December 3, 2003—As the global community marks World AIDS Day this week, and watches with growing alarm as the disease marches on inexorably in East and South Asia, in Eastern Europe, and Africa, a key group that is being largely overlooked in efforts to stop the spread of HIV/AIDS is the global population of some 600 million people who live with a physical, sensory, intellectual, or mental health disability. According to Judy Heumann, the World Bank Group’s Adviser on Disability and Development, the linkage between HIV/AIDS and its risk factors for disabled people is especially relevant to consider today on the occasion of World Disability Day.
Judy Heumann has used her first 18 months at the World Bank, wanting to amplify the voices of disabled populations which she worries are not heard in global and regional efforts to promote fair and lasting development. In a recent trip to Africa, for example, Heumman and Bank staff met with government officials and NGOs in Ethiopia, South Africa, and Uganda to see first-hand the disability efforts of local communities and how the World Bank could better help them in their work.
Because people with disabilities are among some of the most marginalized in the world today, Heumann worries that the implications of HIV infection for them has been largely ignored. Every major risk factor linked to HIV infection is also present in disabled populations. Disabled people are significantly more likely than their non-disabled peers to live in poverty, to be illiterate and to be unemployed. Heavily stigmatized, they are often barred from taking part in the social, legal, religious and political affairs of their communities. Too often, disabled people are also incorrectly assumed to be sexually inactive, unlikely to use intravenous drugs and alcohol and at little risk for abuse or violence. | |  | | | Judy Heumann, the World Bank Group’s Adviser on Disability and Development |
“Some people think that people living with disabilities are not sexually active, but they’re as active as everyone else,” says Heumann. Another problem, she says, is that abuse against disabled women is quite high and so it’s common that they have multiple sex partners and are acquiring AIDS. Over the past year, Heumann joined forces with two powerful allies to undertake a Global Survey of HIV/AIDS among disabled populations—Nora Groce of the Yale School of Public Health, and Debrework Zewdie, Director of the World Bank’s Global HIV/AIDS Program. As a result of their collective efforts, a global survey was distributed to over 3000 organizations, advocates and activities in July 2003, has thus far yielded hundreds of responses from 57 countries. Although collection and analysis of the survey is still underway, interim results show the following: - HIV/AIDS is a significant and almost wholly unrecognized problem among disabled populations worldwide;
- While all individuals with disability are at risk for HIV infection, subgroups within the disabled population—most notably women with disability, disabled members of ethnic and minority communities, disabled adolescents and disabled individuals who live in institutions, are at especially increased risk; and
- HIV/AIDS educational, testing and clinical programs are largely inaccessible to individuals with disability.
According to Heumann, these preliminary findings from the Yale/World Bank study strongly argue that disabled people can—and should—be included in all HIV/AIDS outreach and service efforts. Much of this work can be done at little or no additional expense; other programs need only slight modification to be made significantly more inclusive. Disability-specific measures will also be needed to reach some subgroups within the larger disabled population. These can be justified from the perspective of both development economics and human rights. A three-stage intervention model is proposed to ensure that individuals with disability are reached by HIV/AIDS outreach efforts. The need for expanded research, and increased educational and clinical outreach is strongly urged. Overlooking the threat of HIV/AIDS to disabled populations is one of the most dramatic forms of exclusion they face, there is the larger situation that disabled people are largely invisible in their communities, and are largely overlooked in efforts by the global development community to improve the human welfare and living standards of millions of the world’s poor people. It is important for policymakers and development practitioners alike to realize that, with roughly 10 percent of the world’s population living with one form of disability or another, disability components must be built in all development projects. “From an economic perspective, we look at the fact that most disabled children don’t attend school,” says Heumann, “and as this population becomes older and cannot get jobs because they have no education, it means that families have to take care of people who could be contributing to society.” She says the disabled thus become an economic drain on their communities simply because they were denied the opportunity to contribute. Heumann notes that the Bank has historically focused on preventing disability, which is quite important, “but humankind will continue to make people become disabled, whether it’s with them losing their limbs or being blown up with bombs.” The Bank, she says, has to be able to help governments remove the stigma that is attached to disability. “People need to know that disability is not a curse or punishment for some past wrong, as many in some of the countries we deal with seem to believe.” Among her top priorities has been education, specifically what has come to be known as Inclusive Education. “Inclusive education is where you're bringing disabled children to the same schools as non-disabled children, but keeping the cost of educating these children at a level that's feasible for the governments to be able to participate in,” says Heumann. Heumann is not counting solely on the Bank to bring the disabled into the mainstream of development. She is working to develop a Global Partnership on Disability and Development, bringing together other donors, governments and NGO’s “to shine a light on the needs and solutions to problems disabled people are facing.” |
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