Lived experiences of persons with disabilities living with HIV in accessing HIV services in Africa: a qualitative systematic review

Abstract

Purpose

This qualitative review applies an intersectional lens to explore the lived experiences of persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in accessing HIV services.

Methods

Using thematic analysis, the intersections relating to HIV, disability, gender, stigma, and poverty were explored.

Results

Three themes were identified from the analysis: (1) intersection of gender, HIV, and disability – “For a man, it is easier because we women have a lot to take care of at the home and would not have enough time to go get services”; (2) intersection of stigma, HIV, and disability – “…Look at that one. He’s disabled, at the same time HIV-positive. He doesn’t even feel sorry for himself … to die quietly at home”; (3) intersection of poverty, HIV, and disability – “…maybe you don’t even have money to buy food and if you’re on medication you need to eat frequently”. The findings highlighted how stigma, poverty, and gender collide in a hierarchy of identities to impede accessibility to HIV services.

Conclusions

Researchers and programme implementers should note the intersecting issues of marginalisation that influence inequities in access to HIV services for PWDs living with HIV. National Strategic Plans should address these specific barriers to ensure accessibility for this marginalised population.

Implications for rehabilitation

• Governments within Africa should commit to including persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in National Strategic Plans (NSPs), which will support disability-inclusive HIV programming. The development process of NSPs should also include PWDs living with HIV.

• The inaccessibility of HIV services for PWDs living with HIV is multifaceted and intersectional. Interventions that consider the different social identities such as gender and socioeconomic status of PWDs living with HIV may be more impactful.

• Understanding the specific dimensions of access that impacted both the demand and supply side will facilitate efficient HIV programming for PWDs living with HIV.

Keywords:

• HIV
• disability
• intersectionality
• access
• HIV services
• persons with disabilities living with HIV

Acknowledgements

The first author was supported with a PhD scholarship at the Queensland University of Technology. The authors would like to thank Cameron Rutter, the Librarian for the School of Public Health and Social Work, who supported developing the search strategy and providing guidance on the databases to search.

Disclosure statement

The authors declare no conflict of interest.