NIEHS DISCOVER Centers

Background: Manipur and Nagaland in northeast India are among the Indian states with the highest prevalence of HIV. Most prevention and care programs focus on identified "high risk" groups, but recent data suggest the epidemic is increasing among the general population, primarily through heterosexual sex. People with disability (PWD) in India are more likely than the general population to be illiterate, unemployed and impoverished, but little is known of their HIV risk. Methods: This project aimed to enable HIV programs in Manipur and Nagaland to be more disability-inclusive. The objectives were to: explore HIV risk and risk perception in relation to PWD among HIV and disability programmers, and PWD themselves; identify HIV-related education and service needs and preferences of PWD; and utilise findings and stakeholder consultation to draft practical guidelines for inclusion of disability into HIV programming. Data were collected through a survey and several qualitative tools. Results: The findings revealed that participants believe PWD in these states are potentially vulnerable to HIV transmission due to social exclusion and poverty, lack of knowledge, gender norms and obstacles to accessing HIV programs. Neither HIV nor disability organisations currently address the risks, needs and preferences of PWD. Conclusion: The Guidelines produced in the project and disseminated to stakeholders emphasise opportunities for taking action with minimal cost and resources, such as using the networks and expertise of both HIV and disability sectors, producing HIV material in a variety of formats, and promoting accessibility to mainstream HIV education and services. The human rights obligations and public health benefits of modifying national and state policies and programs to assist this highly disadvantaged population are also highlighted. Background Evidence suggests that in developing countries poverty and a lack of economic and educational opportunities, as often experienced by people with disability (PWD), influence HIV vulnerability [1-4]. Despite this theoretical link, there is a dearth of research that documents HIV prevalence, risk and vulnerability among PWD, the adequacy of service provision, and the extent to which HIV programs have addressed their needs. The 2001 census identified that 2.2% of the Indian population were living with a disPublished: 26 June 2007 BMC Public Health 2007, 7:125 doi:10.1186/1471-2458-7-125 Received: 30 March 2007 Accepted: 26 June 2007 This article is available from: http://www.biomedcentral.com/1471-2458/7/125 © 2007 Morrow et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.