Disability, Violence and HIV Among Girls and Young Women in Eswatini, 2022

Eswatini has made substantial progress against its HIV epidemic and in reducing violence against children. But adolescent girls and young women remain especially vulnerable: among 15- to 24-year-olds, an estimated 11.0% of young women live with HIV, more than three times the rate among young men (3.4%). Those with disabilities may face even greater risk — through physical or communication barriers to HIV prevention, testing and treatment, economic vulnerability, exclusion from school, and discrimination.

A team from CDC, Eswatini’s Ministry of Health and USAID used the 2022 Eswatini Violence Against Children and Youth Survey to compare girls and young women with and without disabilities.

The survey

The survey is a nationally representative household study of people aged 13–24, covering violence, HIV, and risk and protective factors. The analysis included 6,318 girls and young women (a response rate of 90.1%). Interviewers of the same sex recorded answers on tablets, with parental permission and the participant’s assent for those under 18. A referral plan was in place for anyone who needed help, including those who had recently experienced violence. Forty-nine people with severe disabilities or difficulty understanding or answering questions were excluded.

Functional disability was measured with a modified version of the Washington Group Short Set: a participant counted as having a disability if she reported at least “some difficulty” in any of six areas — vision, cognition, mobility, self-care, independent living and communication. Hearing was not asked about, because the interview itself required hearing.

What it found

• 14.0% of girls and young women aged 13–24 had a functional disability — 11.2% with one type and 2.8% with two or more. Vision was the most common (6.7%).
• Those with a disability were more likely to face food insecurity (67.0% against 59.7%); otherwise the two groups were similar in their characteristics.
• After adjusting for age, education, food insecurity, orphan status, marital status and residence, girls and young women with a functional disability had a higher lifetime prevalence of:

• They were also somewhat more likely to know where to seek help for violence (adjusted ratio 1.2) — perhaps because they experience it more, or because they have more contact with health services where violence referrals are shared. How accessible and disability-inclusive those services are is unknown.
• HIV measures — testing, infection status, risk factors, sexual risk behaviors, and prevention and treatment services — did not differ by disability status after adjustment. A 2018 survey in Lesotho had found links between disability and HIV, so more work is needed to understand how these factors interact.

What it means

The higher rates of violence point to a need for accessible, disability-inclusive violence prevention programs and services, in line with the Eswatini government’s own efforts to include people with disabilities and to end violence, stigma and discrimination. The authors recommend that violence prevention partners work with disability-led and disability-serving organizations, and directly with girls and young women with disabilities, to design programs they know about and can use.

Limitations

• Answers were self-reported and may be affected by recall or social-desirability bias.
• The survey is cross-sectional, so it cannot show cause.
• The strict statistical threshold used may have missed some real differences, such as in HIV status.
• Counting “some difficulty” as a disability may have diluted the differences.
• Numbers were too small to compare by type or degree of disability.
• Excluding people with severe disabilities means prevalence is underestimated and the results may not apply to them.
• Girls and young women whose only disability is in hearing were not captured.

Sources

Based on Besera G, Annor FB, Swedo EA, et al., "Functional Disability, Violence, HIV Status, and Risk Factors for HIV Among Adolescent Girls and Young Women — Eswatini, 2022," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; written with the Government of Eswatini’s Ministry of Health and rewritten in hubnx’s own words.