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Sex and HIV Education for the Disabled. Advice, Experiences

Youth Development Fund assisting vocational training centers for the disabled in Bhutan. These centers cater to both the intellectually challenged, hearing and speaking impaired groups, whose ages range from ten to thirty years, and have thirty students in total. It provides them with both vocational training and literacy class. However, from students' assessment, it is identified that sex education should be required for the disabled as personal or safety skills improvement.

Currently, lady teachers at the center are teaching hygiene during menstruation and safety precautions related to sexuality especially targeting the 18-24 year old girls of the hearing and speaking impaired groups. However, I wonder if such sex education must be taught to male students as well as the intellectually challenged groups. Moreover, what would be the effective approach: for example, whether they must be taught separately between girls and boys or together and whether professionals in the area should teach them?

Relevant to sex education, we are also concerned of lack of access to information on HIV prevention by the disabled. I hear the number of HIV infected is also increasing in Bhutan among youth. I understand that quite a few HIV awareness activities targeting on youth even here in Bhutan have been carried out except for the disabled youth. In addition, although I researched on the issue online, the disabled appear to be excluded from such education opportunities around the world.

Sex and HIV education for the disabled will be a good initiative for the centre as it is very much required to prevent the spread of the sexually transmitted diseases. It is a global concern and disabled lot should also have the same right to access to information on sex and HIV.

The prevalence of HIV in Bhutan is increasing yearly and our disabled citizen may not be spared by this disease.

The national scenario of HIV is quite alarming and before it gets worst, we should come out with some initiative to share the information on preventive measures not only to a normal citizen but also to those handicapped and disabled.

After having gone through five days of training on HIV as part of my company's Corporate Social Responsibility (CSR) activity, We have been learned how HIV affects the individual, society, community, and finally the economy of the nation. The training session has enlightened me and it was a good opportunity for me to hear from the guest speaker of the Health Ministry. I have also come to know how the government is taking initiative to contain this diseases and I must mention here that unless all of us involve in solidarity, such diseases will spread and it will get into our small and happy population. Therefore, I strongly support that sex and HIV education should be taught to our disabled brothers and sisters and in fact, we should start talking freely within our family circle about sex.

We have taken HIV as one part of our CSR agenda and we have been traveling all over the place where our employees are deployed taking classes on HIV and AIDS. The response from our employees and family and from our client has been encouraging and we are hopeful that this initiative from us will go a long way in preventing HIV amongst our employees, families and our clients.

The centre for disabled should go ahead in imparting the education on sex and HIV to their student and as I mentioned, it will really have an impact in preventing HIV at our national level.

People with disabilities are very vulnerable to the risk of HIV. Moreover HIV is a significant and almost wholly unrecognized problem among disabled people in the Community. Due to their disability and ignorance, the guardians of these persons are not aware of the different problems related to their behavior.

In the urban sector I have seen disabled children who love to sit on English toilets and playing with the open jet. When the water touches their anus with force their penile nerve is stimulated and they find sexual pleasure. Due to ignorance they indulge in sexual activity with each other or the people who stimulate them and approach them. I remember few of my clients shared with me that their teacher doesn't allow them to sit together in schools. Particularly, I remember one teenager who was jealous of me and gave me an unfriendly look when I spoke with the female counselor who was attending him. A slow learner from among them commented, "Sir, you lucky, because the girl is talking to you", I did not understand the meaning of this sentence at that time. However, when I started working on Adolescent Reproductive and Sexual Health than I realized the needs of disabled adolescents. Still, we don't have any project for them.

As per information disabled people living with HIV in Africa often face multiple discrimination from being disabled, poor and HIV-positive:

  • Individuals with disabilities are at many fold risk of HIV infection, and they have several sexual partners in a series of unstable relationships because they are less likely to marry
  • They are also more likely to be victims of sexual abuse or rape in cultures where HIV-positive people believe they can be "cleansed" of the virus by having sex with virgins, because disabled people are often assumed they are not sexually active
  • Physical dependence, life in institutions, and "the almost universal belief that disabled people cannot be a reliable witness on their own behalf", also make them particularly vulnerable to abuse and infection
  • Low literacy and understanding rates among disabled people and difficulty to access and understand radio and television messages for the deaf and the blind, present real challenges to information outreach.
  • Health, Hygiene and Sex education programs for disabled people persons are rare.
  • Access to general healthcare services is also poor for a variety of reasons, including social and economical obstacles and problems to physically access the health facilities.
  • Despite the fact that the Global Survey on Disability & HIV/ AIDS by World Bank & Yale Uni., USA has concluded that persons with disability are vulnerable to HIV, nothing much has been happening with regards to this marginalized community; except a few sporadic efforts in this direction.

    One such effort was a study undertaken by Shodhana Consultancy, in 2006-07, with support from UNICEF (Mumbai) on "Exclusion of Persons with disability from HIV programming in Maharashtra". The main objectives were to explore the existing situation of persons with disability in Maharashtra with regards to the access to information, services, and rights related to sexual and reproductive health as well as HIV. The primary aim was to identify the gaps in knowledge and need for a database that is prerequisite for further policy making and programming. The study incorporated major stakeholders including adolescents and young adults with disability, Parents' groups, NGOs working in the field of HIV as well as Disability, Government officials, Health Care Professionals who were selected from five districts of Maharashtra, namely, Pune, Nagpur, Chandrapur, Yavatmal and Beed, representing three regions. A total of 88 persons were contacted for primary data collection. The secondary data was collected through available literature on the topic.

    In the endeavor to gather information, a "query" in the AIDS Community of Solution Exchange related to HIV was put up to accrue as much knowledge as possible. This query highlighted the need to undertake various studies regarding sexual health in disabled population on various facets of HIV, necessity to create awareness, carry out risk assessment as well as curtail HIV infection. The discussants also justified the much-required focus on the disabled group in policy and programmatic interventions related to HIV.

    The major findings of the study were:

    The awareness level regarding HIV among the disabled population is limited to the words, HIV, or AIDS. The knowledge of signs, symptoms, and risks is very low. Similar is the case of Sexually Transmitted Infections. It is very much clear that access to information and services related to not only HIV but mainly "Growing Up" issues including puberty changes, sexuality, pregnancy, contraception, sexually transmitted infections and so on, must be provided to this population.

    No database, both qualitative and quantitative is available with regards to disabled population living with HIV in India. Hardly any special IEC material is available for this population. The NGOs working with Commercial Sex Workers for STI, in a targeted approach to HIV, has mentioned that about 2% of the Commercial Sex Workers are girls and women with disability and similar number of disabled men visit as customers. But there are no special methods used to reach the HIV related information to them. The study, in brief revealed that the issue is not only of HIV or AIDS in specific, but Sexual and Reproductive Health in general needs urgent attention in regards with the disabled population.

    I think it's important to provide information to both girls and boys during the different stages of adolescence. The quantum of information provided can vary. In India, the information on sexuality, reproductive health, HIV and broader issues has been provided as sessions in a school or college setting, via help lines or in camp or centre approaches to reach out to in-school and out-of-school populations. NGO's have worked with separate gender groups or mixed gender groups depending on the setting and comfort levels.

    I think if it is difficult to find specific material for young people with disability developed in India, then adapting the plethora of material available on life skills, reproductive health, HIV for this age group could be an option to address the needs and issues of young people with disability. These materials address the issues that affect a young person's life and include information on anatomy, hygiene, understanding their bodies, pregnancy, contraception, risk of HIV, sexuality and so on.