The emergence of accessible HIV resources and services

Issues of accessibility are beginning to be addressed. For example, the International AIDS conferences in 2006 and 2008 were criticized for the lack of accessibility for people with disabilities at the conference sites. However, a team has been established to plan for enhancing accessibility and inclusion of people with disabilities at the XVIII International AIDS Conference to be held in Vienna, Austria, in 2010.

Other initiatives to enhance accessibility of HIV services and educational materials for people with disability are being piloted. For example, recognizing the need for VCT counsellors trained in working with people with disabilities, the African Union of the Blind has produced a "Train the Trainer" manual that targets service providers to better understand the needs of people who are blind [75, 76]. To address the challenge of sexuality, intimacy and HIV with people with intellectual disabilities, teaching materials have been developed with particular focus on poor countries [77, 78].

In 2004, the Liverpool VCT, Care and Treatment disability programme in Kenya was launched to provide HIV services to deaf people [50, 79]. It also produced a sign language manual, entitled "Signs for Sexuality and Reproductive Health", and is now training other staff in Kenyan sign language. The programme, run entirely by deaf counsellors and administrative staff, is the only one of its kind in Africa. Notably, many sign languages are missing signs for sexual- or HIV-related issues (e.g., Mexican sign language); however, it may be possible to borrow ideas from the Kenyan model.

Another challenge involves engagement with the legal system for people with disabilities who are involved in sexual abuse and/or gender-based violence, especially in resource-limited countries.

To respond to this need, the Cape Mental Health Organisation in Cape Town, South Africa, developed a comprehensive counselling intervention to support people with intellectual disabilities during trials for rape [44, 80].

Other disability organizations that have become involved in HIV issues include: CBR Education and Training for Empowerment (CREATE) in South Africa, which is involved in VCT programmes; Christian Blind Mission, which funds work in the field; Enablement in the Netherlands, which offers courses on HIV and disability; and the Brazil Universidade of Mackenzie initiative, which has developed a video addressing sexuality and human rights for youth with intellectual disabilities. Although coverage falls far short of demand, the advent of these programmatic responses indicates that issues of HIV and disability are beginning to receive recognition and, surely, we will soon see the first best-practice collection arriving in the field.

Jill Hanass-Hancock and Stephanie A Nixon

Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South AfricaDepartment of Physical Therapy, University of Toronto, Canada, and Research Associate, HEARD, University of KwaZulu-Natal, South Africa