HIV Disparities for Those with Disabilities

Author: Michigan Medicine: University of Michigan
Published: 2024/02/15 - Updated: 2026/01/25
Publication Details: Peer-Reviewed, Research, Study, Analysis
Category Topic: HIV - Aids - Related Publications

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: This research analyzes epidemiological data from one of the largest studies examining HIV care gaps among people with intellectual and developmental disabilities. The peer-reviewed study found significant disparities in both testing rates and treatment access, particularly for Black patients and those with autism and co-occurring intellectual disabilities - groups receiving antiretroviral therapy at rates far below national targets. The findings are especially valuable for healthcare providers, disability advocates, and policymakers working to address systemic barriers that prevent appropriate sexual health screening and treatment, revealing that outdated assumptions about asexuality in this population directly contribute to preventable health disparities that impact thousands of vulnerable individuals - Disabled World (DW).

Introduction

People with disabilities are often at higher risk for exposure to HIV due to barriers in engaging healthcare and other systemic factors and are thus considered a priority for prevention and testing efforts. However, these efforts don't always extend to people with intellectual disabilities due to the perception that people with intellectual disabilities are mostly asexual.

Researchers at University of Michigan Health conducted one of the largest epidemiological studies of individuals with intellectual and developmental disabilities to closely examine where the gaps in HIV care lie and found large disparities in care for Black patients as well as for patients with autism and co-occurring intellectual disabilities.

Main Content

People with autism and an intellectual disability and Black people with intellectual and developmental disabilities received worse care outcomes across the board since they were not tested as often for HIV and had disparities in receipt of HIV-related treatment.

"There is a large misunderstanding that patients with intellectual disabilities are asexual and therefore don't require HIV testing or education," said Tyler G. James, PhD, an assistant professor of family medicine at U-M Medical School and lead author on the study.

"This is not true and not providing proper treatment for this population leads to increases in patients with HIV and the spread of HIV."

Of those who have an intellectual disability and HIV, 59% are Black despite the fact that Black people are just 21% of the population with intellectual and developmental disabilities.

The results of the study found that among people with HIV and intellectual disabilities, 71% were receiving antiretroviral therapy in line with global estimates in the general population.

However, only 54% of autistic adults with co-occurring intellectual disabilities and HIV received antiretroviral therapy, well below the national goal of 95%. This result aligns with past research indicating that autistic people with intellectual disabilities experience worse health and social outcomes.

In addition, people with intellectual disabilities were more likely to receive an HIV diagnosis but less likely to receive antiretroviral therapy if they had co-occurring serious mental illness or a substance use disorder.

This infographic highlights significant disparities in HIV testing and treatment for adults with intellectual and developmental disabilities (IDD). It presents three key findings: Black adults with IDD are over 5.5 times more likely to be diagnosed with HIV than white adults with IDD, and while Black adults comprised only 20% of the IDD sample studied, they represented 60% of those living with HIV. Second, only 54% of autistic adults who also had an intellectual disability and HIV received antiretroviral therapies (ART), despite 71% of all people with HIV and IDD receiving ART overall. Third, people with IDD and serious mental illness or substance use disorders were more likely to be diagnosed with HIV but less likely to receive ART treatment. The infographic uses illustrations of diverse adults, medication bottles, an HIV ribbon symbol, and a medical clipboard with a blood sample to visually represent these statistics, emphasizing the critical need to address healthcare inequities in this vulnerable population - Image Credit: T.G. James, Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.

James and his team want to use this research to spark national conversation about how to ensure patients with intellectual disabilities and other populations that are underserved are receiving proper care when it comes to HIV testing, treatment and education.

"The more we can expose how ableism works itself into our healthcare, the better we can change to improve healthcare for all patients," said James.

"For people with intellectual disabilities, we want you to know that your experiences are seen, and it is important to continue to advocate for yourself and your sexual health. We are advocating with you."

Additional Authors

T. G. James, Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. M.S. Argenyi, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA. A. Gravino, Rutgers Center for Adult Autism Services, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA. T.W. Benevides, Institute of Public Health and Preventative Health & Department of Occupational Therapy, Agusta University, Augusta, GA, USA.

Funding

Funding for this research provided by NIDLIRR (ACL), under 90RTHF0005 and American Occupational Therapy Foundation Health Services Research Grant (awarded to T. Benevides).

Insights, Analysis, and Developments

Editorial Note: The persistence of HIV testing and treatment gaps in people with intellectual and developmental disabilities underscores a troubling blind spot in public health practice. When nearly 6 in 10 people with intellectual disabilities living with HIV are Black - despite representing only one-fifth of that population - the disparity reflects both implicit bias and structural neglect. What distinguishes this research is its unflinching documentation that these gaps stem not from medical complexity but from ableist assumptions that disabled people, particularly those with autism and intellectual disabilities, do not have sexual lives worthy of clinical attention. The data demand immediate accountability: healthcare systems must implement routine HIV testing and education for all people with disabilities, challenge false narratives about asexuality, and ensure antiretroviral therapy reaches those currently falling through the cracks, because sexual health is a basic healthcare right that no structural barrier should deny - Disabled World (DW).

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Michigan Medicine: University of Michigan and published on 2024/02/15, this content may have been edited for style, clarity, or brevity.