title: Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia.
abstract: Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease.
  
  
  
  We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012-2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach.
  
  
  
  Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only).
  
  
  
  Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities.
authors.affiliation: HIV and AIDS Program, Population Council, Washington, DC, USA; wtun@popcouncil.org.
authors.forename: Waimar
authors.initials: W
authors.lastname: Tun
authors.affiliation: HIV and AIDS Program, Population Council, Nairobi, Kenya.
authors.forename: Jerry
authors.initials: J
authors.lastname: Okal
authors.affiliation: Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Schenk
authors.affiliation: Reproductive Health Program, Population Council, Accra, Ghana.
authors.forename: Selina
authors.initials: S
authors.lastname: Esantsi
authors.affiliation: Development Consultant, Formerly with Zambia Agency for Persons with Disabilities, Lusaka, Zambia.
authors.forename: Felix
authors.initials: F
authors.lastname: Mutale
authors.affiliation: Ghana Federation of Disability Organisations, Accra, Ghana.
authors.forename: Rita Kusi
authors.initials: RK
authors.lastname: Kyeremaa
authors.affiliation: National Union of Disabled Persons of Uganda, Kampala, Uganda.
authors.forename: Edson
authors.initials: E
authors.lastname: Ngirabakunzi
authors.affiliation: Reproductive Health Program, Population Council, Accra, Ghana.
authors.forename: Hilary
authors.initials: H
authors.lastname: Asiah
authors.affiliation: The World Bank, Washington, DC, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: McClain-Nhlapo
authors.affiliation: HIV and AIDS Program, Population Council, Lusaka, Zambia.
authors.forename: Grimond
authors.initials: G
authors.lastname: Moono
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D017144:Focus Groups; D005869:Ghana; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D057545:Social Stigma; D013240:Stereotyping; D014454:Uganda; D015024:Zambia
keywords: HIV positive; PLHIV; accessibility; disability; persons with disabilities