HIV activists in Malawi are beginning a new collaboration with advocates for people with disabilities to ensure that HIV prevention messages are reaching even those who cannot see or hear.
According to World Health Organization (WHO) estimates, around 1% of most African country's populations are deaf or blind. In Malawi, this amounts to roughly 25,000 people who are active members of their communities, engaging in the same kinds of behaviors that can increase the risk of HIV infection.
The president of the African Federation of the Deaf-Blind, Ezekiel Kumwenda, told Aidspan that HIV prevention efforts have until now failed to integrate messaging specifically targeting the blind or deaf.
“This gap therefore creates an unfortunate window within our communities through which the country may find that the gains in HIV and AIDS interventions are getting reversed,” Kumwenda said.
With a recorded prevalence rate of 10.8 percent for adults aged 15-49, and 50,000 new cases of HIV registered annually, Malawi is considered a high-burden country by the Global Fund. The National AIDS Commission has never recorded prevalence among the population of people with disabilities, but according to Kunwenda, HIV prevalence is higher, at 14%, than among the general population.
This can be attributed to a wholesale lack of understanding and awareness about HIV within the population because it has never been packaged in a way that is easily accessible, he said.
“Don’t leave the disabled behind. How can condoms be used effectively by people who cannot see or hear?" he asked. "If someone can read instructions for you, then it means you have no privacy. Why don’t manufacturers put expiry dates in Braille in condom packets?"
Other challenges include the difficulty of accessing HIV and AIDS service centres, while noting that there are few counselors who are fluent in sign language who can reach deaf clients.
According to the 2009 Malawi National Association of the Deaf (MANAD) Baseline Survey, about 47 percent of the respondents revealed that they have never been reached with any message about HIV and AIDS.
MANAD executive director Byson Chimenya told Aidspan that though Malawi has had some success in reducing its prevalence rate due to targeted interventions for youth, married couples and other key populations, the deaf community has been left behind.
“This has been aggravated due to lack of appropriate forms of information dissemination for deaf people. Most service providers do not have requisite communication skills to liaise with the deaf,” Chimenya said through a sign-language interpreter.
Reaching people with disabilities is not a problem unique to Malawi, Chimenya said, noting that a comprehensive initiative developing messaging in Braille for behavior change and advocacy campaigns, and supporting training in sign language for voluntary counseling and testing (VCT) counselors would be useful the world over.
Conducting HIV and AIDS awareness through focus group discussions among deaf people, training deaf people to become VCT counselors and finding effective ways to promote condom use for people who cannot see or hear will require resources, innovative approaches and a global commitment to including all people in prevention and safer sex messaging.
MANAD has been a sub-recipient of Global Fund grant money since June 2013. Chimenya said that he is working closely with the NAC and other HIV stakeholders to ensure that the country's concept note for allocations available under the new funding model (NFM) includes provisions for activities targeting people with disabilities.
One activity that could potentially find support is a project proposed in early 2014 that was shelved for want of funds. The project would target five districts in Malawi with a prevention campaign specifically designed to reach deaf and blind populations with condom promotion and distribution, and counseling services that accommodate their disabilities.
The project, with a price tag of roughly $65,000 would also train existing VCT counselors in international sign language in the five districts so that the hearing impaired and the deaf could access VCT services through public facilities.
Owen Nyaka lives in Malawi and is a member of the Key Correspondents network which focuses on marginalized groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.