Predictors of negative beliefs toward the sexual rights and perceived sexual healthcare needs of people with physical disabilities in South Africa.

Background: Although sexuality is a ubiquitous human need, recent empirical research has shown that people without disabilities attribute fewer sexual rights and perceive sexual healthcare to benefit fewer people with disabilities, compared to non-disabled people. Within a global context, such misperceptions have tangible, deleterious consequences for people with disabilities (e.g., exclusion from sexual healthcare), creating an urgent need for effective strategies to change misperceptions.Methods: To lay the groundwork for developing such strategies, we examined predictors of the recognition of sexual rights of people with physical disabilities within the South African context, derived from three key social psychological literatures (prejudice, social dominance orientation and intergroup contact), as well as the relationship between sexual rights and beliefs about sexual healthcare. Data were obtained through a cross-sectional survey, given to non-disabled South Africans (N = 1989).Results: Findings indicated that lack of recognition of the sexual rights for physically disabled people predicted less positive beliefs about the benefits of sexual healthcare. In turn, high levels of prejudice (both cognitive and affective) toward disabled sexuality predicted less recognition of their sexual rights, while prejudice (both forms) was predicted by prior contact with disabled people and possessing a social dominance orientation (cognitive prejudice only). Evidence was also obtained for an indirect relationship of contact and social dominance orientation on sexual healthcare beliefs through prejudice, although these effects were extremely small.Conclusion: Results are discussed in terms of their implications for rehabilitation, as well as national-level strategies to tackle negative perceptions of disabled sexuality, particularly in contexts affected by HIV.Implications for rehabilitationFindings demonstrate an empirical link between prejudice toward disabled sexuality, lack of recognition of sexual rights and viewing sexual healthcare of less benefit for disabled people.Consequently, there is need for increased attention to these dimensions within the rehabilitative context.Contact with disabled people, including dedicated interventions, is unlikely to meaningfully impact beliefs about the benefits of sexual healthcare.

'When it comes to HIV, that's when you find out the genuinity of that love': The experience of disclosing a HIV+ status to an intimate partner.

Despite a medical discourse of the 'normalisation' of HIV, it remains a highly stigmatising condition and makes the issue of disclosing one's HIV status particularly complex. This article reports on the experience of 18 people living with HIV in the United Kingdom of disclosing their HIV+ status in arguably their most important relationship, their intimate partnership. Five main themes arose: disclosure as the battlefield, preparing psychologically to disclose, disclosure as a test of the partner's love, disclosure as an opportunity for the partner to know them more deeply and the renegotiation of the relationship narrative.

Dating persons with physical disabilities: the perceptions of South Africans without disabilities.

There is good reason to believe that the attitudes of persons without disability towards dating a person with a physical disability might be unfavourable. However, in general, and in the Global South in particular, there is a dearth of research in this area. This study sought to take the first step in addressing this lack of enquiry, by surveying the attitudes of a general population sample in South Africa towards dating people with physical disabilities, using a vignette. Data from 1723 survey respondents were analysed thematically. Findings reveal largely negative attitudes towards people with physical disabilities. Respondents without disability perceived numerous barriers to dating a person with a physical disability, including social stigma, anxiety and concerns about the burden of care they believed such a relationship would place upon them. However, there was some evidence to suggest that some positive attitudes do exist, and a few respondents were open to dating a person with physical disabilities. Findings contribute to a nuancing and expanding of the 'myth of asexuality' among physically disabled people by showing that people with physical disabilities are actively desexualised by persons without disability. Future research is needed to explore how the inclusive attitudes, of which we did find evidence here, can be further cultivated.

Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa.

There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation's World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their 'fitness' as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.

The sexual and reproductive rights and benefit derived from sexual and reproductive health services of people with physical disabilities in South Africa: beliefs of non-disabled people.

There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores non-disabled South Africans' beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.

The sexual lives of people with disabilities within low- and middle-income countries: a scoping study of studies published in English.

BACKGROUND: Although approximately 80% of the global population of people with disabilities reside in low- and middle-income countries (LMICs), very little is known about their sexual lives due to a lack of empirical data. We aimed to provide a scoping review of English-language research conducted on disability and sexuality in LMICs. OBJECTIVE: Our research questions concerned what topics in disability and sexuality have (and have not) been investigated, where this research has been carried out, and how this research has been conducted. METHODS: A scoping review was conducted to examine the published English-language research literature on disability and sexuality within LMICs. We searched three electronic databases (PsycINFO, Web of Science, and PsycARTICLES) for research meeting these criteria published between 2000 and 2016 (inclusive). Through this search, we identified 103 articles. RESULTS: It is concluded that: (a) disability and sexuality research in African countries has focused predominantly on sexual abuse and violence or HIV, (b) the sexuality of people with disabilities within many LMICs has received little or no empirical investigation, and (c) there have been very few experimental studies on disability and sexuality conducted in LMICs in general. CONCLUSIONS: Much remains unknown about the sexual health and sexual lives of the majority of people with disabilities, globally. Moreover, what has been done in certain contexts has tended to focus predominantly on vulnerabilities rather than emancipatory practices. Thus, urgent action is needed within LMICs on issues related to disability and sexuality to meet the goal of global optimal sexual health.

Taking into Account the Quality of the Relationship in HIV Disclosure.

Despite growing interest in HIV disclosure, most theoretical frameworks and empirical studies focus on individual and social factors affecting the process, leaving the contribution of interpersonal factors relatively unexplored. HIV transmission and disclosure often occur within a couple however, and this is where disclosure has the most scope as a HIV transmission intervention. With this in mind, this study explores whether perceived relationship quality influences HIV disclosure outcomes. Ninety-five UK individuals with HIV participated in a cross-sectional survey. Retrospective data were collected on their perceived relationship quality prior to disclosing their HIV positive status, and on disclosure outcomes. Perceived relationship quality was found to significantly affect disclosure outcomes. Positive qualities in the relationship were associated with positive outcomes, whereas negative qualities were associated with negative outcomes. Results further confirmed that this association was not merely correlational, but demonstrated predictive power. Relationship quality might act as either a risk or a resilience factor in the disclosure process, and thus warrants greater attention in future research.

Disability and HIV in Africa: Breaking the barriers to sexual health care.

Three decades into the HIV pandemic, the issues affecting people with disabilities remain less known. Increasing attention has been given to this overlooked population when it comes to HIV prevention, treatment and care. This is related to the significant unmet sexual and reproductive healthcare needs facing people with disabilities worldwide. This article discusses the barriers to sexual health for people with disabilities in Africa and presents an argument about how mainstream HIV prevention work and research do not adequately attend to the sorts of systemic barriers that exclude people with disabilities, which a more targeted and critical approach could.

Experience of sexual self-esteem among men living with HIV.

Much of the focus on sexual health for people living with HIV has been on promoting safe sex behaviours. However, also important for sexual health is a positive sexual self-esteem. This article reports on an interpretative phenomenological analysis of interviews with seven men about the impact that having HIV has had on their sense of sexual self. Five overarching themes were identified: the 'destruction' of a sexual self; feeling sexually hazardous; sexual inhibition; reclaiming a sexual self and finding a place through sero-sorting. With HIV now being a chronic illness, interventions are required to support people to lead sexually satisfying lives.

A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury.

PRIMARY OBJECTIVE: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. DESIGN: The study was qualitative, using a thematic analysis approach. METHODS AND PROCEDURE: Six children between 9-18 years of age, six parents (three with ABI) and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. RESULTS: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. CONCLUSIONS: The results reveal an interaction between the child's experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child and the children's need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

A qualitative investigation into the HIV disclosure process within an intimate partnership: 'The moment I realized that our relationship was developing into something serious, I just had to tell him'.

OBJECTIVES: This study sought to elucidate the process through which people living with HIV (PLWH) in the United Kingdom disclose their status to an intimate partner (IP). DESIGN: A qualitative cross-sectional survey design was used. METHOD: A total of 95 PLWH took part. They were presented with a series of open-ended questions enquiring into their last experience of disclosing to an IP. The data were analysed using thematic analysis. RESULTS: Disclosure became a salient issue when the discloser acknowledged their relationship as meaningful. A decision to tell was mostly made to build a foundation for the evolving relationship. Once the decision was made, it was enacted via one of two mechanisms (self-initiated or opportunistic) and partners' reported reactions fell within one of four main reaction types. In the long-term for couples who remained together, disclosure was understood to have brought them closer. However, for both those whose relationships remained intact, and for those whose relationship had since broken down, sexual difficulties associated with being in a sero-discordant partnership pervaded. At a personal level, the experience resulted in increased confidence in living with the diagnosis, and an increased sense of disclosure mastery. CONCLUSIONS: Disclosure is a highly nuanced process. In particular, it was found to be largely characterized by the IP relational context in which it was occurring. The clinical and theoretical implications of these findings are discussed. In particular, these findings highlight a need for the provision of long-term support to PLWH in negotiating their relationships throughout the process. Statement of contribution What is already known on this subject? Disclosing a HIV+ status to an intimate partner (IP) is key in addressing the global HIV epidemic, social stigma, and the psychological and physical well-being of people living with the condition. It is increasingly recognized that HIV disclosure is a process, rather than an event. Researchers have begun to initiate a line of research into a process-based theoretical account of disclosure. What does this study add? This study provided a nuanced account of the disclosure process within an IP relationship. The process was found to be largely influenced by the discloser's subjective experience of the intimate partnership. The findings point to a need for a disclosure intervention that supports couples more longitudinally, particularly in negotiating the emotional and sexual difficulties that often arise upon disclosing.

'Understanding' as a practical issue in sexual health education for people with intellectual disabilities: a study using two qualitative methods.

OBJECTIVE: Sexual health education is important in addressing the health and social inequalities faced by people with intellectual disabilities. However, provision of health-related advice and education to people with various types and degrees of linguistic and learning difficulties involves addressing complex issues of language and comprehension. This article reports an exploratory study using 2 qualitative methods to examine the delivery of sexual health education to people with intellectual disabilities. METHODS: Four video-recordings of sexual health education sessions were collected. Conversation analysis was used to examine in detail how such education occurs as a series of interactions between educators and learners. Interviews with 4 educators were carried out and analyzed using thematic analysis. RESULTS: The analysis shows how educators anticipate problems of comprehension and how they respond when there is evidence that a person does not understand the activity or the educational message. This occurs particularly when verbal prompts involve long sentences and abstract concepts. We show a characteristic pattern that arises in these situations, in which both educator and learner jointly produce a superficially correct response. CONCLUSIONS: Although interviews allows us some insight into contextual issues, strategy, and aspects of sexual health education that occur outside of the actual teaching sessions, analysis of actual interactions can show us patterns that occur in interactions between educators and learners when comprehension is in question. Addressing how sexual health education is delivered in practice and in detail provides valuable lessons about how such education can be improved.

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 world's 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.

Gender differences in HIV knowledge and unsafe sexual behaviours among disabled people in South Africa.

PURPOSE: The international literature suggests that disabled people may be at increased risk for HIV infection. There is a growing increasing recognition of this in South Africa, although there remains a paucity of literature on how disabled people are affected by HIV/AIDS. This is a concern given the seriousness of the epidemic here. This paper reports on descriptive data exploring gender differences in HIV knowledge and unsafe sexual behaviours among disabled individuals in South Africa. METHOD: Data was collected by means of a survey questionnaire from a total sample of 285 disabled individuals in three of the nine provinces in South Africa. Data was analysed by means of descriptive statistics. RESULTS: There are low levels and uncertainty of knowledge about HIV transmission and HIV prevention, with females tending to have lower levels of knowledge than males. Although the importance of condoms in HIV prevention was recognised, there were relatively high levels of reported unsafe sexual behaviours. Males reported higher number of monogamous and concurrent sexual partnerships and sex without a condom after alcohol use. CONCLUSIONS: The results support the literature that suggests that disabled people are at risk for HIV infection, and that both male and female individuals with disability are at risk.

Challenges faced by parents of children diagnosed with autism spectrum disorder.

Few studies address the daily challenges faced by parents of children diagnosed with autism spectrum disorder. This article reports on a qualitative interview study with 20 parents exploring their experiences, challenges faced, and what has helped them to cope. A thematic analysis of the data identified five core categories: Dealing with challenging behaviour; dealing with judgements from others; lack of support; impact upon the family; coping and the importance of appropriate support. The findings emphasize where the parents themselves believe they still require additional support. It raises key strategies and resources that parents have found helpful.

Challenges to providing HIV prevention education to youth with disabilities in South Africa.

PURPOSE: In South Africa, little is known how HIV prevention education is implemented in schools for learners with disabilities. This article reports on findings from a study exploring the extent to which HIV education is reached to people with disabilities in South Africa, and the challenges faced by educators providing HIV prevention education to learners with disabilities. METHOD: A survey questionnaire completed by 34 schools for learners with special education needs in the Western Cape province of South Africa. Additional complimentary data were collected through interviews with a total of 21 members of staff at schools for learners with disabilities. RESULTS: Respondents recognise the importance of providing HIV prevention education for people with disabilities. Staff reports some challenges in providing HIV prevention education: barriers to communication; discomfort about issues of sexuality and disability; disagreements among staff about what is appropriate content for sexual health education; and fears of promoting sexual activity. CONCLUSIONS: There is a need for HIV prevention education to be specifically customized to the needs of the specific population. A general programme, which is included as part of a general curriculum and generally tailored to "mainstream" schools, would need to be adapted according to specific needs and disabling barriers faced.

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.

Broadening psychology's contribution to addressing issues of HIV/AIDS, poverty and nutrition: structural issues as constraints and opportunities.

HIV/AIDS, more than any other public health problem, challenges dominant models of the role of psychology in health promotion and prevention. This paper focuses on poverty and resulting food insecurity as a structural risk factor for HIV infection. The paper considers the role of health psychology in global health concerns and argues that, while individual-based interventions are important, health psychology needs to shift to playing a proper role in broader level initiatives. Health psychology, in thinking about global health concerns such as HIV, needs to view an understanding of health, education and nutrition delivery programmes in low resourced contexts as at the core of the discipline.

HIV/AIDS and disability organisations in South Africa.

Despite the seriousness of the HIV epidemic globally, and in South Africa in particular, little is known about how HIV/AIDS affects disabled people. One important and little explored area is the role that organisations that represent disabled people or that work on behalf of disabled people, are playing in addressing the HIV/AIDS epidemic among the disabled people they represent or serve. This paper presents the findings of a nationwide survey of disability organisations in South Africa. The purpose of this study was to explore the role of disability organisations in addressing the HIV epidemic among disabled people in South Africa. The findings suggest that while organisations recognise the importance of providing HIV education, and many have taken steps to do so, disabled people are largely excluded from general HIV prevention messages. Disabled people also have significant difficulties in accessing general health care, relevant for HIV testing and treatment. In a country trying to manage serious social problems with limited resources, this paper highlights the need for increased cooperation and collaboration between relevant parties in order to facilitate the changes necessary for disabled people to access needed health information and care.