HIV/AIDS AND WOMEN WITH DISABILITIES IN ZIMBABWE by PAULA SUE GRIMES A THESIS Presented to the Department of International Studies and the Graduate School of the University of Oregon in partial fulfillment of the requirements for the degree of Master of Arts June 2012 THESIS APPROVAL PAGE Student: Paula S. Grimes Title: HIV/AIDS and Women with Disabilities in Zimbabwe This thesis has been accepted and approved in partial fulfillment of the requirements for the Master of Arts degree in the Department of International Studies by: Anita M. Weiss Chairperson Stephen Wooten Member Yvonne Braun Member and Kimberly Andrews Espy Vice President for Research & Innovation/Dean of the Graduate School Original approval signatures are on file with the University of Oregon Graduate School. Degree awarded June, 2012 ii © 2012 Paula S. Grimes iii THESIS ABSTRACT Paula S. Grimes Master of Arts Department of International Studies June 2012 Title: HIV/AIDS and Women with Disabilities in Zimbabwe This study focuses on HIV risk factors and organizational programming at the intersection of gender, disability and HIV in Zimbabwe. Women are disproportionately impacted by HIV in sub-Saharan Africa, though few studies have investigated how women with disabilities are affected. This study determines their unique vulnerabilities to contracting HIV and articulates their barriers to accessing HIV/AIDS prevention and treatment services. Collaborating with two Southern African organizations in three southern Zimbabwean provinces, I interviewed 50 disabled women, 7 disabled men and 44 staff from various AIDS service organizations, community based health and women’s organizations, disabled peoples’ organizations, clinics and hospitals. AIDS programs are not reaching many people who need services who had pre- existing disabilities or who became disabled as a result of HIV. I argue that more must be done to reach persons with disabilities and to think more inclusively and collaboratively when designing and implementing AIDS programs. iv CURRICULUM VITAE NAME OF AUTHOR: Paula S. Grimes GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED: University of Oregon, Eugene San Francisco State University, San Francisco, California DEGREES AWARDED: Master of Arts, International Studies, 2012, University of Oregon Bachelor of Arts, Adapted Physical Education, 1987, San Francisco State University AREAS OF SPECIAL INTEREST: Disability Inclusive International Development HIV/AIDS and Disability PROFESSIONAL EXPERIENCE: Technical Advisor, Mobility International USA, 2008-present Project Manager/Administration Director, Mobility International USA, 1997-2003 Adaptive Community Recreation Instructor, City of Eugene Specialized Recreation, 1990-1995 Program Coordinator/ Coach, Wheelchair Sports Program, Bay Area Outreach and Recreation Program, 1986-1990 GRANTS, AWARDS, AND HONORS: SYLFF Graduate Fellowship for International Research, HIV/AIDS and Women with Disabilities in Zimbabwe, Oregon University System, 2010-2011 v Slape Research Fellowship, HIV/AIDS and Women with Disabilities in Zimbabwe, International Studies Department, University of Oregon, 2010 Graduate Student Research Grant, HIV/AIDS and Women with Disabilities in Zimbabwe, Center for the Study of Women in Society, 2010 Graduate School Promising Scholar Award, International Studies Department, University of Oregon, 2009-2010 PUBLICATIONS: Grimes, Susie. 2010. After the Glory. PVA Publications 36(1): 13-17. Grimes, Paula S. and Lloyda French. 1987. Barriers to Disabled Women’s Participation in Sports. Journal of Physical Education, Recreation and Dance 58(3):24-27. vi ACKNOWLEDGMENTS I wish to express sincere appreciation to Professors Anita Weiss, Stephen Wooten, Yvonne Braun, and Janis Weeks for their assistance in the preparation of this research project and for their fabulous academic mentorship. I would also like to extend my appreciation to Alice Tallmadge and Debbie Sharp for their important input on this manuscript. In addition, thanks to Professors Maram Epstein, Irmary Reyes-Santos and Melissa Graboyes for their valuable insights and perspectives which helped me formulate conceptual frameworks. Thank you to Susan Sygall and Cindy Lewis for opening up my world to include international disability perspectives. I extend my gratitude to my family at the farm for their unflinching understanding and support during these past three years of graduate school. Special thanks are due to my research collaborators and Zimbabwean friends, Dorothy Musakanya, Lizzie Longshaw, Annie Malinga and Constance Sibanda. Without their commitment and enthusiastic participation, this project would not have succeeded. Thank you to all who participated in interviews for this study. The investigation was supported in part by a SYLFF Graduate Fellowship for International Research from the Oregon University System, a Graduate Student Research Grant from the Center for the Study of Women in Society and a Slape Research Fellowship from the International Studies Department at the University of Oregon. This research study is dedicated in part to my late father, Edwin E. Grimes, whose constant love, support and confidence gave me the courage to tackle difficult challenges. It is also dedicated to my mother, Patricia A. Metcalf, who taught me that love is the answer, vii no matter what the question. I also want to dedicate this project to the numerous disabled women around the world whose voices speak out loud and proud, and to those who have yet to be heard. viii TABLE OF CONTENTS Chapter Page I. INTRODUCTION .......................................................................................................... 1 Hypothesis and Research Questions ....................................................................... 4 Research Collaboration ........................................................................................... 4 Research Methodology ........................................................................................... 6 Biases .................................................................................................................... 17 Plan of the Thesis .................................................................................................. 23 II. DISABILITY CONCEPTS AND APPLICATIONS ................................................... 24 Introduction ........................................................................................................... 24 Disability Prevalence and Development Implications .......................................... 30 Disability Inclusive Development......................................................................... 32 Current Theoretical Approaches on Disability ..................................................... 36 Applied Theory ..................................................................................................... 42 Existing Literature ................................................................................................ 44 III. ZIMBABWE’S DEVELOPMENT CONTEXT ......................................................... 50 Introduction ........................................................................................................... 50 Zimbabwe Background Information ..................................................................... 51 Demographics ................................................................................................. 51 Independence .................................................................................................. 52 ix Chapter Page Matabeleland ................................................................................................... 52 Political Conflict ............................................................................................. 55 Land Reform, Hyperinflation and Economic Collapse ................................... 56 Health Care Crisis ........................................................................................... 58 HIV and AIDS in Zimbabwe ................................................................................ 60 The National Plan ........................................................................................... 60 Anti-Retroviral Drugs ..................................................................................... 62 Decline in Prevalence Rates............................................................................ 63 Current Health Care Delivery ......................................................................... 63 Living Conditions of People with Disabilities in Zimbabwe................................ 65 Conclusion ............................................................................................................ 66 IV. GENDER, DISABILITY AND HIV IN ZIMBABWE .............................................. 68 Introduction ........................................................................................................... 68 Data Analysis ........................................................................................................ 69 Geographic and Economic Distinctions................................................................ 70 Social Elements of Vulnerability .......................................................................... 71 Stigmatization ................................................................................................. 71 Family Status .................................................................................................