ATTITUDE TOWARDS COMMUNITY HIV SCREENING EXERCISE AMONG
INDIVIDUAL FROM SELECTED RURAL COMMUNITIES AT
EFFIA/KWESIMINTSIM MUNICIPALITY.
INTRODUCTION
1.0 Background of the Study
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)
were identified in 1981 among homosexuals in the United States of America (USA). Since
then, it has spread rapidly to other countries around the world, and it has become a global health
challenge and a threat to human rights and development. HIV and AIDS have become a
pandemic globally (Fana, 2018; UNAIDS, 2020]. Globally, more than 74.9 million people have
been infected with HIV since the start of the pandemic. 32 million people are reported to have
died from AIDS-related illness worldwide. In 2018, the Joint United Nations Program on HIV
and AIDS (UNAIDS) reported that 37.9 million people were living with HIV and AIDS
globally, and of these, 36.2 million were adults and 1.7 million were children (<15 years old).
1.6 million new infections were among people with ages 15 and older, and 160,000 infections
were among children with ages 0-14. Globally, deaths from AIDS-related illnesses were
estimated at 770,000 (UNAIDS, 2020).
HIV stands for human immunodeficiency virus. HIV infects and destroys cells of your immune
system, making it hard to fight off other diseases. When HIV has severely weakened your
immune system, it can lead to acquired immunodeficiency syndrome (AIDS). Because HIV
works backward to insert its instructions into your DNA, it is called a retrovirus. AIDS on the
other hand is the final and most serious stage of an HIV infection. People with AIDS have very
low counts of certain white blood cells and severely damaged immune systems. They may have
additional illnesses that indicate that they have progressed to AIDS. HIV is spread most
commonly by sexual contact with an infected partner. The virus enters the body through the
lining of the vagina, vulva, penis, rectum, or mouth during sexual activity (UNAIDS, 2020).
HIV may also be spread through contact with infected blood. However, due to the screening of
blood for evidence of HIV infection, the risk of acquiring HIV from blood transfusions is
extremely low. HIV is frequently spread by sharing needles, syringes, or drug use equipment
with someone who is infected with the virus. Transmission from patient to healthcare worker,
or vice-versa through accidental sticks with contaminated needles or other medical instruments,
is rare. Some people may develop a flu-like illness within a month or two after exposure to the
HIV virus, although, many people do not develop any symptoms at all when they first become
infected. In addition, the symptoms that do appear, which usually disappear within a week to a
month, are often mistaken for those of another viral infection.
Persistent or severe symptoms may not surface for 10 years or more, after HIV first enters the
body in adults, or within two years in children born with an HIV infection. This
"asymptomatic" period of the infection is highly variable from person to person. But, during
the asymptomatic period, HIV is actively infecting and killing cells of the immune system. Its
most obvious effect is a decline in the blood levels of CD4+ T cells (also called T4 cells) the
immune system's key infection fighters. The virus initially disables or destroys these cells
without causing symptoms. As the immune system deteriorates, complications begin to surface.
The following are the most common complications, or symptoms, of AIDS. However, each
individual may experience symptoms differently. Symptoms may include lymph nodes that
remain enlarged for more than three months, lack of energy, weight loss, frequent fevers and
sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky
skin amongst others (WHO, 2020). AIDS is treated with antiretroviral drugs and in some cases
organ transplants. HIVAIDS can be prevented in a number of ways. This include getting tested
for early diagnosis and treatment, using condoms, choosing less risky lifestyles amongst others
(WHO, 2020).
In Ghana, HIV/AIDS remains a public health issue. For instance, 346,120 people in Ghana
were HIV positive in 2020, and the prevalence among young people was 0.70% (42,016
people) (Nubed and Akoachere, 2020). In addition, 5211 new HIV infections were estimated
to have occurred, accounting for more than a quarter of all new HIV cases in Ghana (Nubed
and Akoachere, 2020). Adolescent HIV infections increased alarmingly by 500% in 2017 in
the Tema Metropolis (Doku, 2019). Thus, 143 cases of HIV infection were reported, including
60 males and 83 females. By 2025, the Ghana AIDS Commission wants to see an 85% decrease
in the number of new HIV infections among young people, particularly among adolescent girls
and young women. All sexually active young people in Ghana have unrestricted access to
sexual and reproductive health services, including HIV testing.
In countries with high prevalence of HIV, the disease has had a significant economic impact
on the country and its population at both societal and individual levels. The HIV epidemic’s
potential impact on Ghana’s economy is considerable. There are three primary ways by
which the disease hinders economic well-being: a reduction in life expectancy resulting in
both early death and economic disability, a reduction in parental investment in children and,
lastly, the overall negative effects on returns on investments in business and infrastructure
(Henkel, 2019).
According to the National HIV and AIDS/STI Policy (2018), good quality testing and
counselling (TC) for HIV should be made available and accessible to each person seeking
these services and adequate information also provided prior to testing and post-test counselling
provided when test results are received. In the policy framework, HIV and AIDS
Testing primarily involves individuals actively seeking HIV testing at facilities offering the
service which should be offered especially in non-health settings, such as the community,
mobile, stand-alone services, during pre-marital counselling and in walk-in health settings
where people go to know their HIV status.
Voluntary HIV counselling, screening and testing (VHCT) is an important intervention for HIV
prevention as it may serve as an early entry point for prevention, cure and support for infected
people. It is also crucial in promoting safe behaviour, providing personalized support and an
opportunity for early detection (UNAIDS 2019). Additionally, VHCT prevents delayed entry
into HIV treatment, which ultimately leads to the desired reduction in deaths related to AIDS.
Though VHCT is used as a diagnostic tool for asymptomatic AIDS, young people find it
difficult to access it. Evidence indicates that only 10% of young men and 15% of young women
know their HIV status (Shitan and Nazrul, 2018). Barriers to the utilization of VHCT services
include lack of awareness, financial constraints, fear of testing positive and stigma. Other
barriers include concerns about privacy, low-risk perceptions, and poor knowledge of
HIV/AIDS (Masoda and Govender, 2018; Shitan and Nazrul, 2018)
Yahaya, Jimoh and Balongun (2020) explain that HIV test involves a scientific analysis of a
client’s blood in order to determine his/her HIV status which aims at assisting clients/
patients to understand themselves, and adjust effectively to life’s challenges and contribute
meaningfully to the development of the society. Voluntary Counselling and Testing (VCT) for
HIV which is now known as HIV testing and counselling (HTC) therefore becomes much
more than drawing and testing blood and offering counselling sessions as it is a vital point of
entry to other HIV and AIDS services, including prevention and clinical management of HIV
and AIDS-related illnesses, tuberculosis (TB) identification for treatment and control,
psychosocial and legal support, and prevention of mother-to-child transmission (MTCT) of
HIV.
Different views have been expressed on the need for HIV screening exercises. On one
hand, some argue that knowledge of HIV status influences people to practice safe sex
behaviours, (Fiaveh, 2021; MacPhail et al., 2022). On the other hand, some think that a
positive HIV test result is a death sentence and that many people would rather not know their
HIV status (Fiaveh, 2021; MacPhail et al., 2022). Irrespective of the results or outcome of a
test and screening, the client obtains information that could translate into behaviour change if
the test result is negative so as to endeavour to always remain negative. On the other hand if
test results turn out to be positive, it offers the opportunity for early treatment and avenues to
also live healthily for a longer time (Tanye, 2021).
1.1 Statement of the Problem
The need for HIV screening and testing as an effective tool of prevention of HIV
and AIDS among the individuals cannot be underestimated. Although HIV screening and
testing has often been used as a diagnostic tool to confirm symptomatic AIDS, it is increasingly
becoming difficult for most of the population to go for HIV Testing and screening
(Fiaveh & Lakas, 2021). Hence, the intended commitment by world leaders to end the HIV
and AIDS menace by the year 2030 seems to be back firing even though more persons living
with HIV and AIDS appear to be on ART (UNAIDS, 2021). The potential of reducing HIV
and AIDS in Ghana for example is undermined by the low patronage of testing and voluntary
screening among individuals, (21% of females and 14% of males). Even among those who
utilize HTC, only 17% of females and 12% of males return for their results (Chris-Koka, 2021
citing GSS, 2020). According to Yahaya et al (2020), a study in Ghana showed that 78% of the
respondents had never undergone any HIV testing and majority of the respondent were not
accessing the available HTC services.
Similar, studies (UNAIDS Technical Update, 2020; Dejere, 2018) have shown that HIV
screening might have far reaching implications and consequences for the person being tested
though there are important benefits for knowing one's HIV status. According to The Family
Guidance Association of Ethiopia (FGAE) (2019) reveal there are several possible contributing
factors that must be addressed if HIV screening is to have an important role in HIV and AIDS
prevention and care. One issue of particular relevance is stigma surrounding both the HIV
testing process and the disclosure of an HIV-positive status. The stigmatizing nature of HIV
and AIDS is a factor that affects delayed HIV screening by at-risk persons and influences the
acceptability of testing (Genberg, Kawichai, Chingono, Sendah, Chariyalertsak, Konda, &
Celentano, 2017; Kipp, Kabagambe & Kondelelu, 2015 cited in Pikard, 2019). For instance,
stigma and discrimination account for a considerable portion of the barriers to HIV Testing and
screening uptake in countries like Zimbabwe (8%), Uganda (51.7%) Ghana (46%) and Nigeria
(48%) of respondents (Pikard, 2019).
Citing numerous writers, Leta et al (2020) have stated socio-demographic characteristics,
proximity to a clinic, awareness/knowledge related to HIV and AIDS, perception of being at
risk of HIV infection, perceived benefits of HTC, the belief that knowledge of infection may
accelerate disease progression, psychosocial factors such as HIV and AIDS related stigma
and discrimination and concerns about confidentiality are several possible contributing
factors that could play an essential role in the low uptake of HIV screening.
Though, there has been a persistent decline in the prevalence rate generally in Ghana, same
cannot be said of Effia/Kwesimintsim Municipality since the prevalence rate keeps increasing
over the last few years. For instance, the years; 2016, 2017 and 2018 recorded 1.4%, 2.4% and
4.2% respectively (GAC/MOH, 2018), becoming an area with one of the highest prevalence
rate in HIV Sentinel survey conducted in Ghana for the year 2018. The pattern of the disease
in the municipal is disturbingly unpredictable and has therefore become imperative to conduct
research on HIV testing and counselling among the youth in Effia/Kwesimintsim Municipality.
Based on this the study examines attitude towards community HIV screening exercise among
individual from selected rural communities at Effia/Kwesimintsim Municipality
1.2 Purpose of the Study
The rate of HIV spread and infection among individuals represents a compounded public health
hazard and therefore the need for further research in order to detect the risk factors and help
physicians detect condition early for treatment and prevention. The aim or purpose of the study
is to examines attitude towards community HIV screening exercise among individual from
selected rural communities at Effia/Kwesimintsim Municipality.
1.3 Objectives of the Study
The objectives of the study are to;
1. Examine the knowledge level of the youth about HTC or HIV Screening services
2. Examine the attitude of the youth of Effia/Kwesimintsim Municipality towards HIV
screening services.
3. Assess the extent to which youth in Effia/Kwesimintsim municipal utilize HIV
screening services.
4. Determine the factors affecting the willingness of people to be tested
for HIV among people at Effia/Kwesimintsim Municipality.
1.4 Research Questions
The study will find answers to these questions.
1. What is the knowledge of individuals about HIV screening services at
Effia/Kwesimintsim Municipality?
2. What is the attitude of the youth of Effia/Kwesimintsim Municipality towards HIV
screening services?
3. To what extent do youth in Effia/Kwesimintsim municipality use HIV screening
services?
4. What are the factors affecting the willingness of people to be tested for HIV among
people at Effia/Kwesimintsim Municipality?
1.5 Significance of the Study
The study will be of benefit to respondents as it will increase their awareness and the
importance of HIV screening so that they could take advantage to get tested and know their
status. Furthermore, it will it affords the individual the opportunities to learn, adopt and sustain
healthy sexual behaviour that could help improve their quality of life and prevent others from
being infected by the disease.
The municipal will benefit from this study as it will give members in the community the needed
education on HIV/AIDS and its impact on communities and open more screening centres and
put in place measures to make the populace comfortable while taking HIV screening tests.
For nursing education and practice, it will give the opportunity to examine how people feel
about screening of HIV and provide the means for nursing institutions to train professionals to
be sensitive on the issue of HIV while encouraging the populace to take the tests.
This study will offer all stakeholders in health, useful suggestions with regards to
improvements in HTC services as a means of reducing the prevalence rate and impact of the
HIV and AIDS pandemic among youth irrespective of their sex, religion and educational
level. The study is important because it could guide the introduction of HTC programmes and
provide baseline information for evaluating the effectiveness of strategies for the prevention
of HIV infection among rural dwellers in Effia/Kwesimintsim Municipality.
It will also offer the Ghana AIDS Commission and the Ministry of Health strategies to help
young people to accept their HIV serostatus if found to be positive and to receive care, and
support.
1.6 Delimitation of the Study
Geographically, the study covers the Effia/Kwesimintsim Municipality and no other district or
municipality. The study will examine attitude towards community HIV screening exercise
among individual. This study is confined to only individuals in the municipal. The study does
not cover all the individuals but those within the ages of 15 to 40 years. Again, the study does
not cover other forms of prevention of HIV and AIDS such as Prevention of Mother to Child
Transmission (PMTCT) or condom use but only HIV screening.
1.7 Definition of Terms
Acquired immunodeficiency syndrome (AIDS): is a chronic, potentially life-threatening
condition caused by the human immunodeficiency virus (HIV). By damaging your immune
system, HIV interferes with the body's ability to fight infection and disease (Google).
Attitude: a settled way of thinking or feeling about something (Google).
Community: a group of people living in the same place or having a particular characteristic in
common (Google).
Confidentiality: An agreement between the counsellor or health officer and the client, that
all issues that prevail at the HIV Testing and Counselling centre will not be disclosed to any
other person (Google).
HIV (human immunodeficiency virus): is a virus that attacks the body's immune system. If
HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is
currently no effective cure (Google).
HIV Testing and Counselling (HTC): is a process whereby people willingly undergo an
HIV counselling process and have an HIV test (Google).
1.8 Organization of the Study
The study is organized into five chapters. The first chapter examines the background of the
study, statement of the problem, purpose of the study, objectives of the study, research
questions, significance of the study, scope and delimitation of the study, definition of terms
and organization of the study. The second examines pertinent literature related to the topic
under study. Chapter three looks at the methodology adopted for the study. Issues to be studied
include study design, study setting, target population, selection criteria, sample and sampling
technique, sample size determination, data Collection tool, data collection procedure, data
analysis and management, instrument validity and reliability and ethical consideration. The
fourth chapter looks at analysis and discussion of results. Chapter five looks at the summary,
conclusion, implication, limitation and recommendations.