Need for evidence based information on Disability related to HIV/AIDS in Africa Adonis TOUKO Cameroun Addis Ababa, Dec 7 th 2011 OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa INTRODUCTION WHO and World Bank (2011) estimates that 15% of the worlds population live with a disability But the breakdown depends on many factors: - Environment and natural catastrophes - Living conditions - Road accidents - Wars and armed conflicts - Food and substance abuse Based on this, African countries in particular located Sub-Sahara are the most affected because of economic disadvantage (UN, 2005; WHO/World Bank, 2010). Therefore the following question: Is there any correlation between Persons with disabilities predominantly living in Africa and development policy?

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa INTRODUCTION…/. The answer lies in challenges that concerned countries need to address: 1/- Challenges related to statistics related to persons with disabilities 2/- Challenges in policies related to development 3/- Challenges related to health policies and in particular to HIV and AIDS

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to statistics… -No policies can be elaborated without any relevant data and statistics -For African countries, there is a need to look at quantitative and qualitative data At the quantitative level Paucity in statistical data or data diverging from world estimations as seen in: - Benin : RPGH 3 (2004) estimates that 2.6% of the population is disabled, far from the estimations from WHO and World Bank - Cameroon: RPGH 3 (2010) surveyed 262,119 persons with disabilities in the entire country or 1.5% of the population ! - En Central Republic of Africa: according to the last census (2003), 39,335 persons with disabilities have been survey or less than 1% of the population The problem lies in the estimations of the WHO/World Bank or RGPH?

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to statistics… At the qualitative level Do the RGPH takes into consideration the different types of impairments (sensory, intellectual, mental and physical)? Hence, how can disability experts be included during elaboration of data collection tool during RGPH?

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to development policy… At the level of education At the level of infrastructures In relation to recruitment Example: Out of 25,000 young graduates, 52 are disabled, or 0.2% !!

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to development policy…. At the level of international legal instruments (UN Convention on the Rights of Persons with Disabilities (CRPD)) Countries in CEMAC Countries of CEDEAO Out of 15 countries 2 have not signed the CRPD (Gamba/Guinea Bissau) et 6 did not ratified the CRPD (Gambia/Guinea Bissau/Bénin/Ivory Cost/Ghana and Liberia) Country CEMACSigned the CRPDRatified the CRPD CamerounYes (2008)No GabonYes (2007) DRCYes (2007)No Central Republic of Africa Yes(2007)No Eqautorial GuineaNo TchadNo Total4/61/6

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to development policy At the national level : There are some instances and tools for measurement : In Cameroun -A national rehabilitation and social inclusion committee for persons with disabilities (CONRAH) has been created through a decree N° 96/379/PM, June 19, Law N° 2010/002, April on the protection and rights of persons with disabilities In Gabon -Social law on the protection of persons with disabilities (Law 19/95, February 13, 1996) -National day for the persons with disabilities (08 January), 03 December -Disability card for reduction of fees in relation to several public services But the issue is the applicability and application of these tools and instruments

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to health Challenges related to health, especially related to HIV and AIDS Hope has been generated from the work of the World Bank (2005) and the African Campaign on HIV and disability (2007), as supported by the Kampala Declaration (2008). This has resulted in various new responses on HIV and disability from the international community. Question: Have these hopes been met? - at the level of national AIDS strategic planning - at the level of research on HIV and AIDS - at the level of HIV programming

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa At the strategic level Many national AIDS strategic plans (NSP) have been examined in several countries of the Central and West Africa region on whether they are including persons with disabilities NSP that have been looked at: Benin: NSP Cameroun: NSP Central Republic of Africa: NSP Tchad: NSP DRC: NSP Challenges related to health…

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to health… TCHAD: HIV prevalence: around 3.3% Priority groups: Youth, Mossos, sex workers, young women and girls No reference to persons with disabilities / No mention of persons with disabilities in the NSP DRC: HIV prevalence: between 1 to 7% Priority groups: General population/ sex workers / PLHIV/ Other groups exposed to HIV infection: people using drugs, athletes, musicians, prisoners, persons with disabilities, MSM Central Republic of Africa HIV prevalence : 6.2% (the highest in central Africa) Priority groups: youth of years old, sex workers, truck drivers and miners No reference to persons with disabilities

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to health… BENIN Prevalence around 2% No mention of persons with disabilities in the priority groups CAMEROUN Prevalence: 5.5% Groups using vehicles identified Youth / truck drivers and moto taxi drivers / sex workers / MSM / security and protection officers for refugees and displaced people / persons with disabilities / orphans and vulnerable children / Les populations mobiles (réfugiées, déplacés, pêcheurs…) In summary: Most NSP do not include persons with disabilities

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges related to health… At the programmatic level The situation is not better, through there are some exceptions: In Cameroun (2008), the project « Closing The Gaps by CBC et CWG HIV and Disability (Canada) In Cameroun (2009), a project on « Deafs Against AIDS » In Mali, there is a programme on HIV and disability of three years by Handicap International supported by the French Development Agency and USAID In Senegal, a similar programme was implemented In all the other mentioned countries (Benin, Congo, Tchad, Central Republic of Africa), there are no specific information on persons with disabilities

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Au niveau des ETUDES Enquêtes CAP La situation des études est elle aussi caractéristique du peu dintérêt - Rareté des données comportementales sur la sexualité de cette population, comme déjà indiquée par plusieurs sources (Nora, 2005, World Bank, 2010) Enquêtes sérologiques - Cette rareté sétend aussi aux études de séroprévalence, en dehors de quelques rares cas dont : - une étude séro-comportementale réalisée dans le projet dont nous avons déjà parlé au Mali et au Sénégal - une étude menée au Cameroun par nos soins*. Toutes ces études font état dun taux de prévalence plus élevée chez les PSH que dans la population générale LES DEFIS SANITAIRES…

The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa CONCLUSION Il semble y a voir une très faible volonté politique des décideurs sur les questions de handicap Ce faible intérêt sappuie sûrement sur les perceptions négatives et les représentations sociales stigmatisantes du PSH dans limagerie populaire Mais il est aggravé entre autres par le fait quil ny a pas suffisamment de données en quantité et en qualité pour soutenir les causes des PSH Cest particulièrement le cas dans la lutte contre le SIDA, où lon remarque que les stratégies sont loin dêtre inclusives Dans un tel cas, on ne saurait parler daccès universel aux soins, ou encore de latteinte des Objectifs du Millénaire, notamment lOMD N°6 Il est donc plus que urgent dagir ici et maintenant, en particulier dans les pays dAfrique noire francophone.