Chapter Six
CONCLUSION AND RECOMMENDATIONS
We have now come to the end of the study. The main objective
of the study was to generate useful information on current level of knowledge
and perceptions of unmarried young adults towards HIV PCT in order to predict
their acceptance and behaviors towards utilization of such services and to
deduce appropriate program/policy for intervention in the relevant area. The
qualitative and quantitative methods adopted in the study contributed to
respond to our research questions, to verify our conceptual framework and to
achieve the main and specific objectives of the study.
Findings drawn from 150 surveyed unmarried young adults in the
3 sub-districts targeted for the study proved sufficiently the attainment of
our study objectives.
The study findings show that 97% of respondents have good
knowledge and 100% of them have adequate positive perception towards HIV PCT.
Majority of unmarried young adults express the need of HIV PCT service (99.3%)
and show positive acceptance and willingness (98%) towards utilization of such
service in Kintampo District. There is positive linear relationship between
score of knowledge and of perception on HIV PCT with positive perception even
among people with poor knowledge. Thus little or average knowledge on HIV
PCT is enough to still create a very strong positive perception towards HIV PCT
among unmarried young adults.
Willingness to undergo HIV PCT is strongly positively
associated with readiness of a respondent to know and accept his/her HIV result
and negatively associated with age, post-primary education, being a student and
premarital sex. Akan and Mo ethnic groups showed greater preference for HIV
PCT.
Majority of the targeted group show greater preference towards
HIV VCT for marital reason.
Respondents recognize there are some barriers to HIV PCT and
suggest several activities in order to deal with those barriers and make HIV
PCT more effective.
Majority of respondents show disapproval of marriage between
HIV discordant and HIV seropositive couples and presume that they would break
marriage relationship in case of HIV positive results during HIV PCT
session.
Not all populations of unmarried young groups in Kintampo
have an equal likelihood of perceiving the need of HIV PCT service and of
accepting HIV PCT. Therefore Public health intervention (BCC/IEC) in the
district on HIV PCT implementation and promotion should be tailored
specifically for each target group. A policy document is needed to specify the
scope and procedures of premarital examinations in light of the findings in
this study.
Based on the study findings, for the VCT /HIV PCT service to
be successfully implemented, we recommend the following:
A. At the National/Regional level:
1.Since the lack of specific law was stressed as one of
barriers to HIV PCT in Ghana, a specific law and policy document on premarital
examination should be elaborated in light of the findings in order to make
easier the implementation of HIV PCT services.
2. Since the study showed a low rate of awareness acquired on
HIV PCT through mass media and religious bodies, the use of Mass Media and
Religious Institutions in awareness creation on HIV PCT should be enhanced and
coordinated on a regular basis.
3. Given the fact the study showed a very high premarital sex
rate among unmarried adults (66%), considering that participants in IDI and
FGDs also mentioned premarital sex as a core barrier to HIV PCT promotion in
the area, since those who have had sex were less likely to go for test because
they fear they might have been HIV infected, we recommend that:
a) A certain number of measures, such as sex education,
adolescent counseling, creation of virgin clubs, parent's implication in sex
education, reduction of poverty and of illiteracy.., should be put in place
nationwide in order to prevent and reduce the high rate of premarital sex among
young adults.
b) Because pornographic films were recognized as factors
pushing young adults to engage in premarital sex in Kintampo, all cinema
centres where projections of pornographic films take place should be closed in
Ghana in general and in Brong Ahafo Region in particular.
4. Considering the fact that education and awareness creation
on HIV/AIDS is still lacking among some unmarried young adults, promotion of
peer education, including persons/unmarried young adults living with AIDS
should be carried out in order to break up gaps of knowledge on HIV/AIDS and
HIV PCT revealed through this study.
5. Concerning the question whether HIV PCT should be
compulsory or optional, we recommend that the national and regional health
authorities and legislators should put all views together in order to make a
holistic representative and acceptable policy that protect each individual and
the community. Long term education and sensitization campaign and programs are
crucial to make sure HIV PCT later becomes a spontaneous «routine
screening» with the full and straight commitment and
understanding of communities and the target groups.
6. Given similarities in adequate positive perception towards
HIV PCT among respondents of low and high level of knowledge on HIV PCT, we
recommend that the development of BCC and IEC materials and messages aiming at
promoting HIV PCT should be based on participatory methods and research
evidence-based data, leading to segmentation of the audience and to the
production of appropriate messages and materials for different target groups
according to their need of knowledge to appropriately fill specific identified
gaps.
7. Considering the crucial need of confidentiality in VCT and
HIV PCT service mentioned by respondents, we recommend that national health
authorities and the national AIDS control program should ensure that the
personnel (counselors, lab technicians...) are adequately well trained to
maintain confidentiality so that people patronize the service without fear of
lack of confidentiality.
8. Considering the finding that majority of unmarried young
adults (77%) exclusively prefer HIV PCT than Voluntary
testing, we recommend that for VCT service to be patronized very well, HIV PCT
must be implemented and promoted as well so that unmarried young adults could
come for it when they are about to enter into marriage.
B. At the District level:
1. Since it was found that only 31.9% of respondents heard
about HIV PCT through health workers, we recommend that the District should
incorporate HIV PCT among the top IEC/BCC messages in the fight against
HIV/AIDS and multiply IEC/BCC sessions on HIV PCT by Health Workers using
in-service health education of patients or through local mass media (FM
stations, TV, newspapers...).
2. Because the study showed the involvement of schools in
informing young people about HIV PCT seems still very low (29.2%), we recommend
that special programs on HIV PCT should be introduced and intensified in
schools in Kintampo District.
3. Given the high perception of HIV PCT as a social norm
(98.7%), the high perceived need of HIV PCT services (99.3%), the high rate of
willingness (98%) to undergo HIV PCT and the high rate of readiness (96.7%)
of respondents to know and accept their HIV test results after a PCT session,
considering that data from KDH show a timid starting of the service in an
embryonic stage where by now few would-be couples are coming irregularly for
HIV PCT, also knowing that 86% of respondents had a higher probability
(>0.75) of perceiving the need of HIV PCT service in Kintampo and of
willingness to undergo HIV PCT, we recommend that a VCT/HIV PCT service should
be officially implemented in Kintampo District in due course in order to
respond to the need expressed by the beneficiaries of such service still
lacking in the area. Resources should be allocated to the preparation of
infrastructures, equipment, laboratory reagents and for training activities
prior to the launching of such service.
4. Considering the major role of Religious bodies in promoting
HIV PCT, given the fact that majority of would-be couples who came for HIV PCT
so far were counseled by their Churches, we recommend that the District health
authorities should coordinate and train counselors from religious institutions
since their involvement is crucial in managing marriages.
5. Given the fact that results showed we could strongly
predict the willingness of a respondent to undergo HIV PCT from his/her
readiness to know and accept his/her HIV Result, we recommend that if the
service is to be implemented in Kintampo, many sessions of sensitization and
anticipated pre-counseling among the target groups should be continuously
carried out in order to dissipate, through specific and appropriate BCC
messages, the anxiety and the fear clients manifest to know their HIV test
results.
6. In view of many barriers to HIV PCT acceptance and
implementation invoked by respondents in this study, we recommend in priority
that district authorities should address major and moderate barriers one by
one, step by step, or even holistically, in order to guarantee smooth
implementation and take-off of VCT and HIV PCT service in the area.
7 Due to the need of promoting HIV PCT among unmarried young
adults, we suggest that District authorities address properly, in order of
priority, all measures mentioned by respondents and summarized in Figure 14 in
order to promote HIV PCT in Kintampo District. The District should imperatively
collaborate with local religious bodies in order to achieve that.
8. Because 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, we suggest that district authorities should examine the
possibilities of implementing a free VCT/HIV PCT service through donor
intervention in order to make HIV PCT services accessible to beneficiaries.
9. In order to make HIV PCT more effective,
acceptable and attractive for young people in Kintampo district , district
authorities should apply, in priority order, measures that respondents
suggested and summarized in Figure 15 for VCT/HIV PCT service to be successful
once implemented. Here again we suggest the district health authorities should
imperatively collaborate with local religious bodies in order to achieve
that.
10. Since majority of respondents suggested HIV PCT services
should be established in Kintampo District Hospital (KDH) whilst majority of
respondents from Jema Sub-district rather chose Jema Health centre, we
recommend that the service should be established first in KDH in the
implantation phase. However district authorities should later on assess the
possibility of extending the service in Jema Health centre or even elsewhere in
order to bring the service closer to beneficiaries.
11. Since our inquiry revealed a big lack of official
statistics of marriages in Kintampo District Court although marriages occur
regularly in local religious Institutions, we recommend that local
administrative, judiciary, religion leaders and health authorities examine the
problem in order to reactivate marriage registration in the area.
12. Finally given all information generated in this study, we
recommend that district health authorities make some of the findings useful in
policy-making towards a successful VCT and HIV PCT service in Kintampo
District.
C. At the community level:
1. Since majority of respondents suggested HIV PCT should be
considered as one of current social norms, all community leaders should make
HIV PCT as part of marriage norms.
2. Due to the window period, we recommend that the HIV PCT
should be done at least twice in all communities, with 3 months interval
between the two tests, as a large part of our respondents also suggested it.
Given the lack of knowledge some respondents showed on required frequency of
HIV PCT before marriage, we suggest that the District should target this issue
in awareness creation campaigns. During their counseling sessions, Religious
bodies should orient would-be couples on the required number of tests before
marriage.
3. 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, we recommend that, even if a couple decides
voluntarily to undergo the test, a third neutral body within the community,
whether religious or not, medical or not, counselor or not, should 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.
4. Since our findings 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 due to lower
understanding of -use of Assisted Reproduction in HIV infected
Individuals/couples, -use of available protective measures (PMTCT, permanent
condom use) and -adoption of children, large campaign of education and
sensitization of young people and the community on these measures should
intensively be carried out by the district health team, religion bodies and
others NGO involved so that people understand that marriage between discordant
couples or HIV infected couples is possible and workable.
D. At the household level:
1. Since the study showed a very high premarital sex rate
among respondents, parents should educate their young children on sexual
matters, specifically on how to abstain from sex before getting married.
2. Given that it was shown is the study that not all parents
educate their children on HIV PCT, parents should educate their adolescents and
young adults so that they may undergo HIV PCT as a routine examination before
getting married.
E. At individual level:
1. Given the approved importance of HIV PCT, each unmarried
young adult should consider the practice of HIV PCT as an integral part of
marriage preparation and process.
F. To Researchers:
1. Since it was found that Akan respondents were more
knowledgeable on HIV PCT than respondents of the Mo ethnic group, we recommend
that a further study should be carried out in order to deeply research into
this to determine the why of this knowledge discrepancy between these two
ethnic groups.
2. Several other studies should be planned based on the gaps
the current study did not explore.
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