5.5. PREFERENCE TO UNDERGO HIV VCT FOR MARITAL REASON
OR NOT
Findings in Table 12 suggest that 77% of
unmarried young adults exclusively preferred HIV PCT whereas only minority
(23%) of them preferred HIV Voluntary testing in no marital purposes. Although
the difference between the two trends is not statistically significant, the
findings suggest that most unmarried young adults are less likely to
voluntarily go for HIV testing unless it is for marital reasons, females being
1.36 times more likely than males to prefer undergoing HIV PCT. This supports
findings from the Adolescent Counseling and Recreation Centre (AcRC) in Kenya
where most unmarried young adults who come for the HIV test come for certain
reasons especially premarital purpose10. Therefore as implied in
findings in the previous study on `Formative research for the establishment of
VCT service in Kintampo District'32, the picture in this present
study support that for VCT service to be well patronized, HIV PCT must be
promoted as well so that unmarried young adults could come for it when they are
about to enter into marriage.
5.6. BARRIERS TO HIV PCT ACCEPTANCE AND
IMPLEMENTATION
IN KINTAMPO
DISTRICT
Respondents had to give their view on a long list of 25
barriers drawn from IDI and FGDs.
For easier interpretation perceived barriers described in
Table 13 were grouped under 4 categories, given the frequencies derived from
respondents:
a) Major absolute barriers (Yes = 70%):
These are respectively -High cost (price) of premarital
examinations , -The attitude of the service provider, -Premarital sex and fear
to know their HIV status, -Fear of stigma and discrimination in marriage
(denial of marriage for HIV+), -Ignorance of the importance of PCT, -Inadequate
VCT/PCT facilities, -Lack or inadequate trained personnel & counselors,
-Lack of confidentiality and privacy among health care providers in PCT
services and Little solution for those who test HIV (+) ( no effective drugs to
treat AIDS).
b) Moderate barriers (Yes 50-69%):
These are -Inexistence of regulatory procedures and Law/Policy
on PCT in Ghana, -Mandatory imposition of PCT that infringes the Human Right of
individuals, -The location of the centre/hospital at long distances,
-Reluctance of fiancés, -Preference of young people to get married
without PCT, Polygyny (Polygynous/polygamous marriages) & Islamic
religion, -Marriage by convenience (outside churches & civil registrar
officer or court or without customary ritual) , -Forced marriage (e.g.
traditional early marriage), -unregistered marriage, -Fiancés are in a
hurry to get married very quickly for any reason and -Medical premarital
certificate provided to fiancé(e) by doctors without performing any
medical check-ups (fraud), - Re-marriage (for divorced or widowed), Inability
for girls to negotiate HIV PCT when their prospective husbands don't like it
and Blind love among young people.
c) Minor barriers (Yes 30-49%):
These
barriers regroup - Opposition of some churches and - Opposition of some
parents.
d) Negligible barriers (Yes < 30%).
Barriers grouped under `others» (not providing gifts to
couples) in index number 26 fit to this category.
Most of the major and moderate barriers above have been
identified worldwide in VCT implementation and practice.10,64 Some
of these barriers (fear of lack of confidentiality and privacy, fear of stigma
and discrimination, ignorance) were also identified in the 2004 previous
study32, and therefore merit special interventions for VCT promotion
in Kintampo District.
We discuss some of these barriers here below.
Certain barriers like «Inexistence of specific law on
premarital examinations in Ghana» emerged from official key informants who
wished there should be a specific law describing the scope, the procedures of
the exam. And respondents also gave their approbation on this as a barrier.
This confirmed one of the factors (inexistence of conducive law/policy) in our
initial conceptual framework. But at this stage where some churches have
already started organizing PCT among young people despite the inexistence of
any specific law on PCT, we assume it is not as such a big barrier. However
although this barrier fell among the category of moderate barrier, we still
strongly recommend there should be a specific law/policy on premarital
examinations in Ghana in order to make it clear regarding its scope and
procedures, like it is the case in many other Countries in accordance to
recommendation from WHO11 and from many other authors10.
Mandatory imposition of HIV PCT fell under moderate barriers.
This is simply because from Table 6, majority of respondents (61%) opted that
HIV PCT should be compulsory although it is recognized that mandatory
imposition infringes human right of individuals and therefore push them not to
attend the service10. In fact observations in two states of the USA
(Louisiana and Illinois) where premarital testing was made compulsory showed a
large proportion of premarital couples got married elsewhere in surrounding
states63. This may have happened like that if the governmental
bodies in these two states imposed the compulsoriness of the HIV PCT to people
without consulting them in a base-line study. In our case, if the view of
majority was to be respected in Kintampo based on the current study, we don't
assume that reluctant unmarried young adults would run away and go to marry
elsewhere in Ghana. And even if it happens it will just be a minority. And
since no law can satisfy completely everybody, the service would still function
normally.
Polygyny (polygamous marriages) and Islamic religion fell in
moderate barriers against HIV PCT. We think it is true since qualitative study
also proved similar trend where Moslem girls disapproved polygyny in Islam
during a FGD and recognized it would be a barrier to HIV PCT. This corresponds
partially to findings from a study of the Kaguru people of Tanzania
68
What is paradoxical and interesting in our study is that a
large part of Moslem respondents (43.9%) also recognized their Religion as a
barrier to HIV PCT (Table 14). They were just frank to tell the truth. This led
us to seek an additional IDI from the Imam and one Moslem elder:
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«People saying Moslem community or Islam is a
big barrier to implementation of HIV premarital examinations in Kintampo are
totally wrong. If some Moslems are also having this conviction, it means they
haven't understood Islam yet. In the history the prophet recommended
examination of prospective spouses before marriage, not textually quoting HIV
test, but implying check-up of their health status. So Islam is not a
barrier.....
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.... It is even rather a protective institution which
contributes very much in reducing HIV spread. Since women are many than men,
men marrying more than one wife help reduce the number of prostitutes who would
be spreading the disease in looking for casual husbands. So we even call
Christians to join Islam in promoting polygamous marriage which, I believe,
will further definitely reduce HIV/AIDS spread and prevalence in the country.
We will soon start sending our young people for HIV premarital test too, things
are in the pipeline. Then, be convinced that Islam is not a barrier to this
beneficial service».(IDI: Imam,Central Mosque/Kintampo, Picture No
22)
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«On the subject of premarital examinations, there is
an Hadith that the Prophet told a man that he should first check carefully the
woman he intends to marry. This could be interpreted in the present days by
having a premarital examination to make sure that there is no danger of all
kind of diseases such as sexually transmitted infections, HIV/AIDS and genetic
consequences for offspring. Therefore there should be extensive campaigns in
the media, churches and Mosques to encourage would-be couples to undertake
these examinations. We are planning to start it in our Mosque. So Islam is not
a barrier at all.»
(IDI: A 46-year-old man, fervent Moslem
believer/Kintampo central Mosque)
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Without commenting much on the explanation we got from the
Imam, what we can add is that it is true plygyny (polygamous marriage) could be
a barrier, but just a moderate one. This is because through the FGD of Moslem
Girls, it was revealed that most Moslem men do not perform any prior medical
procedure when they choose to marry other wives. However we believe the
integration of HIV PCT in Muslim community would change the current reality so
that people do no longer claim Islam as a barrier to HIV PCT as it has been
proved in many other Islamic Countries where premarital exam is legal and
commonly done14,52. Further studies would be needed in the future to
follow-up this issue if possible.
Finally we recommend in priority that major and moderate
barriers to HIV PCT revealed in this study should be addressed properly in
order to guarantee a smooth take off of VCT and HIV PCT service in the
District.
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