The myth of asexuality? Disability stigma as a barrier to sexual relationships in South Africa Literature review

Reading note 10. Gender differences in HIV knowledge and unsafe sexual behaviours among disabled people in South Africa.

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Keywords

Emotional and sexual life;

Author’s note

Purpose: The international literature suggests that disabled people may be at increased risk for HIV infection. There is a growing increasing recognition of this in South Africa, although there remains a paucity of literature on how disabled people are affected by HIV/AIDS. This is a concern given the seriousness of the epidemic here. This paper reports on descriptive data exploring gender differences in HIV knowledge and unsafe sexual behaviours among disabled individuals in South Africa.
Method: Data was collected by means of a survey questionnaire from a total sample of 285 disabled individuals in three of the nine provinces in South Africa. Data was analysed by means of descriptive statistics.
Results: There are low levels and uncertainty of knowledge about HIV transmission and HIV prevention, with females tending to have lower levels of knowledge than males. Although the importance of condoms in HIV prevention was recognised, there were relatively high levels of reported unsafe sexual behaviours. Males reported higher number of monogamous and concurrent sexual partnerships and sex without a condom after alcohol use. Conclusions: The results support the literature that suggests that disabled people are at risk for HIV infection, and that both male and female individuals with disability are at risk.
Commentary

In this peer-reviewed article (C4), Rohleder et al. investigate the characteristics of persons with disabilities affected by HIV in South Africa, with particular attention to gender differences and frequencies of unsafe sexual behaviours. Rohleder et al. highlight that persons with disabilities have been overlooked in terms of their risk of HIV and prevention strategies. Given the lack of knowledge of how HIV may affect this population, the authors seek to describe the characteristics of individuals with disabilities living in communities affected by HIV in South Africa (C1). The authors survey 285 individuals with disabilities in three different provinces of South Africa and attempt to obtain as representative a sample as possible of persons with disabilities (e.g., collecting data from urban, semi-urban and informal settlements). The methodology used does not allow for as close collaboration persons with disabilities as more participatory research designs (e.g., Chappell, 2015), however, Rohleder et al. consult disability organisations in order to facilitate and complete data collection of their project (C2). The nature of the findings (see below) also means that the study is highly useful to actors in the field (C2). The findings illustrate some areas of HIV prevention where persons with disabilities lack knowledge (e.g., Having fewer sex partners) and also suggest that, despite recognising the importance of condoms, there exists considerable ambivalence about their use. Moreover, while the majority of the sample was found to have had sexual intercourse, levels of unsafe sexual behaviours (e.g., unprotected) were also high. The study also notes gender differences (e.g., males reported more sexual activity than females). As such, this research identifies some problematic ways in which persons with disabilities are affected by HIV, which allow the authors to make some recommendations for future targeted interventions (e.g., substance use may not be a significant risk factor compared to lack of condom use; C3). Although effort has been made to collect data from as representative a sample as possible, nevertheless the authors caution that the data is not fully representative of South Africans. Additionally, they highlight the presence of missing data, which required imputation.

Reading note 11. Experiences and perceptions of sexuality and HIV/AIDS among young people with physical disabilities in a South African township: A case study.

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Keywords

Child and teenager; Emotional and sexual life; Family: Caregiver

Author’s note

This study explored the experiences and perceptions of sexuality and HIV/AIDS among 15–24 year-old young people with physical disabilities in a South African Township characterised by high unemployment rates and lack of social services. Ten young people and ten parents participated in multiple individual interviews as well as in focus group discussions. The analysis of audio taped and transcribed responses identified common experiences and perceptions among participants. The results indicate that disabled young people have limited factual knowledge about sexuality and HIV/AIDS. The decisions and choices they make about sexual behaviour are not informed by what they know; rather, they are part of the whole life situation in Nyanga. Their need to be loved and accepted, need for job security and family life, were more important than practicing ‘safe sex’. Therefore, there is need for HIV/AIDS programme developers to take into account the experiences and perceptions of the target population.

Commentary

In this peer-reviewed article (C4), Wazakili et al. explore the sexual experiences and perceptions of youth who have physical disabilities, as well as parental attitudes, within a South African township. The purpose of this study is to identify barriers that prevent these young persons from accessing sexual information, particularly about HIV (C3). In exploring this topic, Wazakili et al. help address the urgent need to understand the links between disability, sexuality and HIV, which has been neglected in the past (C1). The authors recruit their participants from Nyanga, a township suffering from high levels of poverty and violence. As such, this paper gives voice and agency (as sexual beings) to a particularly vulnerable group of youths with physical disabilities (C1, C2). The findings indicate that youths with physical disabilities face many (inter-related) barriers to accessing sexual information. These barriers are identified as negative socio-cultural attitudes toward the sexuality of persons with physical disabilities, a lack of awareness about HIV, and vulnerabilities toward HIV infection (e.g., sexual exploitation). Wazakili et al. assert that their study shows the need for policy developers to take into account the experiences of this population, though further specific recommendations are not given (C3).

The authors also caution against generalising the results of the study to other persons with disabilities, even within Nyanga, due to the qualitative nature of the methodology. They further acknowledge that, due to high crime and violence levels, youths living in some areas of the township were unable to be accessed. Notwithstanding, Wazakili et al. rightly suggest that their findings should be viewed as illustrating the complex web of ways in which young persons with disabilities experience both sexuality and HIV concerns (C1, C3). It is herein that the study is of particular value to the field.