1. Responses on How to Address Disability Within National Response
Dr. Jill Hanass-Hancock
HEARD

2. John Meletse Film “Stepping into the Unknown”
“You are given a beautiful cocktail of tablets, and no one explains what they are for and how they would help me”
John Meletse Film “Stepping into the Unknown”
Intro which shows that ART us now available – however if one has a disability (or acquires one) there is no “reasonable accommodation” of this disability

3. Interrelations of Disability and HIV
People with disabilities and/or mental health problems
PLHIV who experience disability
People who care for PLHIV
especially young carers
mental health disorders
e.g. depression,
schizophrenia, anxiety,
substance abuse …
neuro-cognitive
disorders...
sensory impairments (visual, hearing, touch)
problems with the
digestive system
problems with sexual
functions
episodic disabilities
stigma, discrimination ?
increased risky
behaviour
increased risk of
sexual abuse and less
access to justice
negative attitudes from
health care staff
problems with
accessing health
services and education
can effect adherence
AIDS related activity
limitation is associated
with increased child
healthcare task, less
school attendance, food
insecurity and
educational outcomes
the interrelationship between increased care giving burden and disability is exacerbated in the context of HIV
Present that there are some studies available who looked into the interrelationship of disability/impairment and HIV
The available studies provide:
Argument that PWD are at increased risk of exposure to HIV
Growing concern of HIV related health challenges (which we summaries as disabilities)
In some areas such as mental heath there is also some evidence available in regards to the scope of the problem (cross-sectional surveys and prevalence studies)
However none of the studies provides us with and understanding what impact an HIV related impairment and disability has on the person life and surroundings (social side of disability is missing), does not reflect on activity limitations and social impact – and with this doesn’t guide our response be joint a very medical response (in from of medication)

4. Methodology
Two reviews were conducted looking at all countries within Eastern and Southern Africa
1. Review of Disability Rights and HIV/AIDS
This included a desk review of international commitments and in country legal documentation and policies in regards to disability and HIV
2. Review of National Strategic Plans on HIV /AIDS
A tool was developed for the review using the Convention on the Rights of Persons with Disability (CRPD) and the UNAIDS International Guidelines on HIV and Human Rights as a guiding tool. (see
Short explanation

5. Disabiltiy rights in Africa (building blocks)
The Convention on the Rights of People with Disabilities (CRPD, 2006)
The Maputo Protocol on Human and People’s Rights and on the Women in Africa (1995)
The African Charter on the Rights and Welfare of the Child (1989)
Talk to inclusion of disability in previous declarations
African charter on human rights – recognizes the rights of persons with disabilities (not discrimination on the grounds of disability but recognises the rights of the “disabled!”
Maputo Protocol and African Child charter include provisions relating to disability
Talk about relevant key articles in CRPD
Basic concepts of universal design and reasonable accommodation + article 4 to provide research into this
Article 9 accessibility
Article 13 access to justice
Article 25 right to health
The African Charter on Human and People’s Rights (1981)

6. Uptake of international commitments
Country
African Charter
Maputo Protocol
African Children’s Charter
Angola
Yes No
Botswana
Burundi
DRC
Kenya
Lesotho
Madagascar
Malawi
Mauritius
Mozambique
Namibia
Rwanda
Seychelles
South Africa
Swaziland
Tanzania
Uganda
Zambia
Zimbabwe
Explain and highlight
Ratification of CRPD 2010

7. Domestication of disability rights
Examples of Good Practice in the region
The right to equality and non-discrimination
The right to care, including health care
The right to employment
The right to participation
Legal protections and penalties
Interlinkages of disability and HIV in policies
Explain and give examples
The right to equality and non-discrimination e.g. Malawi constitution (1994), SA Promotion of Equality and Prevention of Unfair discrimination Act (2000)
The right to care, including health care Kenya's The Persons with disability Act (2003)
The Right to employment e.g SA Employment Equity Act or the Mauritius Equal Opportunity Act (2005)
The right to participation Malawi constitution (1994) section 13
Legal protections and penalties SA Promotion of Equality and Prevention of Unfair discrimination Act (2000) chapter 4 – Equality court
Interlink ages of disability and HIV in policies e.g. Lesotho National HIV and AIDS policy (2006), Tanzania National Policy on Disability (2004)

8. Gaps and weaknesses in domestication
Separate development of disability and HIV legislations – no systematical approach to address the links between HIV and AIDS
Limited obligations to ensure the availability and accessibility of specialized goods, services and facilities, including the provision for access to information
Limited provision for access to justice
Limited provision for data collection on disability as well as disability and HIV
Limited recognition of the gender dimension of disability
Limited inclusion of disability into National Strategic Plans on HIV

9. Integration of Disability into HIV Policies and Programs 2010
NSP fails to recognise disability as an issue in any way
NSPs do not specifically indentify disability as an issue but nevertheless include some reference to disability within the response
NSP identifies disability as an issue but fails to operationalise this concern
NSP identifies disability as an issue and takes selective steps to operationalise this concern
NSP identifies disability as an issue and takes extensive steps to operationalise the issue
Explain criteria's + good practise examples + reflection on link between domestication of disability laws, recognition of interrelationship and NSPs
Criteria:
Recognition of people with disabilities as a vulnerable part of the population in need of special protection in the context of HIV and AIDS
Inclusion of people with disabilities within the national response to HIV and AIDS
Protection of the rights of people with disabilities to equality and non-discrimination, in order to reduce vulnerability and to mitigate the impact of HIV and AIDS (including through appropriate law and policy; awareness, education and rights-based training; access to legal support services and other measures to reduce disability-related stigma and discrimination and socio-economic inequality of people with disabilities)
Provision of HIV-related prevention, treatment, care and accessible and appropriate support services for people with disabilities including those who become disabled due to HIV and AIDS, and
Inclusion of disabled people in research, monitoring and surveillance relating to HIV and AIDS.
Interesting that PWD were recognised in some NSPs but not HIV related disability
Good practice examples:

10. Inclusion of Disability in National Strategic Plans on HIV and AIDS
NSP task group on disability and HIV, Framework for the Inclusion of Disability in the National Strategic Plans on HIV and AIDS, Jill Hanass-Hancock (HEARD) and Emelia Timpo (UNAIDS), Editors. 2011, HEARD, School of Law, UKZN, Barrett Advocacy and Training, AIDS-Free World, University College London, CWGHR, Handicap- International, DHAT, UNAIDS: Durban and Geneva.
Golden standards for the future – explain disability concept possible role in ART management – treatment care and support
Universal design
Rehabilitation and Access
Reasonable accommodation
Wellness and Enablement

11. Inclusion of Disability in National Strategic Plans on HIV and AIDS
The framework is targeted at NSP development and provides advise on:
NSP background analysis
Key principals (enablers within an NSP)
National frameworks and structures
Priority areas / strategic objectives
Human Rights approach
Health related Services (prevention, treatment care and support)
Legal Support services
Research, monitoring and evaluation
5. Resource mobilisation
6. Step by Step guidelines
Explain development of framework, explain outline of framework – launch it

12. Please join us for more Discussions
Tomorrow
at the disability zone
Roundtable discussion: Including the world’s biggest minority in HIV-programming: how can it be done?
With speakers from Cameroon, Burundi, Geneva, Ethiopia, Kenya, Uganda, South Africa and Zimbabwe
DHAT, HEARD, Handicap International, NUDIPU, UNAIDS, RATN and many more …
Explain also links to main panel question: along the way there will always pop up the question: What is disability? How can we measure it? It will be of advantage to use a model that has been international tested, culturally adapted and covers a range of issues ....

13. THANK YOU
The following organisations contributed to the Disability Inclusive NSP Framework