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DISABILITY AND HIV/AIDS HANDICAP INTERNATIONAL

DISABILITY AND HIV/AIDS HANDICAP INTERNATIONAL. Brief presentation of Handicap International Why is Handicap International working on HIV/AIDS issues? Three projects related to Disability and HIV/AIDS (Ethiopia , Kenya and France). Brief Presentation of the NGO.

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DISABILITY AND HIV/AIDS HANDICAP INTERNATIONAL

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  1. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  2. DISABILITY AND HIV/AIDSHANDICAP INTERNATIONAL Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  3. Brief presentation of Handicap International • Why is Handicap International working on HIV/AIDS issues? • Three projects related to Disability and HIV/AIDS (Ethiopia, Kenya and France) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  4. Brief Presentation of the NGO Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  5. Handicap International is a French NGO, created in 1982 • Annual budget: 59 millions Euros, funded through private fund-raising (66%) and institutional donors (34%) • 5 offices in Europe: Belgium (operational section), United Kingdom, Germany, Switzerland and Luxemburg • About 2,200 staff members in the field and 180 in the Lyon (France) headquarters Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  6. Both operational sections (HI France and HI Belgium) are implementing projects in collaboration with local partners in 50 countries worldwide, in Africa, Asia, Eastern and South-East Europe and in Central and South America: • Senegal, Mali, Burkina Faso, Togo, Guinea Bissau, Sierra Leone, Central Africa, Liberia, Ivory Coast, RDC • Kenya, Somaliland, Ethiopia, Rwanda, Burundi • Angola, Mozambique, Madagascar, Mauritius Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  7. Morocco, Algeria, Tunisia, Palestinian Territories, Lebanon, Egypt, Irak, Iran, Yemen • India, Nepal, Bangladesh, Afghanistan, Sri Lanka, China • Philippines, Thailand, Cambodia, Vietnam, Laos • Nicaragua, El Salvador, Brazil, Cuba, Colombia • Russia, Ouzbekhistan, Kosovo, Albania, Bosnia, Serbia, Macedonia, Montenegro Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  8. MAIN ACTIVITIES(based on a twin-track approach) • Training of physiotherapists, orthopaedic technicians, psychomotricians, orthophonists, at a provincial or national level in collaboration with Ministries of Health • Support to Ministries of Health or Social Affairs for the elaboration of national policies related to disability Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  9. Support to demobilization process (disabled ex-soldiers, reunification process for children,…) • Community-based rehabilitation projects • Support and capacity building for organisations of and for people with disabilities • Advocacy for the inclusion of people with disabilities’ concerns into mainstream development projects or processes (inclusive education, inclusion of disability in PRSP, present lobbying on EU delegations and embassies…) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  10. Mine Risk Education • Humanitarian de-mining based on development indicators (access to potential agricultural areas, access to schools, drinking water, etc.) • HI is one of the founding organisation of the world-wide lobbying action of the International Campaign to Ban Landmines for which it shared the Nobel Prize in 1997. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  11. Involvement with other excluded and vulnerable groups into the society and the community, based on a broader understanding of the «disabling process» touching both the individual and his/her environment.This approach includes the Handicap International projects related to HIV/AIDS issues (work on disability and HIV/AIDS) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  12. Why is Handicap International involved in the fight against HIV/AIDS? Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  13. Some of the main reasons are: • Some « traditional » projects were implemented in countries with a high HIV prevalence (Ethiopia, Mozambique,…) • The teams in the field and our partners were facing HIV/AIDS in theirprofessional activities and daily life • Some of our partners requested us to take into consideration their specific needs related to HIV/AIDS prevention Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  14. HIV is a cause of physical, psychological and social incapacities • Environmental factors such as stigma and discrimination in societyor non access to appropriate healthcare either because of distance, cost, or lack of medication also create a disabling situation for people with HIV • People with motor, sensorial and mental disabilities are among the most vulnerable to infection Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  15. General approach • Strategy based on the equalisation of opportunities, inclusion and social integration of people living with the virus. The four components are primary prevention, healthcare, social and economic integration, and rights and policy. • This comprehensive approach is implemented through the combined efforts of people living with HIV themselves, their families and communities, and the appropriate health, education, vocational and social services Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  16. Three specific initiatives in the field of HIV/AIDS and DisabilityEthiopia (sensorial disability) Kenya (physical disability) France (mental disability) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  17. HIV/AIDS prevention for people with hearing impairmentsETHIOPIA Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  18. Project implemented in partnership with ENAD (Ethiopian National Association of The Deaf people) • General partnership between HI and ENAD (capacity building) before a specific request related to HIV/AIDS prevention was made • Request related to HIV/AIDS prevention activities for their members including a specific training of trainers Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  19. KAP survey conducted among 205 deaf individuals (79% under 25 years old, 45% female, 50% in school or university ) able to communicate in sign languages • 85.9% of the respondents were aware of HIV/AIDS Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  20. Correct modes of transmission reported as possible ways for transmission of HIV/AIDS • Unprotected sexual intercourse, if one of the partners is carrying the virus, was reported by 95.1% of the respondents • Sharing of syringes and other skin piercing and cutting sharp instruments reported by 85.1% of respondents • Other major modes of transmission: transfusion of infected blood (79.9%) and mother to child transmission (67.4%) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  21. Incorrect modes of transmission reported as possible ways for transmission of HIV/AIDS • Biting of mosquitoes reported by 41% of the respondents • Kissing by 39.6% • Sharing of eating and drinking ustensils with HIV positive people reported by 26.4% Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  22. Attitude towards a person living with HIV • 69,8 % said that they would give him/her care and support • 45% reported that they would advise him/her no to tell anyone that he/she is infected with HIV/AIDS • 31.7% indicated that they would tell other people to protect themselves against the individual because he/she is the victim of AIDS, • 24% would advise him/her leave the village and to go far away Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  23. Source of information • Television (through translation by friends, and before the starting of the program now held on Ethiopian TV about HIV/AIDS in sign language) • Friends / colleagues • Written documentation (newspapers / leaflets) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  24. Training of Trainers • Six-day training carried out by three trainers from OSSA (Organization of Social Services for AIDS) for 14 participants with hearing impairments selected by ENAD • Topics addressed during the training: • Participatory Methods and Tools • Human Anatomy (Participants rose questions that invited warm discussion) • Gender & Sex Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  25. Adolescent Sexual Life • Life Skills (Self confidence, Intra-personal communication skill, decision making,… • Sexually transmitted diseases / HIV/AIDS • Contraceptives (including condoms’ distribution and demonstration) • An 18-page manual was given to each participant. This was derived from the 215 pages manual used by OSSA. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  26. General Comments on the training Strengths: • Use of a global approach, including a training of trainers, and not only prevention activities directly for ENAD members. • Contents of the training not focused only on HIV/AIDS but also on sexuality, reproductive health, life skills,… • Allowed for open discussions of « taboo » topics Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  27. Weaknesses • Trainers often spoke too fast, making it difficult to translate into sign language. Some terms were also a challenge to express in sign language • Information gaps were identified (based on age and education background) and there was a lack of uniform understanding among participants • Given these difficulties, it was decided to hold a refresher training before the main awareness session Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  28. Main awareness session for 783 deaf people • A two day refresher course was held for the 14 trainers in order to: • clarify concepts which might have not be understood during the first training, • improve their confidence during the training • facilitate their appropriation on the two-day session (starting from a six day training) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  29. 783 participants dispatched in 19 groups (42% female) • 2-days awareness sessions over two months (with two OSSA trainers, two interpreters (amharic – sign language) and 14 Deaf trainers / facilitators) • Four major topics covered: • Reproductive Organs • Sexually Transmitted Infections • Family planing • HIV/AIDS Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  30. IEC tools delivered to the 783 participants: • 1,500 posters (designed by a deaf painter) • 3,000 leaflets • Condoms Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  31. General Comments Strengths • A Reporter and a cameraman were present and a part of the sessions was broadcast within the “deaf program” of the Ethiopian TV • Most of the participants were willing to use what they had learnt to carry out new sessions in the provinces (peer educators) • Strong request to ENAD to create a specific resource centre in Addis-Abeba Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  32. Weaknesses • Logistical problems with the first rooms allocated to the training where exchanges were based on sign language: • In one room, participants sat one behind the other in classroom style • The other room had almost no window ….whereas electricity was not functioning Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  33. Prevention and home-based care activities for disabled people living with HIV/AIDSKENYA Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  34. Project established within the framework of a large HIV/AIDS program run by HI in the Trans N’Zoia District since 1997 • The comprehensive program includes the following components: • HIV/AIDS prevention in 69 secondary schools of the district (in collaboration with an association of people living with HIV/AIDS, TIPHA-K) • support to 2 Voluntary Counseling and Testing Centers, home-based care and counseling (with community groups and trained nurses from the district hospital), Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  35. training for the management of opportunistic infections in 21 dispensaries of the district, and support to the introduction of ARVs. • Social and economic integration of people living with HIV/AIDS and their families, with a specific focus on people with disabilities • First contact with the association « Trans Nzoia Disabled » in 2003 (225 registered members, and 40 active members) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  36. Trans N’Zoia Disabled was already active in the community through: • Identification/registration of disabled persons through community leaders and local associations. • Advocacy for disabled people • Identification of those requiring medical care and linking them with community health workers or with health facilities • Identification of children with mental disability in the community and link with the appropriate schools or institutions • Networking with other groups of disabled people (Busia district) with the aim to create an association at the North Rift Valley province's level Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  37. The well-established community network of « Trans N’Zoia Disabled » was a key starting point for activities related to HIV/AIDS. • The following were launched in 2003: • Awareness sessions among members with support from the Handicap International IEC team. • One member currently in charge of HIV awareness among the deaf people. • Home based-counseling: two members trained by Handicap International are now visiting 3 disabled people living with HIV/AIDS • Improved links with the Health workers. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  38. General Comments • Activities still at a « low-level », however, this link with other associations of people with disabilities in the province promises to lead to a larger impact. • Possible links with an emerging HI initiative in Nairobi which aims to improve access to HIV/AIDS information for deaf and visually impaired people in the city’s slums. This project was designed in collaboration with: • KUB (Kenya Union of the Blind), • KSB (Kenya Society of the Blind) • KNAD (Kenya national association of the Deaf) • NFFS (Nairobi Family Support Services ) Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  39. Intimacy and Sexualityamong people with mental disabilitiesDiscussion groups within specialized institutionsFRANCE Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  40. Reasons why this project was created: • Because people with mental and physical disabilities permanently living in specialized institutions have human needs, including intimacy. • Because some of them wish to live as a couple and raise a family, but are confronted with obstacles • Because individuals living in specialized institutions are sometimes victims of sexual abuse Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  41. Because feeling empowered to refuse sexual advances is not a given, especially in people with disabilities • Because HIV/AIDS is a real threat , even in France and even to people with physical and mental disabilities • Because there is both a need and a demand for addressing sexuality and HIV/AIDS among the disabled population in France Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  42. Objective of the Discussion Groups • To recognize and address the negative attitudes that exist towards disability and sexuality • To improve the well-being of people with mental disabilities living in institutions with regard to respect of their intimacy, sexuality and feelings Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  43. Four types of Discussions Groups are held within each specialized institution: • Groups of people with mental disabilities • Groups of parents and families • Groups of professionals working in the institutions (social workers, psychologists, physiotherapists) • Groups from the management of the institutions Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  44. How are the Discussions groups implemented? • The project leader, who is a licensed sexologist trained in recreational therapy, organizes and moderates Discussions Groups in institutions throughout France • 3 to 6 sessions are carried out separately for each type of Discussion Group and within each institution requesting these services • Discussions surround issues such as intimacy, emotions, sexuality, parenthood and family planning, and depend largely on the group dynamics. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  45. A variety of tools and visual aides are used to encourage expression about sensitive topics • Participants are allowed to pursue their own objectives during the process and are encouraged to make their own decisions about any future action as it relates to their role in the institution. • The project is funded by the Regional delegations of Social Affairs and by the financial contribution of each participant Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  46. In 2003: • 160 children, teenagers and adults with mental disabilities participated in the discussions groups (6 sessions each) • 135 professionals working in specialized institutions attended Discussion Groups sessions entitled: « the affective and sexual life of disabledpeople: what is my role?» Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  47. 105 relatives (mostly parents) participated in Discussion Groups within their own associations on the theme: «The affective and sexual life of my child » • Six management teams committed themselves to review the policies of their respective institutions and to create an appropriate environment respectful of the affective needs of the disabled residents, all the while adhering to the legal responsibilities of the institution Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  48. General Comments • There is no magic recipe: each new Discussion Group brings its own challenges, doubts, questions and partial solutions • Discussion Groups are the first opportunity for many participants to talk freely and constructively about the importance of intimacy and sexual fulfillment for themselves or for their loved ones with mental disabilities. Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

  49. Contacts Handicap International 14, Avenue Berthelot 69361 Lyon Cedex 07 – FRANCE Tel: +33.(0)4.78.69.79.79 Fax: +33.(0)4.78.69.79.94 www.handicap-international.org.uk Handicap International - Activities related to Disability and HIV/AIDS - World Bank 06/05/2004

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