Millennium Development Goals: Inclusion of People With Disabilities

Conference on Millennium Development Goals: Inclusion of People With Disabilities Bratislava – Slovakia, 14t - 15t May 2007

By: Mwesigwa Martin Babu Millennium Development Goal 6: Combat HIV/AIDS, Malaria and other diseases;

What are the Millennium Development Goals (MDGs) They are a set of commitments that the international community and the United Nations (UN) agreed upon during the UN Millennium Summit in 2000 in order to promote sustainable development in developing countries all over the world. A time schedule to achieving the targets for each goal was set to be achieved by 2015. They are eight in number.

Order of presentation • The relationship between HIV/AIDS, poverty & disability in developing countries’ context • A brief of Uganda’s progress in the struggle against HIV/AIDS, 1986 – 2007 • The situation of PWDs in Uganda • Achievements of PWDs & HIV/AIDS • A brief review of MDG 6 • The Monitoring Tools of MDG 6 • An analysis of the Indicators • Way forward • Conclusion

The relationship between HIV/AIDS, poverty & disability in developing countries’ context The relationship between disability and poverty has often been referred to as a vicious circle. Interesting to note is that the incidence and prevalence of HIV/AIDS is greatly linked to poverty and low incomes. Because PWDs constitute the poorest of the poor in our country; coupled with the absence of disability HIV/AIDS programming; interlinked with the stigma and discrimination; stereotyping and myths about disability; your guess is as good as mine.

Uganda’s Progress in struggle against HIV/AIDS, 1986 - 2007 • The first HIV/AIDS cases in Uganda were identified in 1982 along the shores of Lake Victoria in Rakai District in southern Uganda by Ugandan medical personnel. • By the end of 1992, the national prevalence rate was estimate at 18.3% with some centers registering rates above 30%. • Uganda AIDS Commission, established by Act of Parliament in 1992 – to coordinate the multi-sectoral efforts so as to unify the national response • Conceptualization of a Multi-sectoral Approach to the Control of AIDS (MACA) which was adopted by Parliament in 1992. • According to the National HIV/AIDS sero and behavior survey by the Ministry of Health Surveillance 2004, adult prevalence rates had been reduced to 6.4% as against the 30% prevalence rates in 1992. • Uganda acclaimed as a global model of success by the international community due to the the adopted HIV prevention approach; the ABC (A=Abstinence, B=Being Faithful to one partner, C=Condom use).

The Situation of PWDs in Uganda Allow me to provide a broad picture on the situation of PWDs so that it is the basis for the analysis of MDG 6, the target and monitoring indicators below? i.e. • 10% (2.5 million ) of Ugandans are living with disability • Disabled among the 38.5 of Ugandans in absolute poverty • 75% of PWDs lacking functional literacy (limited access of information of HIV/AIDS and other issues ) • 30 of CWDs complete primary education (ie orphaned unable to achieve education as provided by the indicator ) • health facilities generally inaccessible to PWDs ( the affects access to therapy)

Achievements for PWDs vis a vis HIV in Uganda so far. • Inclusion of PWDs issues in the National HIV/AIDS Strategic Plan 2007 – 2012 • Discussion is underway towards granting PWDs a Self • Coordinating Entity (SCE) status (Explain what this means) • Formation of Disability Stakeholders HIV/AIDS Committee • (DSHAC) • Development of strategic partnerships with national HIV/AIDS • actors and stakeholders, such as The AIDS Support • Organization (TASO).

A review of MDG 6 • MDG 6 is – Combat HIV/AIDS, malaria and other diseases. • The target is to ‘halt the prevalence of HIV/AIDS by 2015 and begun to reverse the spread of HIV/AIDS’ • The indicators for MDG 6 are: • HIV prevalence among pregnant women aged 15 -24 years as an indicator is rationalized to mean that the infection rate for pregnant women is similar to the overall rate of the adult populations – simply because behind every pregnant woman is a man who played un-protected sex. • Condom use as a contraceptive among the married for birth control and in high – risk sex populations ages 15-24; is used to monitor progress towards halting and reversing the spread of HIV/AIDS. This is because condoms are the only contraceptive method effective in reducing the spread of HIV, and for those unmarried young populations who experience the highest rates of HIV/AIDS infection due to having irregular partners, but also for the married who could scale down infection rates by practicing safe sex in and out of the marital relationships.

A review of MDG 6 - cont • Ratio of school attendance of orphans to school attendance of • non-orphans aged 10-14 years. As a result of HIV/AIDS claiming • the lives of adults when they are just forming families, orphan • prevalence is rising steadily. It is important therefore to monitor the • extent to which AIDS support programmes succeed in securing • educational opportunities for orphaned children. Otherwise the cycle • of AIDS is perpetuated in the community when ignorance due to lack • of education and its attendant opportunities of getting out of poverty, • through gainful employment and self esteem are not promoted • amongst the younger populations.

Monitoring tools • It was found appropriate that in order to effectively monitor the progress of implementation of the Millennium Development Goals, a set of tools had to be developed to measure the extent to which the set target had been achieved over the years. The list of indicators that was developed is not prescriptive and can change depending on individual country’s choices. I can imagine how difficult and challenging it must have been for the team to come up with these particular tools. They are; • The indicators • Rationale • Data collection and source • Periodicity of measurement • Gender issues & • Desegregation issues

The indicators The set indicator for MDG 6 miserably fall short of addressing the issues and needs of PWDs in Uganda in as far as HIV is concerned. With all due respect to the framers of the millennium development goals and the corresponding targets and indicators, one thing is for sure – There was a high level of unconsciousness about disability needs and issues. The following analysis is a justification of the statement I just made. • HIV prevalence among pregnant women aged 15 -24 years as an indicator • Reproductive health services in Uganda are not responsive to needs of disabled women. The services are not disability friendly, and are characterized by a lot of stigma and discrimination towards women with disabilities by service providers. • A study undertaken to establish - Reproductive Health and HIV/AIDS among Persons with Disabilities in Uganda in three districts of Kampala, Katakwi and Rakai; DWNRO 2003 – offers a very grim picture about disabled women’s attempts to access reproductive health services. • Correspondingly, the tool of data collection and source that may be used to track the progress of this particular indicator can not provide specific information on persons with disability.

The indicators – cont. • Condom use as a contraceptive among the married for birth control and in high – risk sex populations ages 15-24 cannot also be sufficiently used to establish the levels and progress of the target amongst the disabled population for a number of reasons. • One: 99% of people who use condoms do so with consent. For persons with disability, where sex is by chance for disabled men and most often by coercion for the disabled women, the chance that one will use a condom is very rare. • Secondly: Sex education and the attendant sub topics like condom usage do not address the information needs of specific disability categories. How for instance can a visually impaired person distinguish between a damaged and safe condom? What about the ability to negotiate consensual sex acts – when the power balances in terms of demanding for and satiating one sexual desires for PWDs is tilted unfavorably against them? How about the issues of negative stereotypes that still abound in developing countries about disability and PWDs?

The indicators – cont. • Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years as an indicator cannot be used to quantify and qualify children with disabilities and their levels of knowledge about HIV. Though Uganda launched a very successful Universal Primary Education (UPE) programme and has registered high turn over of children from primary to secondary education levels in the last three years, the ability of the programme to retain children with disabilities and those with special learning needs has been a total failure. This has been due to lack of planning for this category of children. Implication is that the chance that the PWDs as a section of the population shall continually live in perpetual poverty and ignorance is very high. The correlation between poverty and HIV is a well known matter that I should not delve so much into. • The monitoring tool for this indicator is correspondingly incapable of really establishing the real progress of PWDs in as far as achieving MDG 6 is concerned.

Way Forward • I could go on and on. As I said, the purpose of my presentation is to stimulate debate. From whatever perspective, direction or angle one looks at MDG 6, its target and the monitoring tools, a lot is still desired to enable PWDs in the developing communities be part and parcel of the aspirations of the framers of the Millennium Development Goals at the onset of this century – “……….a strong commitment to the right to development, to peace and security to gender, to the eradication of the many dimensions of poverty and to sustainable human development” I can only say that they owe the entire disabled population of this world an apology, and corresponding commitment to ensuring that PWD issues and concerns are given due regard in all national and international development endeavors.

DPOs working in Partnership in Uganda The DPOs that are working together in Partnership in Uganda include the following; Disabled Women Network Resource Organisation Sense International Uganda Others include: Deaf Blind Association

Conclusion This can only be possible, when everybody perceives us as follows: • WE are unable not because of our disability. • WE are unable because of major deficiencies in addressing our issues and needs in an appropriate manner that would take care of us. • WE are unable because the environment disables us. • WE are unable due to our continued exclusion in decision-making processes at planning, budgeting and programme implementation levels. • WE are unable because our disability is presumed more visible than our humanness. • WE are unable because you consciously and unconsciously disregard us. • We demand that you place our humanness above our disability. We demand that you start perceiving disability as a human rights issue. By doing these persons with disability will be accorded what every other human being aspires to 'dignity'

Finally Allow me to quote Tony Blair’s words when he was launching the African Commission Report two years ago – “There can be no excuse, no defense, no justification for the plight of millions of our fellow human beings in Africa today. There should be nothing that stands in the way of our changing it.” This should be the attitude of the international development partners towards persons with disabilities in regards to HIV/AIDS programming all over the world. I thank you very much. Thank you

Millennium Development Goals: Inclusion of People With Disabilities