Arne H. Eide

Poverty and disability in Eastern and Western Cape Provinces, South Africa

The impact of disability on the living conditions of people living in specifically resource‐poor areas in South Africa has not previously been addressed. This paper presents a comparison of people with a disability and their non‐disabled peers with respect to some key poverty indicators among a sample of Xhosa speaking individuals in resource‐poor areas of Eastern and Western Cape Provinces. A questionnaire on the level of living conditions (household composition and socio‐economic characteristics) and a detailed disability questionnaire that captured more specific details of the disability experience of the individual with a disability were adapted to the South African context and utilised. Despite the improved situation of households with a disabled family member in terms of financial resources (due primarily to the allocation of disability grants), other measures of poverty (education and employment) remain divisive for those with disabilities.

HIV/AIDS and disability in Southern Africa: a review of relevant literature.

Purpose. HIV/AIDS has grown to become the biggest epidemic in modern history. Southern Africa is at the epicentre of the global epidemic, with just of a third of the worlds HIV-positive population living here. It is known that HIV/AIDS affect vulnerable population groups. It is surprising then, that persons with disabilities, one of the worlds most vulnerable population groups, particularly in southern Africa, have been largely overlooked with regards to HIV/AIDS. This review sought to establish the state of the knowledge at present. Method. This article reports on findings of a literature review conducted as an initial step in a research project currently underway in South Africa. This article focuses on HIV/AIDS as it affects persons with disabilities in southern Africa, as it is in this region that the majority of people living with HIV live. However, as fewer studies exist that have as its focus southern Africa (particularly looking at HIV/AIDS and persons with disabilities), relevant articles from the international literature were used as indications of what we may find through future research also in the southern African countries. Given the paucity of published literature dealing with HIV/AIDS and persons with disabilities, the review looked at various risk factors associated with HIV infection, and how it affects persons with disabilities. Results. Findings from the literature review suggest that persons with disabilities, particularly in southern Africa, are at significant risk for HIV infection. Conclusions. There is an urgent need for more research on HIV/AIDs and sexuality among persons with disabilities in Africa.

HIV issues and People with Disabilities: A Review and Agenda for Research

The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the worlds population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their non-disabled peers.

Environmental barriers experienced by urban and rural disabled people in South Africa

Impairments pose a certain degree of difficulty to disabled people, however the impact of the environment is the major cause of disability. Despite the fact that the disabling effect of environmental factors is acknowledged, little research has been done to explore the impact of the environment on varying degrees of disability and different impairments. The aim of this study was to investigate the experience of disabled people with regard to environmental barriers in an urban as opposed to a rural setting. The specific objectives were to identify which items within the International Classification of Functioning, Disability and Health (ICF) checklist of environmental factors presented people with disability with the most barriers and to see whether the barriers were different for those living in a rural as opposed to an urban setting. The study was conducted amongst Xhosa speaking people in the Eastern and Western Cape aresa of South Africa which have, respectively, 5.8% and 4.1% disability prevalences. A descriptive, analytical, cross‐sectional study was used to gather the data. The primary data collection tool was the Xhosa version of the ICF checklist. The sample consisted of 468 respondents, with 375 living in the Eastern Cape and 93 in the Western Cape. Physical problems were reported by 54.6 % of the sample, 14.6% had had an intellectual impairment and 9.9% had visual, hearing or speech problems. Approximately 2% of the sample reported more than one impairment. The prevalence of the different types of impairments between the two areas was similar. Respondents from the urban area reported experiencing more barriers in the categories Products and technology and the Natural and built environment, while respondents from the rural area experienced more barriers with Attitudes. An equivalent number of people in the respective areas identified barriers in the Services category. In this study the face and construct validity of the ICF appeared to be acceptable and it is recommended that further studies be conducted to establish the reliability and content and concurrent validity of the instrument.

Assistive Technology in Low-Income Countries

World Health Organization (WHO) has estimated that 10% of the global population has a disability, with social educational and/or economical consequences. Although such estimates have a weak basis (Metts, 2000; Eide and Loeb, 2006a) it might be about 600 million people around the world with special needs in terms of health care, education, rehabilitation, appropriate assistive devices and social support. Furthermore it is indicated that 80% of people with disabilities live in low-income countries and also in very poor life conditions with limited access to health care services, rehabilitation and assistive devices. Case studies in developing countries show that higher disability rates are associated with higher rates of illiteracy, poor nutritional status, lower immunization coverage, lower birth weight, higher rates of unemployment and underemployment, and lower occupational mobility (Elwan, 1999). Disability can cause poverty by preventing the full participation of persons with disabilities in the economic and social life of their communities, especially if the appropriate supports and accommodations are not available. This chapter draws on results from recent studies on living conditions among people with disabilities in southern Africa (Eide et al. 2003a, b; Loeb and Eide, 2004; Eide and Loeb, 2006b) and aims at describing the situation for disabled people in low-income contexts with regards to assistive technology.

Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries

There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? a cross-sectional community study in South Sudan

BackgroundLimited data exists on the association of war trauma with comorbid posttraumatic stress disorder (PTSD)-depression in the general population of low-income countries. The present study aimed to evaluate socioeconomic and trauma-related risk factors associated with PTSD, depression, and PTSD-depression comorbidity in the population of Greater Bahr el Ghazal States, South Sudan.MethodsIn this cross-sectional community study (n=1200) we applied the Harvard Trauma Questionnaire (HTQ) and MINI International Neuropsychiatric Interview (MINI) to investigate the prevalence of PTSD, depression, and PTSD-depression comorbidity. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, sociodemographic, and socioeconomic factors.ResultsPTSD only was found in 331 (28%) and depression only in 75 (6.4%) of the study population. One hundred and twelve (9.5%) of the participants had PTSD-depression comorbid diagnosis. Exposure to traumatic events and socioeconomic disadvantage were significantly associated with having PTSD or PTSD-depression comorbidity but not with depression. Participants with a comorbid condition were more likely to be socioeconomic disadvantaged, have experienced more traumatic events, and showed higher level of psychological distress than participants with PTSD or depression alone.ConclusionsIn individuals exposed to war trauma, attention should be given to those who may fulfill criteria for a diagnosis of both PTSD and depression.

Disabled persons’ knowledge of HIV prevention and access to health care prevention services in South Africa

The main research question in this article is how access to information about HIV/AIDS and level of HIV/AIDS prevention related knowledge are distributed among disabled people, and whether level of knowledge predicts access to HIV/AIDS related services. A survey was carried out among a sample of 285 disabled people from three provinces in South Africa. Analyses of the data revealed that gender and level of education, together with geographical differences, are key predictors for access to information and knowledge about HIV/AIDS among disabled people. For male respondents number of information sources predicts access to voluntary counselling and testing services and HIV testing, while knowledge about prevention predicts access to Voluntary Counselling and Testing centres. Significant gender differences with regards to information, knowledge and access to services highlight the need for gender specific prevention strategies among disabled people.

Association between exposure to traumatic events and anxiety disorders in a post-conflict setting : a cross-sectional community study in South Sudan

BackgroundThe negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables.MethodsIn this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors.ResultsThe participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD.ConclusionIn individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.

Paradigms Lost: The Changing Face of Disability in Research

Concepts of disability have evolved over the past few decades. The focus of attention has shifted from disability as a state, a consequence of disease, to disability being included as just one of many components of health. This has been realised in part through the implementation of the International Classification of Functioning, Disability and Health (ICF). Despite these developments and increased focus in recent years, reliable disability data, particularly from low-income countries, are lacking.We present an innovative approach to measuring disability in a population that is based on some conceptual elements of the ICF, namely activity limitations and participation restrictions. The results are derived from studies on the living conditions among people with disabilities in Namibia, Zimbabwe and Malawi conducted between 2001 and 2004. From the data analysis perspective, the research challenge lies in a shift in the dependent variable from a dichotomous outcome measure (disability as a state: disabled, not disabled) to a continuous measure of activity limitations and participation restrictions – mirroring the range of disability we see in society.These measures of activity limitations and participation restrictions must however not be interpreted in isolation, but as integral to the environment, society and culture from which they are derived. This will require an expanded view of disability data and effect substantially greater measurement challenges.