Breaking the Silence

Providing access to Comprehensive Sexuality Education and Sexual and Reproductive Health and Rights to Young People with Disabilities in Southern and Eastern Africa.

People with disabilities have the same sexual and reproductive health needs and rights as people without disabilities. Yet people with disabilities face numerous barriers to access sexual and reproductive health and rights (SRHR) services and education and cannot enjoy their SRHR on an equal basis with others. In addition, growing evidence shows that people with disabilities are more likely to experience health inequalities, have poorer health outcomes including sexual and reproductive health and are more likely to be exposed to violence.

The Breaking the Silence (BtS) project has set out to generate more knowledge and data on the sexual and reproductive health and rights of persons with disabilities. It is based at the Gender and Health Research Unit (GHRU) of the SAMRC. This site provides links to key publications from the GHRU and BtS team, information on the BTS flagship project on Comprehensive Sexuality Education (BtS-CSE) and initiatives supported by the BtS team.

Publications

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Teams publication on disability and comprehensive sexuality education in Africa
Carpenter Bradley, Bakaroudis, Maria, Hanass-Hancock, Jill (2023): Validating the Teacher Sexuality Education Questionnaire Scales to assess educators’ preparedness to deliver CSE to young people with disabilities. Disability and Sexuality 41, p 677-690, https://link.springer.com/article/10.1007/s11195-023-09798-8 Hanass-Hancock J, Mthethwa N, Bean T, et al. Leaving No One Behind Feasibility Case Study: Applying the “Breaking the Silence” Approach in Comprehensive Sexuality Education for Adolescents and Young People with Disabilities during the COVID-19 epidemic. Research Report June 2021. Durban: SAMRC, 2021. Hanass-Hancock J, Mthethwa N, Bean T, Mnguni MA, Bakaroudis M. Sexual and reproductive health and rights and disability policy analysis. The South African case report updated March 2021. Durban: SAMRC, UNFPA, PSH, 2021 Hanass-Hancock, J., Chappell, P., Johns R., Nene, S. (2018) Breaking the Silence through delivering comprehensive sexuality education to learners with disabilities in South Africa. Educators experiences. Sexuality and Disability. 36(2), p 105-121 https://link.springer.com/article/10.1007/s11195-018-9525-0?shared-article-renderer Hanass-Hancock, J., Nene S., Johns R. and Chappell P.(2018): The Impact of Contextual Factors on Comprehensive Sexuality Education for Learners with intellectual disabilities in South Africa. Sexuality and Disability, 36(2) p123-140 https://doi.org/10.1007/s11195-018-9526-z https://link.springer.com/article/10.1007%2Fs11195-018-9526-z Chappell, P. Johns, R., Siphumelele N., Hanass-Hancock, J.(2018) Educators’ perceptions of learners with disabilities’ sexual knowledge and behaviour in KwaZulu-Natal, South Africa. Sex Education. 18(2), p 125-139 https://www.tandfonline.com/doi/full/10.1080/14681811.2017.1405801 Johns, R. & Adnams, C. (2016). My right to know: Developing Sexuality Education Resources for learners with intellectual disabilities in the Western Cape South Africa. In The African Disability Year Book ADRY, Pretoria University Law Press. De Reuters, L., Hanass-Hancock J, Henken, S, Barkel, W (2015): Challenges in providing HIV and sexuality education to learners with disabilities in South – the voice of educators. Sex Education, 2015. 15(4), P333-347 http://dx.doi.org/10.1080/14681811.2015.1023283 Hanass-Hancock, J Alli F. (2015): Closing the Gap: Training for health care workers and people with disability on the interrelationship of HIV and disability. Disability and Rehabilitation 2014. 37(21), p2012-21 https://www.tandfonline.com/doi/abs/10.3109/09638288.2014.991455 Hanass-Hancock, J., S. Henken, L. Pretorius, L. de Reus and W. van Brakel (2014). "The Cross-cultural Validation to measure the needs and practices of educators who teach sexuality education to learners with a disability in South Africa." Sexuality and Disability. 32(3), p279-298 https://link.springer.com/article/10.1007/s11195-014-9369-1 Chirawu P, Hanass-Hancock J, Aderemi T, de Reus L, Henken A. (2014) Protect or enable? Teacher’s beliefs and practices regarding provision of sexuality education to learners with disability in KwaZulu-Natal, South Africa. Sex Disabil 2014. 32(1), p259-277 https://www.tandfonline.com/doi/abs/10.3109/09638288.2014.991455
Teams publication on disability and violence in Africa
Stern, E., I. Van der Heijden, and K. Dunkle, How people with disabilities experience programes to prevent intimate partner violence across four countries. Evaluation and Program Planing, 2020. 79: p. 101770. https://www.sciencedirect.com/science/article/pii/S0149718919303155?via%3Dihub Dunkle, K., et al., How do programmes to prevent intimate partner violence among the general population impact women with disabilities? Post-hoc analysis of three randomized controlled trials. BMJ Global Health, 2020. in press. Hanass-Hancock, J., Nomfundo M., Tshiamo K. and Malebogo M. (2020): Preparedness of Civil Society in Botswana to advance Disability Inclusion in Programmes addressing Gender-Based and other Forms of Violence against Women and Girls with Disabilities. African Journal of Disability 9, p1-9 https://ajod.org/index.php/ajod/article/view/664 Chirwa E, Jewkes R,, Van Der Heijden I, et al. (2020): Intimate partner violence among women with and without disabilities: a pooled analysis of baseline data from seven violence-prevention programmes. BMJ Global Health 2020;0:e002156. doi:10.1136/bmjgh-2019-002156 Van der Heijden, I., Abrahams, N., Harries, J. (2016) Additional Layers of Violence: The Intersections of Gender and Disability in the Violence Experiences of Women with Physical Disabilities in South Africa. Journal of interpersonal violence 34, p1-22, https://journals.sagepub.com/doi/abs/10.1177/0886260516645818 Hanass-Hancock, J. (2009). Interweaving conceptualizations of gender and disability in the context of vulnerability to HIV/AIDS in KwaZulu-Natal, South Africa. Sexuality and disability, 27(1), 35-47 https://link.springer.com/article/10.1007/s11195-008-9105-9 Hanass-Hancock, J. (2009): Disability and HIV/AIDS - A systematic review of literature on Africa. Journal of the International AIDS Society, 12(34) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788347/ ALIGHT Botswana: https://www.samrc.ac.za/intramural-research-units/alight-botswana
Teams publication on disability and sexual and reproductive health and rights
Hanass-Hancock, Jill (2020): Understanding the Vulnerability of People with Disabilities to HIV: Who is at risk? EClinicalMedicine early online p1-2 https://www.thelancet.com/pdfs/journals/eclinm/PIIS2589-5370(20)30240-6.pdf Ward, Erika, Hanass-Hancock, Jill, Amon, Joseph J (2020): Left behind. Persons with Disabilities in HIV Research and National Strategic Plans in East and Southern Africa. Disability and Rehabilitation early online https://www.tandfonline.com/doi/abs/10.1080/09638288.2020.1762124 De Beaudrap, Pierre, Pasquier, Estelle, Noelle, Alice, Touko, Adonis, Essomba^,Frida, Brus^,Aude, Aderemi^,Toyin Janet, Hanass-Hancock, Jill, Eide, Arne Henning, Mont, Daniel, Mac-Seing, Muriel, Beninguisse, Gervais (2017): Prevalence of HIV infection among people with disabilities: results of a population-based observational study in Yaoundé, Cameroon (HandiVIH), LANCET-HIV 4(4), e161–e168 https://pubmed.ncbi.nlm.nih.gov/28126484/ Hanass-Hancock, Jill , Catherine Grant, Ann Strode (2012): Disability Rights in the Context of HIV and AIDS: A critical review of nineteen Eastern and Southern Africa (ESA) countries, Disability and Rehabilitation, 34(25), p. 2184-91 https://www.tandfonline.com/doi/abs/10.3109/09638288.2012.672541 Hanass-Hancock, Jill, Strode Ann, Grant, Catherine (2011): Inclusion of disability within the National Strategic Response to HIV and AIDS in Southern and Eastern Africa, Disability and Rehabilitation, 33(23-24), p 2389-2396 https://www.tandfonline.com/doi/abs/10.3109/09638288.2011.573055

BtS-Comprehensive Sexuality Education Flagship Project

BtS-CSE is the teams flagship project and focuses on increasing access to comprehensive sexuality education (CSE) for learners, children and youth with diverse disabilities through providing affordable tools and ideas to educators in diverse settings in Africa. BtS-CSE is an evidence-based ‘curriculum-implementation approach’, South led and developed in collaboration with people with disabilities, researchers, educators, and representatives from the Department of Education in KwaZulu-Natal, UNFPA and local NGOs such as the Western Cape Forum for Intellectual Disability (WCFID) and the QuadPara Association KwaZulu-Natal. Some of the visual resources utilized in BtS have been provided by WCFID.

BtS-CSE is aligned to the UN Technical Guidelines on Sexuality Education (2018). It draws on social learning theory utilizing group-based learning, participatory methods, and a whole school approach to involve community, parents, and peer support. The Breaking the Silence approach is made up of 5 components in its aim to deliver evidenced based CSE to children and youth with disabilities in Africa. BtS-CSE has the following documents developed.

Overview of the BtS-CSE project
Presentation of the BtS-CSE approach
Training approach, manual and toolbox for educators to provide CSE to learners with disabilities in accessible formats suitable for low cost settings (can be requested from Jill Hanass-Hancock)
Disability audit/checklist for sexual and reproductive health and rights services (can be requested from Jill Hanass-Hancock)

Breaking the Silence video by community partners

Collaboration and Support

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Supporting the UNFPA Strategic Guidance on Sexual Reproductive Health and Rights and People with Disabilities in Eastern and Southern Africa
The BTS team supports UNFPAs regional initiative to increase access to sexual and reproductive health and rights for women and young people with disabilities in eastern and southern Africa: UNFPA Campaign: We Decide: Including and Empowering Persons with Disabilities UNFPA situation analysis: Access to Sexual and Reproductive health and Rights and Young people with disabilities in eastern and southern Africa (2017) UNFPA regional strategy: The right to access. Regional Strategic Guidance to increase access to Sexual and Reproductive Health and Rights for Young Persons with Disabilities in East and Southern Africa (2018) UNFPA desk review findings on SRHR and disability in Eastern and Southern African: Country Profiles (2018) UNFPA Disability Summit video: Sexual and Reproductive Health and Rights for Young People with Disabilities (2019)
Informing Inclusion of Disability in the work of UNAIDS
The BTS team supports advocacy and information sharing on disability and HIV to inform UNAIDS: UNAIDS disability and HIV reference report (2017) Disability Sector Situation Report for UNAIDS Strategy Development (2020)
Supporting Advocacy and Capacity Building by People with Disabilities through ARRC
The BtS team supports the Afrique Rehabilitation & Research Consultants (ARRC ) through information sharing and development of strategic documents to advance disability inclusion in programmes that address sexual and reproductive health and rights. Examples are: Disability Inclusion in: South African National Strategic Plan for HIV, TB and STIs 2017-2022 Disability mainstreaming at: Disability Networking Zone at the International AIDS Conference 2020 Disability Inclusion, Language, and Etiquette within Health Care Services. Guidelines
Supporting Partners in Sexual Health Leaving No one Behind Campaign
BtS supports Partners in Sexual Health (PSH) project to Leaving no one behind through training facilitators and educators with the Breaking the Silence approach. The team also collaborates on a Feasibility study to understand the implementation of the Breaking the Silence approach.
Supporting the Development of a Comprehensive and Disability Inclusive Practical Guide for Health care workers
The BtS team is currently supporting the South African Department of Health and ARRC to develop the disability inclusion sections for the “Framework for Sexual and Reproductive Health and Rights Comprehensive Training Package”. This training and comprehensive guide targets health care workers. It is currently under development and will provide a comprehensive training on all elements of sexual and reproductive health and rights and mainstream disability and diversity issues.
Supporting the Dissemination of WCFID Comprehensive Toolbox for Sexual Health and Education of People with Intellectual Disabilities
The Western Cape Forum for Intellectual Disabilities has developed several resources targeting sexual and reproductive health of people with intellectual disabilities. These resources can be purchased at the WCFID https://wcfid.co.za/shop/.

Contact details
For further information on the project please contact: Prof. Dr. Jill Hanass-Hancock (Senior Specialist Scientist at Gender and Health Research Unit) at Jill.hanasshancock@mrc.ac.za