5.7.7. HEALTH FACILITIES WHERE HIV PCT CENTRE SHOULD
BE ESTABLISHED IN KINTAMPO
DISTRICT
As shown in Table 17, 72% of respondents suggested HIV PCT
services should be established in Kintampo District Hospital (KDH), while 75.6%
of respondents from Jema Health (who represented 27% of the whole sample)
expressed that the service should be established in Jema Health Centre. These
findings suggest that respondents knew that KDH fulfills well the required
criteria to run such service given the trained personnel in place (doctors, lab
technicians, Matron-counselor...) and the laboratory equipment available. Those
from Jema just expressed that they wanted the service to be close to them, to
avoid lorry fare as it came up also in FGD where people expressed that HIV PCT
centres should be placed in communities for easier accessibility.
In either case, some thing more must be done now in this
pre-VCT implementation period. If the service is to be implemented in KDH, the
infrastructures for VCT should be prepared now so as to secure privacy and
confidentiality of respondents. The same if the service is to be implemented
else where like in Jema Health centre. In fact the national policy seeks for
the provision of VCT facilities and procurement of VCT commodities such as
laboratory equipment and supplies including reagents for diagnosis and
voluntary testing for HIV61. Since facilities for VCT are currently
limited in the Region and completely inexistent in Kintampo District, special
advocacy efforts should be devoted now to obtaining the support of health
planners at all levels, in both Governmental and Non-Governmental sectors to
allocate resources in their budgets to either rehabilitate existing
laboratories in KDH or build a separate VCT unit , provide VCT materials and
supporting training of qualified personnel towards the implementation of
VCT/HIV PCT service in Kintampo District. Also the implementation of the
VCT/HIV PCT may start at KDH where majority of respondents actually expressed
it to be established, before progressively expanding it later in other places
like in Jema in order to bring the service closer to target groups, depending
on resources available.
5.8. POSSIBLE DECISIONS ON MARRIAGE THAT WOULD-BE
COUPLES ARE MORE LIKELY TO MAKE GIVEN DIFFERENT SCENARIOS OF HIV TEST RESULTS
AND POINT OF VIEW OF RESPONDENTS ON MARRIAGE BETWEEN HIV DISCORDANT WOULD-BE
COUPLESANDHIV
SEROPOSITIVE WOULD-BE COUPLES.
In general, decision on break up of marriage relationship was
strongly prevalent in case of discordant HIV results whereas decisions greatly
diverged when it is about both fiancés testing HIV positive (Figure 12).
This confirms that premarital screening is a major determinant in marriage
choices.69
Our findings support what prevail in Nigeria where calls for
rights of PLWA to marry, although quite significant, still pose problems. In
fact in an article published in April 9th 2003, a journalist wrote
against marriage of PLWA, we quote «However, you will need to
understand that several groups are seriously worried about the spread of
HIV/AIDS in the country. It could be appropriate if we encourage the marriage
of PLWHA to PLWHA, not on the basis of discrimination but to prevent the
further spread of the virus. I therefore think that we all need to observe the
human right not to spread HIV to others if we are infected. Campaigning against
pre-marriage HIV testing is as good as campaigning against the provision of
drugs to PLWHAs.»70
Our findings definitely show there is high popular demand for
HIV PCT among would-be couples, so that young people and their families can
take information on HIV carrier status into account at an earlier stage in the
choice of marriage partner. They also show how denial of marriage right to
PLWA will be a problem which will still enhance stigmatization and
discrimination associated to HIV/AIDS in Kintampo District. Although we
recognize that it is difficult for a person still HIV negative to accept to
marry an HIV infected one, we also recognize that PLWA also have the same right
to marriage as it is recommended by UNAIDS guidelines on the rights of
individuals concerning HIV/AIDS71,72.
What is obvious is that people haven't also understood
availability of PMTCT methods to prevent transmission of the virus from the
mother to the baby. This may explain how few of respondents chose decision to
marry and adopt PMTCT methods in case of discordant couples or HIV infected
couples.
Yet studies have shown that PMTCT (using antiretrovirals &
Cesarean Section, avoiding breastfeeding) and protected sexual intercourse
(permanent condom use) are very effective in limiting further HIV
transmission73, fact that our respondents do not understand well. So
decision on marriage in discordant or HIV infected couples could consist of
marrying and adopting PMTCT or abandoning/limiting childbearing, adoption of
children with permanent condom use, or more sophisticated methods like
artificial insemination73. But our respondents seemed reluctant to
those measures. In FGDs and IDI majority of participants had the conviction
that in actual circumstances it is totally impossible for discordant or HIV
positive couples to permanently perform PMTCT and use condom. And they
suggested that marriage between discordant couples should be rather purely
prohibited (Figure 13). But they seemed agreeing with marriage between both HIV
infected partners, joining the above mentioned view from a Nigerian
Journalist70.
Therefore large campaign of education and sensitization of
young people on Assisted Reproduction in HIV infected people and on
availability of effective preventive measures (PMTCT, permanent condom use)
should also be carried out so that people understand that marriage between
discordant couples or HIV infected couples is still workable.
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