Disability Does Not Mean Inability to Get HIV

By Hannah Slater, CHLP Intern and Heather Heldman, CHLP Program Associate

Winston Zulu, an advisor for AIDS-Free World and the coordinator of Health Triangle Zambia, has used crutches ever since he survived polio as a child. He is also HIV positive. In his opinion piece in the New York Times earlier this summer, Zulu argues for greater acknowledgement and inclusion of people with disabilities in the fight against HIV, saying, "We must no longer be overlooked because of false assumptions about our sexuality. People with disabilities can and do have sex."

Recognizing that people are sexual, regardless of disability, is crucial to ensuring equal access to sexual health care. In fact, a recent study found that adolescents with physical disabilities are as sexually active as their counterparts without disabilities. As Zulu writes, it is naive to think that "all disabilities — of hands, feet, hearing, sight — somehow also affect the ability and desire to have sex." Not only is this misconception inaccurate and stigmatizing, but it is also dangerous and limits access to comprehensive sexual health care.

One major problem is that young people with disabilities often miss out on sexuality education offered to their  peers without disabilities. Depending on where they live, this may be due to the fact that youth with disabilities are enrolled in separate classes at mainstream schools, attend specialized institutions that do not include sexuality education in their curricula, or do not attend school at all. In these types of environments, sexuality education may be considered unnecessary because of the misconception Zulu describes: that people with disabilities are asexual or sexually abnormal. This unjustified lack of access to sexual health information puts people with disabilities at elevated risk for HIV and other sexually transmitted infections.

Further barriers exist inside the classroom and in other educational settings. For example, people with visual impairment miss out on posters, pamphlets, visual demonstrations, television campaigns, and billboards transmitting sexuality education information. Those with hearing impairment do not benefit from radio and television campaigns or oral lessons, and may have difficulty accessing sexual health services if a sign language translator is required. Individuals with disabilities may have to bring family members with them to translate their request for an HIV test, and may be deterred from seeking sexual health services due to lack of confidentiality. People who use wheelchairs or have disabilities that impair their movement sometimes find sexual health services physically inaccessible, and often have difficulty arranging transportation to and from places where these services are offered. Sexual health materials can be complex, written at high reading levels with technical medical terms that may not be easily understood by a person with intellectual or developmental disabilities.

These types of barriers to sexual health information and services must be addressed. Failure to do so contributes to poor sexual health outcomes in people with disabilities. According to a joint UNAIDS, WHO, and OHCHR policy brief on disability and HIV, the limited research available suggests that people with disabilities are infected with HIV at a rate similar to or higher than that of the general population. The US Department of Health and Human Services reports that among people with disabilities, women, people of color, adolescents, and people living in institutions are at even higher risk for HIV infection.

In a different, but also serious, vein regarding HIV prevention in individuals with disabilities, a review of nine studies on HIV infection among seriously mentally ill people estimated prevalence at 4-23%. This prevalence, among a group that cannot always give legal consent, suggests high levels of sexual abuse of people with some disabilities. According to The National Center on Child Abuse and Neglect, children with disabilities are sexually abused at a rate more than twice that of children without disabilities, and the US Department of Justice reports that 68% to 83% of women with developmental disabilities will experience a sexual assault during their lives. Pediatricians report that abuse can be reduced or eliminated by talking freely to children with disabilities about sexuality, body privacy, and reporting violations. Programs need to be similarly tailored for adults with serious mental illness and developmental delays.

People with disabilities must not be ignored in the fight against HIV, and inclusion requires actively addressing barriers to sexual health information and services. People with disabilities face similar or greater sexual risk than the general population, so it is time to end dangerous misconceptions about disabilities and sexuality and work toward ensuring the sexual health of all people.

For resources and information about sexuality education for children and adults with disabilities, see the following resources:

Sexuality Education for Students with Disabilities
National Dissemination Center for Children with Disabilities

Sexuality Education for Youth with Disability or Chronic Illness - A Resource List
University of Michigan Health System