Nixon Stephanie A, Cameron Cathy, Hanass-Hancock Jill, Simwaba Phillimon, Solomon Patricia E, Bond Virginia A, Menon Anitha, Richardson Emma, Stevens Marianne, Zack Elisse
International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Canada; Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.
J Int AIDS Soc. 2014 Apr 23;17(1):18806. doi: 10.7448/IAS.17.1.18806. eCollection 2014.
Despite the emerging body of literature on increased vulnerability to HIV among people with disabilities (PWDs), there is a dearth of evidence related to experiences of PWDs who have become HIV-positive. This priority was identified by a disability advocacy organization in Lusaka, Zambia, where the prevalence of HIV and of disability is each approximately 15%. The purpose of this study was to explore perceptions and experiences of HIV-related health services for PWDs who are also living with HIV in Lusaka, Zambia.
This qualitative, interpretive study involved in-depth, semi-structured, one-on-one interviews with two groups of participants in Lusaka, Zambia: 21 PWDs who had become HIV-positive, and 11 people working in HIV and/or disability. PWDs had physical, hearing, visual and/or intellectual impairments. Interviews were conducted in English, Nyanja, Bemba or Zambian sign language. Descriptive and thematic analyses were conducted by a multidisciplinary, international research team.
Participants described their experiences with HIV-related health services in terms of the challenges they faced. In particular, they encountered three main challenges while seeking care and treatment: (1) disability-related discrimination heightened when seeking HIV services, (2) communication barriers and related concerns with confidentiality, and (3) movement and mobility challenges related to seeking care and collecting antiretroviral therapy. These experiences were further shaped by participants' profound concerns about poverty and unmet basic needs.
This study demonstrates how PWDs who are HIV-positive have the same HIV care, treatment and support needs as able-bodied counterparts, but face avoidable barriers to care. Many challenges mirror concerns identified with HIV prevention, suggesting that efforts to promote inclusion and reduce stigma could have widespread benefits.
Despite the growing body of literature on increased risk of exposure to HIV among HIV-negative PWDs, this is the first published study to examine perceptions of testing, treatment and other HIV services for PWDs who have become HIV-positive. Findings reveal far-reaching opportunities for improving the quality of care for this population.
尽管关于残疾人（PWD）感染艾滋病毒的易感性增加的文献不断涌现，但缺乏与已感染艾滋病毒的残疾人经历相关的证据。这一优先事项是由赞比亚卢萨卡的一个残疾倡导组织确定的，该国艾滋病毒和残疾的患病率均约为15%。本研究的目的是探讨赞比亚卢萨卡同时感染艾滋病毒的残疾人对艾滋病毒相关医疗服务的看法和经历。
这项定性的解释性研究涉及对赞比亚卢萨卡两组参与者进行深入的半结构化一对一访谈：21名已感染艾滋病毒的残疾人，以及11名从事艾滋病毒和/或残疾工作的人员。残疾人有身体、听力、视力和/或智力障碍。访谈以英语、尼扬扎语、本巴语或赞比亚手语进行。由一个多学科的国际研究团队进行描述性和主题分析。
参与者从他们面临的挑战方面描述了他们在艾滋病毒相关医疗服务方面的经历。特别是，他们在寻求护理和治疗时遇到了三个主要挑战：（1）寻求艾滋病毒服务时与残疾相关的歧视加剧，（2）沟通障碍以及与保密相关的问题，（3）与寻求护理和领取抗逆转录病毒疗法相关的行动和行动能力挑战。这些经历因参与者对贫困和未满足的基本需求的深切关注而进一步受到影响。
本研究表明，感染艾滋病毒的残疾人与身体健全的同龄人有相同的艾滋病毒护理、治疗和支持需求，但面临可避免的护理障碍。许多挑战反映了在艾滋病毒预防方面发现的问题，这表明促进包容和减少耻辱感的努力可能会带来广泛的好处。
尽管关于艾滋病毒阴性残疾人感染艾滋病毒风险增加的文献越来越多，但这是第一项发表的研究，旨在研究已感染艾滋病毒的残疾人对检测、治疗和其他艾滋病毒服务的看法。研究结果揭示了改善这一人群护理质量的深远机会。
