Short Abstract:

The paper presents a second part of our study, the results of a questionnaire survey of patients in agreement center treatment at the Cotonou Hospital, carried out in August 2023. The aim of this paper is to examine the sexual and reproductive health capabilities, and associated factors, of people living with HIV (PLWHIV), including those with disabilities (DPLWHIV).

Long Abstract:

Keywords: Sexual and reproductive health; Related factors; Capabilities; Disability; HIV

Barriers to the support of people with disabilities living with HIV in the care unit of the Armed Instruction Hospital (AIH) in Cotonou can lead to deprivation of sexual and reproductive health and rights. These obstacles influence their capacity for participation and social integration, leading to inequalities in the freedom to live a fulfilling sexual and reproductive life, i.e. their capability in this respect. These inequalities are linked to unequal health care provision, access to and use of approved agreement center treatment (non-participation in UNAIDS programme activities, absences, and drop-outs), personal health (co-infections, lethality rate), but also individual preferences in contraceptive methods and in prevention of mother-to-child transmission of HIV; problems of social integration; lack of desire to procreate and form a family.

Our paper at the HDCA 2023 Conference in Sofia presented the qualitative study among medical staff treating people living with HIV in the approved centers of the Military Hospitals of Cotonou and Douala. The aim was to analyse their ability to provide care for HIV-positive people living with disabilities. In particular, the analysis of the content of the interviews had highlighted various obstacles to the follow up of these persons, but above all the lack of data to identify them. It had also been highlighted that medical staff lacked knowledge about their reproductive health and wishes to have children.

This paper presents a second part of our study, the results of a questionnaire survey of patients in these services at the Cotonou Hospital, carried out in August 2023. The aim of this paper is to examine the sexual and reproductive health capabilities, and associated factors, of people living with HIV (PLWHIV), including those with disabilities (DPLWHIV). We administered 32 questionnaires, including 16 among people with disabilities; the two subgroups being matched in gender and age. Disabilities are motor, visual, psychological, as well as those visible such as defined in the ICF.

A first group of questions deals with HIV-related knowledge and treatment (antiretroviral uptake, viral load monitoring, serological testing, integration of UNAIDS programme activities). Other issues relate to sex life and contraception, the desire to procreate, family and social integration, including gender-based violence, are also addressed.

The results show a good knowledge of HIV, including the prevention of mother-to-child transmission (75% of PLWHIV and 69% of DPLWHIV are aware of HIV services). People with disabilities are more likely to be sexually active (75% of PLWHIV and 44% of DPLWHIV are sexually active), but the desire to have children is low and slightly higher among people with disabilities (25% of PHAs and 31.25% of PHAs want to have children); however, only 31% of DPLWHIV and 43.75% of PLWHIV use pills, contraceptive injections or implants; 71.44% of PLWHIV and 66.68% of DPLWHIV use male/female condoms; 18.75% of DPLWHIV experienced different types of gender-based violence, but matched PLWHIV experienced none during the period of their treatment.

In conclusion, these initial results show that disability does not seem to prevent people living with HIV from living their sexuality and, for nearly a third of them, from wanting to start a family or expand it. More detailed analyses will allow us to further explore the reproductive life capabilities despite HIV and disability, namely to analyse DPLWHIV ability to living fulfilling sexual and reproductive lives despite barriers associated with care related to HIV and disability. We shall also compare the case of HIV-positive patients in the Cotonou hospital with those presented in the literature on the sexual and reproductive health of HIV-positive people and people with disabilities.