Presented by Sara Emiru MA Special Needs Education, BA Sociology& Social Administration December 8, 2011 Sexual behavior of Women with Motor Disorders in context to HIV/AIDS Addis Ababa, Ethiopia 2008

Background Women with disabilities in developing countries are one of the most marginalized and vulnerable groups to HIV infection because they are women, disabled and poor. However, little or nothing is known about the sexual behaviours of women with motor disorders in Ethiopia. Women with disabilities in developing countries are one of the most marginalized and vulnerable groups to HIV infection because they are women, disabled and poor. However, little or nothing is known about the sexual behaviours of women with motor disorders in Ethiopia. This study sought to document the sexual behaviours of young Ethiopian women with motor disorders and implications for HIV infection. This study sought to document the sexual behaviours of young Ethiopian women with motor disorders and implications for HIV infection. The study adopted and utilized standard indicators of risk factors to HIV infections (BSS 2002, and DHS 2005) and soci-cultural issues The study adopted and utilized standard indicators of risk factors to HIV infections (BSS 2002, and DHS 2005) and soci-cultural issues

The study tried to address the following questions: What are the sexual practices and experiences of WMD? What are the sexual practices and experiences of WMD? What are the risk factors to HIV infections among WMD? What are the risk factors to HIV infections among WMD? What are the factors if any that contributes for HIV infection in relation to disability ? What are the factors if any that contributes for HIV infection in relation to disability ? What are the possible recommendations to promote safe sex and prevention of HIV infections? What are the possible recommendations to promote safe sex and prevention of HIV infections?

Definition of concept Women with Motor Disorder :A female whose age of and who has disability on her hand, leg or spinal and causes mobility problem in one or two extremes. This could be congenital (from birth), accidental due to injury or results of disease. Women with Motor Disorder :A female whose age of and who has disability on her hand, leg or spinal and causes mobility problem in one or two extremes. This could be congenital (from birth), accidental due to injury or results of disease. Study participants Women with motor disorder who were A member of from January 2003-December 2007 A member of Addis Ababa Region Association of Physically Handicapped who were registered from January 2003-December 2007 Age of (Youth in Ethiopian context) Age of (Youth in Ethiopian context) Non existence of multiple disabilities Non existence of multiple disabilities

Methodology Quantitative and qualitative method Quantitative method sample size calculated by using EPI-INFO version 6 statistical software. (147participant response rate of 93.6%) Quantitative method sample size calculated by using EPI-INFO version 6 statistical software. (147participant response rate of 93.6%) By assuming 50% of women with motor disorders are sexually active By assuming 50% of women with motor disorders are sexually active 95% of confidential standard and 5% of standard of error 95% of confidential standard and 5% of standard of error 10% contingency 10% contingency Qualitative method : One FGD and Eight Key II Qualitative method : One FGD and Eight Key II Instruments of data collection Instruments of data collection Quantitative – Structured questionnaire Quantitative – Structured questionnaire Qualitative – FGD and KII Interview guide Qualitative – FGD and KII Interview guide

Data Analysis The quantitative data was analyzed using SPSS version 15 to generate frequency tables. The qualitative data was contextual analyzed and grouped into themes. Limitation The study population was selected from the association which was not representative for those who were forced to live at the back of the door this is because: Member of the association get a chance to access and communicate each other and exchange information; (training, peer education, awareness raising programs etc.)

Sexual Experiences and Practices of Respondents 78(53.1%) of participants had ever had sex 78(53.1%) of participants had ever had sex Age for first sexual experience ranges from 8-27years; 69 (88.5%) had been sexually exposed by age 24. and mean age for first sexual experience is 19.8 Age for first sexual experience ranges from 8-27years; 69 (88.5%) had been sexually exposed by age 24. and mean age for first sexual experience is 19.8 Reasons for practicing the first sex: personal desire 50%, rape 15%, got married 10% Reasons for practicing the first sex: personal desire 50%, rape 15%, got married 10% Pre-marital sexual experience: 63(80.8%) practiced premarital sex Pre-marital sexual experience: 63(80.8%) practiced premarital sex Number of sexual partners (life time) 40 (51%) of them have more than one sexual partner Number of sexual partners (life time) 40 (51%) of them have more than one sexual partner Findings

Exposure to Sexual Violence Of 147 respondents 16(10.9%) were exposed to rape at list once in their life time Of 147 respondents 16(10.9%) were exposed to rape at list once in their life time 12( 75%) happened at their first sexual contact 12( 75%) happened at their first sexual contact The age range at the first rape was 8-23 years indicated 5 of them were below the age of 15 The age range at the first rape was 8-23 years indicated 5 of them were below the age of 15 11(68%) of abusive act resulted for health complication (pregnancy, STI) 11(68%) of abusive act resulted for health complication (pregnancy, STI) 64(43.5%) of 147 participants were exposed to attempted rape at list once in their life time 64(43.5%) of 147 participants were exposed to attempted rape at list once in their life time

Condom Use Among sexually active participants on the last 12 months 23(51.1%) of them used Condom at list once. Among sexually active participants on the last 12 months 23(51.1%) of them used Condom at list once. Frequency of condom utilization for the last 12 months Frequency of condom utilization for the last 12 months Always – (21.8%), Always – (21.8%), Most of the times(30.4%), Most of the times(30.4%), Sometimes (47.8%) Sometimes (47.8%) Sexuality Transmitted Infections Among sexually active participants on the last 12 months 8(17.8%) of them reported as having STI symptoms Among sexually active participants on the last 12 months 8(17.8%) of them reported as having STI symptoms

HIV prevention method and practice HIV prevention method and practice Knowledge about HIV preventive methods Methods of HIV Prevention Methods of HIV Prevention 97.3% abstinence 97.3% abstinence 69.4% one faithful sexual partner 69.4% one faithful sexual partner 63.1% use condom 63.1% use condomPractice 89 (60.5%) abstinence; 89 (60.5%) abstinence; 37(25.2%) one faithful sexual partner 37(25.2%) one faithful sexual partner 19(12.9%) use condom 19(12.9%) use condom

HIV risk factors related to disability Misconception about asexuality of persons with disabilities and the social stigma made Misconception about asexuality of persons with disabilities and the social stigma made To have limited access to sexual and reproductive health information and services; To have limited access to sexual and reproductive health information and services; To have unstable sexual partners; To have unstable sexual partners; To be exposed to sexual violence and exploitation due to their physical and economic dependence on others and the wrong belief that they are asexual and free of HIV. To be exposed to sexual violence and exploitation due to their physical and economic dependence on others and the wrong belief that they are asexual and free of HIV. The desire to have children and limited access to reproductive health services, including HIV services were reported to increase their risk of HIV infection. The desire to have children and limited access to reproductive health services, including HIV services were reported to increase their risk of HIV infection.

Conclusion Women with motor disorders are at risk of HIV infection due to misconceptions and stigma related to disability and sexuality. Moreover, HIV services are not accessible for women with motor disorder. The result of the finding indicated that HIV risk factors are not only resulted from individual behavior but it is also the product of external factor that is the family, community, institution, and policy The result of the finding indicated that HIV risk factors are not only resulted from individual behavior but it is also the product of external factor that is the family, community, institution, and policy How PwD perceived and given attention in the family and community; supportive environment at institutional level and included in the policy have an effect on having knowledge and skill towards risk reduction plan and practicing safe sex How PwD perceived and given attention in the family and community; supportive environment at institutional level and included in the policy have an effect on having knowledge and skill towards risk reduction plan and practicing safe sex

Recommendations For HIV response to be effective, I. The risk of women with motor disorders to HIV infection must be acknowledged by putting in place specific strategies to target them. Community mobilization to address the wrong beliefs about disability and sexuality; Community mobilization to address the wrong beliefs about disability and sexuality; Building the capacity of health, HIV and rehabilitation service providers on provision of disability-friendly services; Building the capacity of health, HIV and rehabilitation service providers on provision of disability-friendly services; Building the capacity of relevant policy-makers and stakeholders (Gos, NGOs, CSOs, Private sectors, religious institutions, Influential leaders etc) ; Building the capacity of relevant policy-makers and stakeholders (Gos, NGOs, CSOs, Private sectors, religious institutions, Influential leaders etc) ; Provision of accessible health services (free of institutional, environmental and attitudinal discrimination) ; Provision of accessible health services (free of institutional, environmental and attitudinal discrimination) ; Equipping women with motor disorders with reproductive health and life skills; Equipping women with motor disorders with reproductive health and life skills;

II. Ensuring the inclusion of women with disability by mainstreaming Gender and Disability at every levels of HIV/AIDS prevention and control programs (individual, family, community and service delivery system); III. Conducting extensive baseline surveys and Operational researches to the inclusion of women with disability on the battle of HIV and AIDS

Acknowledgment National and Addis Ababa Regional Physically Handicapped Association and members for their Support on the process of the Assessment Dr. Wegayehu Tebedje: Thesis Advisor at Addis Ababa University Handicap International for its valuable support and sponsorship to be here specifically HIV unit section (Mahelet Tigeneh, Toyin Aderemi, Eskender Dessalegn) ICASA 2001 Organizing committee

Advocate to the Inclusion of PwD on HIV and AIDS Intervention Programs