1. Disability in PLHIV Farida Gulamo FAMOD (Mozambique Network of the Disabled) Email: hassuranindo@yahoo.com.br Mobile: +258 82 32 08 000 6 th December 2011hassuranindo@yahoo.com.br OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa www.icasa2011addis.org

2. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Statistics in Mozambique HIV national prevalence rate amongst adults (15 to 49 years old) of 11.5% (MoH: 2010) Persons with disabilities constituting 6-10% (SINTEF & INE: 2009) of total population in Mozambique are also amongst the most at risk populations to HIV (Handicap International: 2010) From 2003, more than 66,000 PLHIV defaulted from ART (MoH:2010). The MoH estimates a monthly drop out rate of 7% In 2004 amongst the 1,238 Health Facilities only 13 provide Functional Rehabilitation Services

3. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Challenges faced by PLHIV Social: poverty, exclusion, stigma and discrimination Psychological: stress, low self-esteem and depression Treatment, Care and support: inaccessibility, affordability of medicines and HR, secondary effects and food security Associated causes of poor-adherence to ART

4. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Disabilities Developing from HIV Infection In the course of HIV illness, PLHIV will have emergence of episodic and chronic impairments (HEARD: 2011) Toxic sides effects of ART and Opportunistic Infection treatments lead to impairments PLHIV under ART live longer and with aging will develop impairments

5. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Inhambane/Mozambique Ricardo, 33 years old, living with HIV and under ART and member of UTOMI (CBO of PLHIV). Decided to drop-put from ART at the health center, rather look for traditional healers, due to mobility barriers (peripheral neuropathy), and hypodystrophy caused by the medicines. He returned to the clinic after receiving a counseling and transport support from UTOMI volunteers. It took long to recover from the impairments caused by the medicines and was not exposed to any physiotherapy session.

6. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Inhambane/Mozambique Although Ricardo did not have physiotherapy follow up, the service is located just behind the room his ART doctor’s office. Interviewed the physiotherapist know about the complications reported by Ricardo and have simple solution for them. Most of the solutions to the reported side effects could be dealt within community with trained community workers.

7. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa Recommendations More evidences on disabilities should be developed in link with ARV treatment and should be produced and disseminated. Investment to improve the integrated health system approach should be continued and reinforced (training on disability, refresher training and debates). Community Based Rehabilitation can fill the gap of more expensive functional rehabilitation services found in health facilities. Health Staff and community workers should discuss about the side effects of medicines with PLHIV and understand about the interaction between HIV and impairments/disability.

8. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa THANK YOU Khanimambo