In Zambia, where disability is often considered a punishment inflicted by evil spirits, nearly one million people with disabilities are struggling to access HIV prevention or testing services or treatment, a rights group said.
Yet these people may be more vulnerable to HIV infection than others because of lower levels of education and literacy, greater poverty and greater risk of physical and sexual abuse, Human Rights Watch (HRW) said.
"Across the continuum of care - from education to testing to treatment - people with disabilities in Zambia face hurdle after hurdle," said Rashmi Chopra, the author of the report, 'We Are Also Dying of AIDS': Barriers to HIV Services and Treatment for Persons with Disabilities in Zambia.
More than one in 10 adult Zambians are living with HIV, and a similar number live with a disability, the report said.
The southern African nation has made progress in expanding HIV prevention and treatment services over the past 10 years, boosting the number of HIV counselling and testing centres to 1,800 in 2013 from 56 in 2001, HRW said.
It also noted that between 2005 and 2013, the number of adults and children on antiretroviral therapy or ART, the drugs that keep HIV from replicating in the body, rose to 580,118 from 57,164.
But people with disabilities are being left behind in Zambia's response to HIV due to stigma and discrimination.
Part of the problem is that people with disabilities are often viewed as asexual or lacking the same right to marry and have children as others, HRW said.
"When you go for VCT (voluntary HIV counselling and testing), you are looked up and down, people say, 'Why should you be in the line? Who would give you HIV?'" Yvone, a Zambian woman with a physical disability, was quoted as saying. "They don't expect disabled women to be sexually active."
The report, released ahead of an international conference on AIDS in Melbourne, also outlined problems encountered by specific groups.
Dominic Vwalya said condom use was difficult for blind people. "A blind person probably relies on their partner to help with using a condom. I can do it by feeling, but I'm not going to see whether it is damaged. The expiry date can be a problem. The one selling might give you the expired ones," he was quoted as saying.
Lidia said many deaf people were forced to rely on friends or family members to help them communicate with health workers, putting the confidentiality of their conversation at risk.
"Even if the interpreter is a friend of a family member, information spreads quickly ... If it's the wife (who has gone to a health centre), the husband will know quickly," HRW quoted her as saying.
Editing by Tim Pearce; email@example.com