Introduction
The findings of this study are structured under the themes derived from the research questions. The four research themes are knowledge on HIV and AIDS, ways in which visually impaired persons access HIV and AIDS information, challenges visually impaired persons face in accessing information on HIV and AIDS and promotion of HIV and AIDS information among the visually impaired persons.
Socio-demographic characteristics
Participants’ age range in the study was between 18 and 60 years old out of which thirty-two were persons with visual impairments and the remaining five were key informants working with the visually impaired and health promoters. The majority of the respondents were aged between 30 and 42 years.
Attributes of persons with visual impairments
The visually impaired participants had varying attributes of age, being an indigenous resident of the Kang’onga Production Centre and education (ability to read Braille and not able to read). The other attribute was gender because both males and females were included. The other attribute was marital status since both married and single respondents were identified.
Knowledge on HIV and AIDS
Respondents when asked to explain what they knew about HIV and AIDS. The responses obtained revealed that there were variations among them regarding knowledge on HIV and AIDS. Some respondents were aware while others had limited awareness in the cause, transmission, prevention and had misconceptions. On the other hand, the respondents exhibited knowledge on treatment of HIV and AIDS. Following below are results of what the visually impaired persons say they know about HIV and AIDS and what their experiences are.
Perceived causes and transmission of HIV and AIDS
The findings on the perceived cause of HIV and AIDS included some perceptions that HIV and AIDS came from urine, wounds, coughing, diarrhea, tuberculosis and from the laboratory to kill the black race as testified by one male respondent in the age range of 25–32 years who said:
HIV and AIDS were made in the laboratory to kill the black race
Further, despite other participants’ revelations of the mode of transmission of HIV and AIDS, some participants interviewed attested that HIV and AIDS came through some diseases such as coughing and fever as another respondent alluded that:
HIV and AIDS came through coughing, fever. When one has these symptoms they should see the doctors because HIV and AIDS came such diseases.
In terms of the knowledge on the transmission of HIV, most of participants said one can get infected through sexual intercourse. Some participants also stressed that, HIV transmission occurred when one engaged in unprotected sexual intercourse as one respondent stated that:
HIV and AIDS come through unprotected sexual intercourse with a person who is positive and using razor blades after someone has used it.
Information from in-depth interviews revealed other ways perceived by the visually impaired persons how HIV was transmitted such as razor blades, during child delivery and injections. Some participants also indicated that women used traditional medicines to make their vaginas dry to increase sexual pleasure for the men. This causes bruises during sexual encounters and the friction led to HIV transmission. This was explained by one married male participant in the age range of 30–40 years when he said:
Even through injections that we get from the hospitals if they inject one who is HIV positive. Nurses when they are delivering during labour, if treatment is not favourable that person assisting if he or she has no gloves for protection can be infected if someone is not following instructions we are given when having sex such as the use of condoms and women not to be using herbs for dry sex. Dry sex makes people to have bruises during sexual intercourse.
Treatment and prevention
Related to treatment and prevention, it was reported that there was no cure for HIV and AIDS but rather medicines to prolong life were there as one participant put it that:
We know that when you are found HIV positive, you can be given medicines to prolong your life … I was told, you cannot be healed, you can just be helped how to live long with the disease.
In terms of prevention, most participants indicated that also it was a known fact that there was no cure for HIV and AIDS and as such they said the only way was to prevent HIV and AIDS by being faithful to their partners, using of condoms, abstinence and avoiding sharing of blades. However, some female participants in the in-depth interviews argued that, they did not trust a condom because they could not see if it was being used correctly or if a partner had put a hole in it. This was stressed by one female respondent when she said:
Using and trusting a condom is a challenge, because one cannot know if a partner was using it correctly or had ripped it and besides we hear that a condom is not safe.
However, some male participants argued that, even if they were visually impaired they were able to use a condom correctly because they were also human beings as testified below by one male respondent when he said:
Even if we cannot see, we also know how to use the condoms correctly just like those who see.
On the overall, the visually impaired persons showed a variation on the HIV and AIDS knowledge because of the different responses on the cause, transmission, treatment and prevention.
Ways in which the visually impaired persons access HIV and AIDS information
Participants indicated a number of ways through which persons with visual impairments became aware of HIV and AIDS. These included the Media, information education communication materials (IECs) and health education.
Media
Information from both the in-depth interviews and focus group discussions indicated that most participants had common ways in which they accessed information on HIV and AIDS which included listening to the radio, television, public address systems and drama or plays and sketches. This was affirmed by what one female participant who said:
We gain HIV and AIDS information by listening to those who teach about HIV and AIDS and listening to the radio and television because they also teach about HIV and AIDS.
Drama as an expressive art is another critical way through which people transmitted information. This mode is also used to communicate information on HIV and AIDS to the visually impaired persons. Drama was cited by most participants as a preferred way of accessing information on HIV and AIDS. One female participant from FGD of age range of 38–42 years argued that:
Even through sketches that teach on how one can take ARVs and how HIV and AIDS is transmitted from one person to another would be used to access HIV and AIDS information.
Further, some key informants involved in health promotions revealed that when mobilising people for HIV and AIDS programmes, they use the public address system (PA) and said:
Currently, we have the public address (PA) system. Using big speakers while going round the community making announcements on health issues to the public.
Information, education and communication (IEC) materials
The other channels through which the visually impaired received information established from the responses especially from those who were able to read Braille were through books transcribed into Braille. However, the participants noted that Braille was hardly accessible as the importance of Braille was illustrated by one male participant who observed that:
Through health education on HIV and AIDS, Braille books though unavailable … the best way to educate us on HIV and AIDS information is through books in Braille.
Pamphlets were sources of written information for persons with visual impairment and it was pointed out as one of the ways HIV and AIDS information was accessed.
Even through books, we have pamphlets and Braille which talks about HIV and AIDS.
It was also learnt from the key informants or health promoters that charts were among the ways information is given to persons with visual impairments though these were not specifically designed for them. These charts had HIV and AIDS messages and other health concerns which were of help to both the sighted and the visually impaired. One key informant echoed these sentiments when he said:
We have the charts with different important messages that we need to communicate but the health education we give is the same whether you are a visually impaired person or you are able person.
Health education
Most participants revealed that one of the major ways they accessed HIV and AIDS information was through health education. They cited visiting health centres, trainings, peer education workshops; community home based care and counseling as some of the ways through which they accessed information on HIV and AIDS.
Peer education and Health Centre visits were another way through which the visually impaired persons accessed information. However, it was also observed that the visually impaired did not usually visit health centres specifically for HIV and AIDS but for other health ailments. It was during such visits that sometimes they coincidentally accessed HIV and AIDS information. The statement below attests to one female participant’s views that:
By listening to those who teach about HIV and AIDS, listening to the radio and television because they also teach about HIV and AIDS. Visiting clinics and hospitals, because each time we go there they sometimes teach us on HIV and AIDS. I also escorted my friend to a clinic and was taught about HIV and AIDS.
The other way female participants accessed HIV and AIDS information was through workshops, community home-based care, counselling and antenatal visits. Participants argued that it was during such programmes that they received HIV and AIDS information and shared information with each another. However, despite these methods being used, the visually impaired persons stated that they were rarely invited to attend these programmes. Hence most participants argued that the best way of communicating HIV and AIDS information to the visually impaired persons was through the one-on-one teaching and demonstrations. The two sentiments that reflect this argument are that:
Through workshops, community home based care and Anti natal they hear about HIV and AIDS and counselling from the clinic, though not specifically but the general one.
Therefore, participants indicated a number of ways through which persons with visual impairments received HIV and AIDS. They revealed ways such as the media, information education communication materials (IEC) and health education.
Challenges faced by the visually impaired persons in accessing HIV and AIDS information
When asked on the challenges that persons with visual impairments face in accessing HIV and AIDS information, participants highlighted a number of ways which included discrimination and stigma, education, poverty, integration, employment and funding.
Discrimination and stigma
Discrimination and stigma seemed to be a big challenge among the visually impaired persons. Some of the participants felt they were discriminated against because information on HIV and AIDS rarely reached them and as such, the visually impaired persons assumed that they were considered less compared to their sighted counterparts. One of the participants in the in-depth interview observed that double discrimination was also a challenge because those who were found to be HIV and AIDS positive would even be neglected by e their own families. These challenges were attested to in the quotes cited below:
Most people involved in the disseminating of HIV and AIDS information did not come to us regularly on HIV and AIDS; they don’t come to us because they mostly think we don’t get sick. They should know that we also get sick. They consider us less when giving us information.
When I was found to be HIV positive, my sighted husband left me and my family chased me from home and I went to stay with friends. They told me that I was going to die and that they do not have money to buy a coffin.
Education
The level of education was identified as having a bearing e on HIV and AIDS information dissemination to persons with visual impairments. For example, most of the visually impaired persons were unable to read and write Braille. The participants reported that most HIV and AIDS programs were in English which they did not understand. According to the respondents interviewed, they argued that they were not cared for because much concentration and care was directed to the sighted persons. It was revealed that they had challenges on the escorts (the people who took and guided them from one place to the other), hence they found it difficult to visit health centres. Even when they managed to visit clinics, they remained unattended to for a long time as one female respondent indicated when she observed that:
Most HIV and AIDS programs are in English but most of us do not know English and we are not cared for because we are visually impaired. They concentrate on those that can see while we are not frequently given a chance to visit clinics, because people who take us at times refuse. Also at clinics they also discriminate us, you can remain at the clinic unattended to for a long time since we cannot see. Other languages should be used because not everyone knows English.
The study also found out that, the visually impaired persons had no HIV and AIDS messages designed specifically to meet their communication needs. The key informants working with persons with visual impairment confirmed that they did not have programmes tailored to meet the diverse needs of the visually impaired persons.
Yes information is not prepared specifically for the visually impaired persons and we do not have much Braille information.
Poverty and unemployment
Besides discrimination, stigma and education, poverty and unemployment were some of the key challenges faced by persons with visually impairments in accessing HIV and AIDS information. It was noted that most persons with visual impairment live in poverty. As such, the majority of them were unable to access health centres due to lack of transport money because they needed to pay for the escort and themselves. It was also noted that despite the radio being the most preferred way of accessing information, few hardly afforded a radio due to poverty. It came out in interviews with participants and key informants that:
Me I have a radio but some of my friends do not have, even though I have this radio cannot always afford to buy cells so sometimes I do not even play the radio and hence miss most of the information.
In the same interview participants argued that, they were more vulnerable to HIV and AIDS infection because they have little or no say on whom to have sex with and how to have it and as such it was difficult for one to prevent HIV and AIDS. One female participant narrated that:
We have no say on whom to have sex because we do not have employment and yet we need to feed so any man offering to help we cannot stop him and we also depend on others to see for us and tell us that he is a good a man and that is how we end up with HIV positive men.
Logistical challenges
Some key informants interviewed also said distance was a challenge for them to reach out to persons with visual impairments on HIV and AIDS information. This was not only a challenge for the health promoters to reach out to the visually impaired persons but to the entire population in rural areas. The contributing factor to this is lack of a utility vehicle.
We as are a regional office we do not have a utility vehicle. So even if they say can we meet at Kang’onga today, it will need me to write a letter to the provincial cabinet that I need to do this and I am asking for a vehicle and driver and will pay for fuel and lunch for the driver. It is a challenge to manage a province without a utility vehicle.
Integration
Through the focus group discussion for both males and females, integration was cited by the majority that it was another challenge that they faced in accessing HIV and AIDS information. They said, some infrastructures had no lift, wide doors and or ramps thus inhibiting them from accessing HIV and AIDS information as most they do not accommodate persons with visual impairments. This made them fail to access health services on HIV and AIDS especially in hospitals were they were referred to.
Other structures do not integrate the visually impaired in activities despite being documented in the national Act for persons with disabilities, and it is not fully implemented.
The other participants felt not integrated in decision making. As one participant argued that the visually impaired persons or disabled in general did not sit on boards which made decisions to give advice on HIV and AIDS or integrate the visually impaired persons into the HIV and AIDS plans as alluded to by one ZAPD participant when he said:
Acts actually require that whatever you do or plan must integrate people with disability. Even if it’s a national HIV and AIDS plan, or anything to do with building or vaccines one needed to consult on how to integrate the disabled but mostly these guidelines are not followed.
Health promoters stated that the other challenge they faced was in isolating and mobilising special groups to disseminate HIV and AIDS information among the visually impaired persons. This was because there were no specialists to help in isolating special groups such as the visually impaired persons to plan specific communication programmes on HIV and AIDS.
We usually have a challenge when it comes to isolating these special groups as per say… we have no qualified health promoters, even me am not qualified but am in charge of health promotion in this district.
Improving communication on HIV and AIDS information among the visually impaired persons
In view of the challenges indicated, a number of interventions were suggested on how communication of HIV and AIDS information to and among the visually impaired persons could be improved and enhanced. These included improving integration, funding and awareness and sensitisation. It was observed that a lot of things had to be put in place. It was revealed that paramount to accessing HIV and AIDS was through integration of the visually impaired persons into HIV and AIDS programmes and programming. Views were expressed by a young participant in the age range of 20–25 years that:
The abled should consider as persons with sexual feelings and not discriminate us from HIV and AIDS programmes and we should also be taken to radio stations to teach others on HIV and AIDS. They should integrate us.
Participants cited trainings, workshops and mainstreaming as tools in the promotion of communication on HIV and AIDS information. They said training the visually impaired persons would enable them to become peer educators. Involvement in programmes such as HIV and AIDS programming and workshops would enhance their HIV and AIDS information accessibility. Readable formats for the visually impaired persons should be availed to those who were able to read because they can become the mouthpiece for the other visually impaired persons who are unable to read. This was supported by a married participant in age range of 30–40 years old who said:
They should be training us so that we can also teach others on HIV and AIDS and we should be encouraged to teach other. Also we should be integrated in workshops, trainings and planning. Braille books should be made available to us who can read and write.
Funding
Prominent in the recommendations was the need for the government to stop neglecting the visually impaired persons in funding. They argued that most funds on HIV and AIDS went to programmes that benefited the sighted which was wrong as they were also affected and infected by HIV and AIDS. They argued that funds should be made available for programmes that benefited persons with visual impairments in accessing HIV and AIDS information as indicated by some participants when they said:
Us who have challenges of sight, the key people to promote or overcome these challenges that we face is government by stopping neglecting us and also to include the blind in HIV funds because mostly government releases funds for HIV and AIDS.
Entertainment was also advanced as one key area that needed to be taken care of if information on HIV and AIDS was to be prioritised among the visually impaired persons. It was revealed that drama or sketches and plays could be enhanced especially for those who cannot read or afford a radio to learn something on HIV and AIDS. In the same line, also it was indicated that there was need to include sporting activities because they lack such social amenities. As noted by people working with the visually impaired persons embraced sexual intercourse as the greatest means of entertainment as pointed out that:
Not that we are trying to make a story sweet but it is a fact they do not have any other entertainment that’s why the biggest entertainment they have is sexual intercourse so why not create awareness.
Collaboration between ministries and other agencies was also mentioned. In order to serve the visually impaired persons better in terms of communication on HIV and AIDS information, it was argued that there was need for collaboration between ministries and other agencies.
Ministries have to come together like in the old days to meet the people and give them hand-outs. We can design and make a programme for that. So that even in churches they can be reached though not in the majority but as a fraction for we know that the visually impaired persons are everywhere
The need for an escort was another challenge which needed to be worked on the accessibility of HIV and AIDS information. It was argued that usually they needed a child to guide or escort them and yet the child had also to go to school. Meaning that, the visually impaired person would have no one to escort them thereby not accessing information or treatment at the health facility. Therefore, it was suggested by the female FGD that it would be better for the hospital to help the visually impaired person. A female participant in the age range of 35–41 years old complained that:
They know the dates they conduct anti-retro therapy (treatment) so if they can send those people they call caregivers to come and take us because most times we are asked that why have you come alone and no one to lead you. Ministry of health can help us by sending caregivers to come and be our escorts especially on the dates for attending ART clinics so that our children can attend school as well.