Knowledge and perception on HIV premarital counseling and testing among unmarried young people of Kintampo town in the republic of Ghana,

5.7. KEY ISSUES FROM RESPONDENTS TOWARDS HIV PCT HEALTH PRACTICE

IN KINTAMPO DISTRICT

5.7.1. VIEWS ON FREQUENCY OF HIV TEST BEFORE MARRIAGE

AMONG WOULD-BE COUPLES

The points of view of respondents were divergent about the required number of HIV tests before people marry (Figure 8). It is however encouraging that a third of them recognized it should be done more than twice, a fifth saying it should be more than once, and another fifth supporting it should be just once. All these findings support different levels of knowledge among respondents regarding HIV laboratory test.

In many countries with legislation on HIV PCT, the HIV test is required at least once before marriage. But in certain countries like China ¹² and certain areas in Democratic Republic of Congo (ECC/CBCA Church North-Kivu Province), due to the need of testing before the officialization of engagement, also because of possible lengthy engagement during which change could occur in serological status of one or both fiancés, HIV PCT is done at least twice. The first one is undergone before the onset of official engagement (before payment of pride price) and the second happens just a few days before the official celebration of the marriage¹².

In this study only 2.6% of respondents opted for the test being done twice, one before bride price is paid and the second prior to official celebration of the marriage. This shows that respondents disagreed with this last option which yet is being used else where.

However it may be, due to the window period, it is normal that the HIV PCT should be done at least twice, with 3 months interval between the two tests¹⁸.

5.7.2. VIEWS OF RESPONDENTS ON WHO SHOULD SEND WOULD-BE

COUPLES AT THE HOSPITAL FOR HIV PCT

From Figure 9, we saw that majority of respondents (42.86%) suggested that the fiancés themselves should decide and go for test without any body sending them. This is the best way of doing thing as far as marriage concerns two people. But this could work well only if couples discuss in pre-test counseling the implications of discordant/positive results of HIV test¹⁰.

But if we look at the social aspect of marriage, involving both families, the religious bodies or lawyers, it is possible some times that a third person (religious leader, counselor...) comes in to play a role of facilitator. This does not destroy the fact that the test remains first of all voluntary.

The big issue is on how to manage the positive HIV test results and to whom to communicate it. Knowing many couples would not be able to cope with the positive HIV test result alone and decide on marriage project without the intervention of a third person such as counselors or religious leaders came in between, we suppose in our opinion that, even if a couple decides voluntarily to undergo the test, a third neutral body, whether religious or not, medical or not, counselor or not, is still needed to facilitate and follow-up their commitment to HIV testing, and help them cope with the anxiety and the consequences of an eventual HIV test result vis-à-vis the decision on marriage.

In most of African countries, including Ghana, Religion Institutions are officially integrated as stakeholders, activists and main partners in the fight against HIV/AIDS^10,61. Thus although only 15.61% of respondents said Religion leaders could send would-be couples for HIV PCT, this role which is unavoidable should not be neglected since Religion Institutions are involved in many counseling programs, including HIV PCT. In our case study Religion institutions are even currently the only reliable and available structures providing premarital counseling sessions in Kintampo district. Therefore a religion body who sends would-be couples to undergo HIV PCT after counseling session is still acting towards the advocacy for an effective national response to the problem of HIV/AIDS as highlighted in the National HIV/AIDS policy.⁶¹ The district health authorities should play a coordinating role to train and orient religion institutions in the directives towards a voluntary consent of would-be couples on HIV PCT.

5.7.3. VIEWS OF RESPONDENTS ON TO WHO THE HIV TEST RESULT SHOULD

COMMUNICATED TO AFTER A PCT SESSION

In Figure 10, about one-third of respondents suggested HIV test results should be communicated to both would-be couples together; others suggested it should also be communicated to parents or guardians, to religion leaders etc. This big issue is about how to maintain confidentiality. Confidentiality and privacy is crucial in VCT and HIV PCT matters¹⁰. But when it comes the necessity of disclosing the test results to the fiancé(e) so that they both discuss and decide on marriage issue and if it happens that the marriage relationship breaks up, confidentiality may no longer be respected.⁴⁵ And that is where the problem resides. It is not bad for religion bodies or any other third person to be involved. But the whole issue is that they should know the HIV test result belongs to the person and the couples. And the National HIV/AIDS policy is very clear on the issue of disclosure of HIV/AIDS test results with insistence that health care providers shall not disclosure any confidential information from the client to any person without the express consent of the client.⁶¹