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Response to disability in the context of HIV/AIDS in KwaZulu-Natal, South Africa
Presented by Jill Hanass-Hancock, South Africa.
J. Hanass-Hancock
Department of Economics, HEARD, Health Economics and HIV/AIDS Research Devision, Durban, South Africa
Background: In indigenous Zulu cosmology, disease and disability can be interpreted as either natural or spiritual, with the social values of pollution and protection being highly influential. This renders people with disabilities (PWD) to become especially vulnerable to HIV/AIDS. This paper focuses on non-medical representations of disability in the context of HIV/AIDS.
Methods: Social representations of disease and disability (WHO definition) were understood through in-depth interviews with 25 PWD and caregivers. Thematic content analysis was carried out. A focus group and a ranking exercise were used for triangulation.
Results: PWD are abused through sexual purification rituals, sexual exploitation and have less access to prevention and treatment. Some notions surrounding disability positively impact on the interaction with PWD. For example, the Zulu custom of ritual ancestor worship can raise the acceptance of disability. There are however other notions that have a negative effect. The concept of PWD as a-sexual, virgins, sexually overactive, cursed, ‘dirty’ or ‘clean’ increases their exposure to abuse and with this to HIV/AIDS. Misconceptions about sexuality, gender and HIV/AIDS have exposed women and girls with disabilities, in particular, to abuse and HIV.
Response to the risk of abuse can be categorised in three coping strategies, denial, laissez fair and sexual communication. Communication through an empowering and enlightening approach enables individuals to negotiate safer sexual practices. In this context sexual enlightenment and emancipation becomes crucial in the fight against HIV/AIDS.
Conclusions: The way people are prone to think about and respond to disability and HIV/AIDS exposes PWD, especially women and girls, to a particularly high risk of infection. Implying women and girls with disability are triple-marginalised, through their status as woman and disability. This is exacerbated by the ambivalent values of pollution and purification. In this context a liaison between Community Based Rehabilitation and HIV/AIDS interventions would strengthen the position of PWD.
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