TCHOUMKEU PENDEME Alice Noël

Résumé : BACKGROUND Available data suggest that women with disabilities have an increased risk of sexual violence, but little is known about the situation of those women living in resource-limited settings. OBJECTIVES To assess the burden and examine the drivers of sexual violence among women with disabilities. METHODS This is a pooled analysis of two population-based surveys conducted in Cameroon and Burundi. Adults with and without disabilities were randomly recruited from the general population. Structured interviews were conducted at both sites to collect data on participants’ functional limitations, life-course history of sexual violence, education, employment, and resources. Only women with disabilities whose impairments started before the age of 10 years (n = 359) and women without disabilities (n = 720) are included in this analysis. The age-adjusted prevalence of violence was computed, and risk factors were assessed using a discrete survival regression and mediation analysis. RESULTS At both sites, the participants with disabilities had a lower education level and had an increased risk of food insecurity. The pooled age-adjusted prevalence of lifetime sexual violence was 19.8% (95%CI:15.3–24.3) among women with disabilities and 11.7% (95%CI:9.3–14.1) among those without disabilities (ORap: 2.0, 95%CI:1.4–2.8). Women with cognitive limitations and those with visual impairments had the highest risk of sexual violence (ORap: 3.5 (95%CI:2.0–6.3) and 2.7 (95%CI:1.4–5.0), respectively). Over the life course, the risk of sexual violence was especially high among women with disabilities who had lived with an intimate partner before the age of 25 years (p < 0.001). Education level mediated approximately one-third of the total association between disability and sexual violence (p = 0.001). There was no evidence of an indirect effect through food insecurity. CONCLUSION This study provides evidence of the high burden of sexual violence among women with disabilities who live in urban African contexts. The social environment and access to education may be key contributors to this vulnerability.

Résumé : Background In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. Methods In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. Findings Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaounde, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3.9%, 95% CI 2.9-5.3) compared with 50 of 739 people with disabilities (6.8%, 5.0-8.6; conditional odds ratio [OR] 1.7; p=0.04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2.5% vs 0.5%, p=0.05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11.0% vs 7.5%, OR 1.5; p=0.01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3.0, 95% CI 1.6-5.6 for sexual violence and 12.3, 4.4-34.6 for sex work). Analyses were done in men and women. Interpretation The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population.

Résumé : Introduction : Dans les pays à ressources limitées, les personnes handicapées (PH) semblent particulièrement vulnérables à l’infection par le VIH en raison de l’exposition à un certain nombre de facteurs de risques telles que les violences sexuelles, des barrières pour accéder à l’information et aux services. Longtemps exclues de toute considération, les PH sont maintenant considérées comme un groupe vulnérable comme le relève le Directeur de l’ONUSIDA en ces termes : « One of the more hidden communites struggling with HIV is people with disabilites. Few programmes exist to enable their access to HIV prevention and treatment services […] because of a lack of data ». M Sidibe, IAS 2014. Toutefois, la collecte des données auprès des PH nécessite des interactions et approches méthodologiques particulières à prendre en compte non seulement au regard des difficultés à les atteindre mais aussi des difficultés à communiquer pour certaines. Cette communication décrit les difficultés de collecte de donnée au près des PH rencontrées par l’équipe de recherche et présente les stratégies mises en œuvre pour remédier à ces difficultés. Données : Cette communication utilise les données de l’étude exploratoire du projet HandiVIH ANRS12302 et du projet exploratoire portant sur: « l’influence des réseaux sociaux sur les comportements sexuels et reproductifs des jeunes handicapés à Yaoundé-Cameroun ». Il est niché dans le projet HandiVIH ANRS-12302 « Handicap et VIH : un état des lieux sur la vulnérabilité des personnes handicapées face au VIH/Sida à Yaoundé » réalisé à Yaoundé en 2015. Résultats : Plusieurs difficultés ont été recensées : (1) la définition du handicap, (2) le biais des OPH, (3) les personnes handicapées enfermées, (4) les personnes handicapées surprotégées par leurs familles, (5) le sentiment d’exploitation et le refus de participer aux études, (6) les difficultés de communiquer avec les PH sourdes et intellectuelles/Psychiques, (7) les difficultés à entrer dans l’intimité des PH. A ces difficultés, plusieurs stratégies ont été inspirées des résultats des données exploratoires et d’autres acquises sur le terrain lors de la collecte des données de HandiVIH. Il s’agit de (1) la sensibilisation des autour de l’étude dans les OPH, (2) la formation adaptées données aux agents enquêteurs et infirmiers, (3) l’inclusion des PH parmi les enquêteurs, (4) l’attitude de patience de l’intervieweur, (5) la simplification de la notice d’information de l’étude, (6) la facilitation de la compréhension des questions par les PH du fait de la simplification du niveau de langue, (7) l’utilisation des illustrations telles que les pictogrammes, les échelles de mesure et les poupées. Conclusion : Cette communication met en lumière la sensibilité de la collecte des données auprès des personnes handicapées surtout intellectuels/psychiques et les personnes sourdes. Les outils développés pourront être utilisés par d’autres intervenants auprès des PH.