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

I.2. STATEMENT OF PROBLEM

Although recommended by UNAIDS/WHO ^10,11,44 , HIV Premarital counseling and testing (PCT) is not yet implemented in Kintampo, leading to uncontrolled marriages with risk of spreading HIV infection in new couples and their offspring. This stands true since in Brong Ahafo Region, including Kintampo District, the HIV/AIDS prevalence is reported to be of 3.6% in 2003 and of 4.5% in 2004, the most affected group being females and adults aged 15-49 years, with the peak ages of 25-39 years.^29,38 Therefore given the high HIV prevalence among young people, the probability for a unmarried young adult to come across a HIV infected fiancé(e) is considerable.

Furthermore, estimations and projections of HIV-AIDS prevalence and mortality suggest that marriages between HIV-AIDS discordant couples and HIV-AIDS seropositive couples in a society could result, within decades, in decimation of generations by early deaths of HIV infected parents and children if adequate HIV preventive and precautionary measures are not taken appropriately ^8,10. This means that policy makers and all bodies who are involved in marriage celebration and legalization, such as political and health authorities, lawyers, registrars, traditional chiefs and religious leaders; have a big responsibility in managing marriage matters and defining regulations and procedures related to the quality control of marriage. In fact like birth control is needed in all developed society, quality control of marriage is also necessary in order to ensure that marriage is safe to both partners, their offspring and the whole nation. In this purpose WHO/UNAIDS recommend HIV premarital counseling and testing in order to prevent the spread of the disease in new couples and their children ^10,11,42. That is why some churches in Ghana and in Kintampo are currently conducting sometimes HIV premarital testing in would-be couples.

Therefore policy makers should make sure that there are clear policies that include not only all requirements needed before marriage but also and especially restricting and limiting rules against unsafe marriages. In Ghana as yet there is no specific law that regulates premarital examinations. Yet Ghanaian people still need this service and some churches are currently allowing would-be couples to undergo HIV premarital examination on either compulsory or voluntary basis. In this context, HIV premarital counseling and testing is offered without any detailed regulatory law/policy. Meanwhile many are those marriages that continue to occur without any HIV premarital check-ups, putting at HIV risk partners and their offspring. That is why VCT, including HIV premarital counseling and testing, is recognized nationwide among current strategies in the national framework to limit the spread of the disease in Ghana ³⁵. For this purpose a VCT service is planned to be implemented in Kintampo.

Since the HIV premarital testing will be incorporated in VCT service in Kintampo, the research questions we ask ourselves are the following:

· Do unmarried young adults in Kintampo really perceive and express the need of HIV premarital counseling and testing program in Kintampo and what are factors associated with the perception of this need?

· How far do young people in Kintampo know about HIV premarital examinations and what are their perceptions towards premarital counseling and testing?

· What are the factors that influence the willingness of young people towards HIV premarital counseling and testing?

· Is HIV premarital examination really a core way to catch young adults to VCT in Kintampo District as it can be inferred from the findings in the previous study?³²

· What are some barriers against the acceptability and the institutionalization of HIV premarital examination in VCT services in Kintampo?

· What key suggestions would unmarried young adults make towards a very effective, operational, attractive, acceptable and accessible HIV PCT program in Kintampo?

· What are the points of view of unmarried young adults on marriage between HIV discordant or HIV seropositive couples and what possible decisions on marriage are they likely to make in regard to HIV positive test results?

· What kind of programmes should be carried out in order to promote HIV premarital counseling and testing in Kintampo district?

Hopefully the study attempts to answer those questions as clearly as possible.

Poor public knowledge on HIV PCT?

Bad perception towards

HIV PCT?

Low perceived need for HIV premarital screening services

HIV Premarital examinations not accepted by the community of Kintampo District

Unwillingness of would-be couples to undergo HIV PCT

Premarital HIV counselling and testing (PCT) not yet implemented in Kintampo

Lack of VCT/PCT facilities

Inexistence of Law/Policy conducive to HIV premarital examinations in the District and Ghana?

Poor utilization of VCT services in KINTAMPO District

Inadequate control of spread of HIV-AIDS in new couples/families

Barriers against

HIV PCT

Little solution for those HIV infected

Lack of trained personnel & counselors

Source: The researcher

I.3. CONCEPTUAL FRAMEWORK: PROBLEM ANALYSIS DIAGRAM (Diagram 1)

Intervention A: As in the previous study majority of people said not every body can go for VCT unless he/she is about to enter into marriage in order to decide whether to marry or have children³², we assume that full implementation of HIV premarital health care in VCT package will be a potential way to catch young people for VCT, thereby enhancing the patronization of VCT service in Kintampo by would-be couples.

Intervention A