title: Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH).
abstract: In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities.
  
  
  
  In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities.
  
  
  
  Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women.
  
  
  
  The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population.
  
  
  
  Agence nationale de recherches sur le sida et les hépatites virales (ANRS-Inserm) and the 5% Initiative.
authors.affiliation: IRD, CEPED, UMR 196, INSERM U1244, Université Paris Descartes-Institut de Recherche pour le Développement, Paris, France. Electronic address: pierre.debeaudrap@ird.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: De Beaudrap
authors.affiliation: Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon.
authors.forename: Gervais
authors.initials: G
authors.lastname: Beninguisse
authors.affiliation: Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon; Initiative 5% Sida, Tuberculose, Paludisme/Expertise France, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Pasquier
authors.affiliation: Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon.
authors.forename: Alice
authors.initials: A
authors.lastname: Tchoumkeu
authors.affiliation: Forum Camerounais de Psychologie, Yaoundé, Cameroon.
authors.forename: Adonis
authors.initials: A
authors.lastname: Touko
authors.affiliation: Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon.
authors.forename: Frida
authors.initials: F
authors.lastname: Essomba
authors.affiliation: Handicap International, Lyon, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Brus
authors.affiliation: Ayahulet Consulting, Abuja, Nigeria.
authors.forename: Toyin Janet
authors.initials: TJ
authors.lastname: Aderemi
authors.affiliation: Medical Research Council & University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jill
authors.initials: J
authors.lastname: Hanass-Hancock
authors.affiliation: SINTEF Technology and Society, Oslo, Norway.
authors.forename: Arne Henning
authors.initials: AH
authors.lastname: Eide
authors.affiliation: Handicap International, Lyon, France; School of Public Health, University of Montreal, London, UK.
authors.forename: Muriel
authors.initials: M
authors.lastname: Mac-Seing
authors.affiliation: Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mont
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D035862:Vulnerable Populations; D055815:Young Adult