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

5.7.5. WAYS TO CREATE EASIER ACCESSIBILITY TO HIV PCT IN THE DISTRICT

Majority of respondents (almost 60%) suggested HIV PCT services should be free or set at affordable cost or paid by the Government or by any charity NGO in order to make HIV PCT services accessible to beneficiaries (Figure 11). Another part of respondents expressed that the number of VCT/PCT centres should be increased and established not at long distances from communities. This is understandable because majority of respondents recognized high cost of HIV PCT as a major barrier (Table13). In fact it has been observed in VCT practice that because of fear of HIV results, fear of stigma and discrimination associated to HIV/AIDS and little solution to cure HIV/AIDS, most people are reluctant to do the test, worse still to pay for their money for HIV testing^10,64. Also when we consider the fact that HIV/AIDS is prevalent in developing countries in poor communities, the affordability of HIV VCT and HIV PCT becomes questionable. That is why UNAIDS has recognized scaling up of free VCT centres as the suitable strategies to fight HIV/AIDS in developing countries^8,10,37. Thus in Ghana VCT is recognized nationwide as part of the strategies for National response to combat HIV/AIDS. Specifically it is stipulated in HIV/AIDS policy that Government Agencies and Institutions will ensure increased collaboration in sourcing resources and technical assistance necessary for the implementation of programmes and interventions throughout the country^35,61. Therefore establishment of VCT centre providing free HIV tests to people and to would-be couples would be very helpful in fighting HIV/AIDS in the general population and new couples in particular in Kintampo district. The only problem associated to free cost of HIV PCT is that sustainability is very low after financing institutions withdraw from sponsoring the VCT program¹⁰. Thus at the starting point, the HIV PCT service could be free, but it should be wise to later put in place some measures to ensure that the program is sustainable and owned by the community.

5.7.6. WAYS TO MAKE HIV PCT MORE EFFECTIVE, ACCEPTABLE AND

ATTRACTIVE FOR YOUNG PEOPLE IN K'PO DISTRICT

In order to deduce interventions to be put in place in decreasing order of priority, depending on what beneficiaries of the service suggested for the HIV PCT service to be more acceptable and attractive, we used similar classification scale mentioned above (point 5.7.4).

Data from Table 16 imply 15 interventions in 4 gradual steps that are summarized in Figure 15 below.

Obviously, given the proportion of respondents suggesting confidentiality should be guaranteed, the very first crucial step in launching the HIV PCT service in Kintampo should actually be maintenance of confidentiality. The patronization of the service would definitely depend upon the confidence respondents have in health care providers, regarding how they are treated with secrecy. This has been proved in VCT practice worldwide.¹⁰

Once confidentiality is worked on, the district authorities should then tackle other suggested points one by one, and step by step, or even holistically, to put in place corresponding measures. Thus for instance the second step would consist of providing care and support services for those found HIV infected and appointment of well trained personnel, especially counselors. These are also very crucial in running a very effective and attractive VCT services as it has been proved in Zambia, Uganda, Kenya and Chili, just to mention few countries¹⁰. In fact the ultimate goal to do HIV test is to let people who are detected HIV infected have access to a comprehensive and continuum care and support. These include provision of antiretroviral drugs, drugs for treatment of opportunistic infections, psychological and social support¹⁰. If clients are being cared for in a such comprehensive way, then people will appreciate and patronize the VCT service. Conversely, when clients are not well cared for, the VCT service will be contested.

The other measures in the subsequent steps could also be progressively addressed (Figure 15).

	Figure 15. Steps and actions needed to make HIV PCT practice										% CI Yes Answers
		more acceptable and attractive for young adults, based on suggestions of beneficiary respondents in K'po district.									Lower Limit	Upper Limit
						15	Seventh line actions	Step 5	Others (give marriage gifts to couples, quote that couple did PCT in marriage ceremony...)		0	49%
						Sixth line action	Step 4	-			50	59 %
				14	Firth line actions	Step 3	Appoint young adults counselors				60	79 %
			13	Fourth line actions	Step 2	Organize more than one counseling session is provided to the fiancés					80	89%
			12			Put in place examiner/counselor of the same sex as the client
			11			Conduct follow up of fiancés / newly married after HIV PCT
10	First line action	Step1	Put in place counselors not known in the area and or change continuously the old counselors by new ones after a certain period.								90	100%
9			Provide entertainment in VCT/PCT centres
8			Provide for unbiased, clear and non-judgmental advices to would-be couples
7			Provide treatment or effective cure for HIV/AIDS
6			Provide for the presentation of test results as soon as possible, to reduce the anxiety of waiting to long (same day result
5			Secure permission of patients before passing on information to anybody (parents, pastors/bishop, Imam and other care providers..)
4			Appoint knowledgeable, well trained, kind, wise and good communicator examiner/counselors
3			Provide permanent caring and support services
2			Provide HIV PCT at affordable cost or free of charge.
1			Guarantee complete confidentiality and privacy
Source: Field survey, Kintampo, June 2005.