women to exchange sex in order to gain access to food, shelter, services or safe passage. So, in women with disabilities in conflict settings, affected by HIV, face numerous layers of stigma severely impeding their access to what little services or resources may be available to the broader community.

Yet, these women are not passively awaiting their fate. There is a recognition at the grassroots of what can and must be done. I will share one example with you today.

When I traveled to Gulu District, the district at the epi-centre of the 20-year conflict with the LRA, I met with Counsellor Janet Otto. Madam Janet is herself an Acholi, a District Counsellor, a woman with a disability and a woman living with HIV/AIDS. She is the secretary of the Gulu District Association of Women with Disabilities, a group that supports women with disabilities who are living with HIV/AIDS and integrates AIDS issues holistically into the overall activities of the organization.  The group had very humble beginnings. It started with Madam Janet and one or two of her friends speaking out publicly about their HIV positive status. They enouraged other women with disabilities to do the same.  The group has grown from 7 to 45 members in less than two years.

The women report that many in their group have lost their jobs or livelihoods because of their HIV-related illness, and many women are no longer supported by their partners because of the stigma surrounding their HIV-status and/or the stigma around their disability. With support from the AIDS and Disability project of the National Union of Disabled Persons of Uganda (NUDIPU) and the Danish Council of Organizations of Disabled People (DSI), the group has been able to offer social support to one other and create a forum for resolving domestic disputes connected to their HIV-positive status.  They are currently seeking funding to support their members in sustainable income-generating projects to assist them with their daily needs. 

But the initiative of Madam Janet and her colleagues are severely constrained about the prevailing silence around disability issues, especially those concerning disability and sexuality. Mainstream initiatives remain inaccessible to people with disabilities due to physical and attitudinal barriers. Yet, the new UN Convention on the Rights of Persons with Disabilities sets a precedent for active integration of people with disabilities into existing relief and development initiatives including those pertaining to AIDS in conflict and post-conflict settings. The convention as well as increased presence of disability issues in international discourse and for a such as this panel, provide us reasons to hope that our call for “Nothing About Us Without Us” will be heard beyond the walls of this conference, into the planning meetings and into the IDP and refugee camps themselves.

And so, I leave you with some recommendations to keep in mind the next time you have a staff meeting or gathering with fellow activists, project staff or service providers:

1. Integrate people with disabilities

• Promote access for people with disabilities in mainstream initiatives addressing HIV/AIDS, sexual violence, child protection, and refugee resettlement. 
• Conduct targeted services for people with disabilities if needed (such as home visits for those who cannot access health clinics, transportation services, or outreach to rural areas).
• Partner with disabled people’s organizations to ensure that the perspective of people with disabilities is included in all aspects of programming. 

2.  Research

• Collect disaggregated data on people with disabilities who live within conflict regions, including those who use or access your organization’s services.

3.  Advocacte

• Ensure that your organization’s advocacy positions in other areas, such as gender-based violence and access to sexual and reproductive health, are inclusive of disability-related concerns.

And

•  Include people with disabilities as a “marginalized group” in programme development and discourse.

4.  Lobby

•  Use the Disability Convention to pressure nations and the international community to strengthen protections and increase opportunities for people with disabilities living with and at risk of HIV/AIDS. 

5.  Combat Stigma

•  Train all members of your staff on disability rights so that they interact with people with disabilities in affirming, non-stigmatizing ways.  Police officers, lawyers, judges, doctors, community health workers, domestic violence shelters, and women’s rights organizations should all be sensitized to the specific needs of people with disabilities.

---

Bookmark this article with any of these social bookmarking sites: