The multidimensional vulnerability of people with disability to HIV infection: Results from the handiSSR study in Bujumbura, Burundi

Pierre DeBeaudrap; Gervais Beninguisse; Charles Mouté; Carolle Dongmo Temgoua; Pierre Claver Kayiro; Vénérand Nizigiyimana; Estelle Pasquier; Aida Zerbo; Emery Barutwanayo; Dominique Niyondiko; Nicolas Ndayishimiye

doi:10.1016/j.eclinm.2020.100477

The multidimensional vulnerability of people with disability to HIV infection: Results from the handiSSR study in Bujumbura, Burundi

EClinicalMedicine. 2020 Aug 1:25:100477. doi: 10.1016/j.eclinm.2020.100477. eCollection 2020 Aug.

Affiliations

¹ Centre Population et Développement, (Ceped), Institut de recherche pour le développement (IRD) and Paris University, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France.
² Institut de Formation et de Recherche Démographique (IFORD), Yaoundé, Cameroon.
³ Institut de statistiques et d'études économiques du Burundi (ISTEEBU), Bujumbura, Burundi.
⁴ Initiative 5%, Paris, France.
⁵ Nouvelle Espérance, Bujumbura, Burundi.
⁶ FSEG Université du Burundi, Bujumbura, Burundi.

Abstract

Background: In resource-limited contexts, available data indicate that people with disability are disproportionally affected by the HIV epidemic. While disability resulting from chronic HIV infection has received some attention, few epidemiologic studies have examined the vulnerability of people with disability to HIV acquisition. The aims of the study were as follows: to estimate and compare HIV prevalence among people with and without disability living in Bujumbura, Burundi; to examine how the interaction among disability, gender and socioeconomic environment shapes vulnerability to HIV; and to identify potential pathways to higher HIV risk.

Methods: In this cross-sectional population-based study, 623 persons with disability (302 with disability onset ≤10 years ["early disability"]) and 609 persons without disability matched for age, sex and location were randomly selected to be tested for HIV and to participate in an interview about their life history, their social environment and their knowledge of sexual health.

Findings: A total of 68% of men and 75% of women with disability were affected by multidimensional poverty compared to 54% and 46% of their peers without disability (p<0.0001). Higher HIV prevalence was observed among women with disability (12.1% [8.2-16]) than among those without (3.8% [1.7-6], OR_a 3.8, p<0.0001), while it was similar among men with disability and those without (p = 0·8). Women with disability were also at higher risk of sexual violence than were those without (OR_a 2.7, p<0.0001). The vulnerability of women with early disability to HIV was higher among those who were socially isolated (HIV prevalence in this group: 19% [12-27]). In addition, education level and sexual violence mediated 53% of the association between early disability and HIV (p = 0.001).

Interpretation: This study highlights how the intersection of disability, gender and social environment shapes vulnerability to HIV. It also shows that the vulnerability to HIV of women who grew up with a disability is mediated by sexual violence.

Funding: This research was funded by the Netherlands Organization for Scientific Research (Grant W08.560.005) and the Initiative HIV-TB-Malaria (new name of the organisation).

Keywords: Disability; Gender; HIV; Intersection; Sexual violence; Sub-Saharan African.