Living with AIDS: perceptions, attitudes and post-diagnosis behaviour of HIV/AIDS patients in Ghana

AIDS infection has created a fear of stigmatization, isolation and panic among infected persons. There are, however, few studies that explore the perceptions and attitudes of HIV/AIDS patients in sub-Saharan Africa, partly because of the isolation and withdrawal of patients. Using data from a study on the social dimensions of AIDS infection in Ghana, this paper explores the attitudes and behaviour of patients and their perception of the attitudes of their relations and neighbours towards them. The traditional forms of support for sick persons in Ghana are under strain either due to or independent of HIV infection. In spite of changes, infected persons perceive their female relatives to be more sympathetic than their male relatves. Some patients continue to deny to themselves their HIV status. These findings have implications for programming as the disease enters its second decade

HIV/AIDS education and counselling: experiences from Ghana

The emergence of HIV/AIDS in sub-Saharan Africa presents a challenge not only to public health paradigms but also models for public health education. Although the nature and spread of the disease have common features with a number of known diseases, the initial reactions to the disease have contributed to produce what Jeanneney (1987) refers to as 'a collective emotional hysteria' characteristic of the debate on syphilis in the early part of the twentieth century. Fear and ignorance associated with the hysteria have led to various reactions such as panic, scapegoating, stigmatization and denial (Jeanneney 1987; Awusabo-Asare and Agyeman 1993). As with some previous epidemics, the strategy has been to make factual and understandable information accessible to people (Carballo and Kenya 1994). The basic philosophy is that people should not die from ignorance. For sub-Saharan Africa, some of the pertinent questions are: how do we provide culturally relevant and socially acceptable information within the existing socio-economic constraints? Given the high illiteracy rate how should information be presented so as to reach as many people as possible? How should audience segmentation be approached in view of the limited resources available for educational campaigns on HIV infection? What are some of the socio-cultural constraints to the counselling of AIDS patients and their relations? The aim of this paper is to describe some of the approaches adopted in three settings in Ghana to provide community education and counselling for communities, patients and their relatives on HIV/AIDS infection. The three areas are Berekum District of Brong-Ahafo Region, Manya and Yilo Krobo Districts of Eastern Region and Assin District of Central Region (Figure 1). The services are operated from the Berekum Holy Family Hospital, the Agomanya Saint Martin de Porres clinic and the Assin Fosu Saint Francis Xavier Hospital. All three hospitals belong to the Catholic Church

Estimating fertility and childhood mortality for the western region of Ghana from pregnancy history data

This study basically aims at estimating fertility and childhood mortality rates for a rural community in the Western Region of Ghana using the pregnancy history method. The method was found to have a few advantages over other indirect methods used for estimating fertility and childhood mortality. However, pregnancy history data suffer from under-reporting, event misplacement and age mis-statement errors; and these off-set some of the advantages of the method. The observed rates from the study area gave an implausible impression of a rise and fall in fertility and childhood mortality in the last 15 years preceding the survey. This feature is believed to be associated with event misplacement errors. The reported data was smoothed using the moving average procedure. Age-specific fertility rates among younger women were found to be declining in the last 10 years preceding the survey; and this was believed to be related to the impact of formal education. Fertility in the area was high and constant over the the last 15 years prior to the survey. Total fertility rate for the last 5 years was estimated to be about 6.1 per female. Childhood mortality was under-reported by about 20 per cent. And the infant mortality rates obtained were considered to be implausible as a result of event misplacement and under-reporting errors. In general, both the infant and childhood mortality [q(5)] rates are high but declining. However, the rate of decling could not be categorically stated as a result of errors in the data

Attitudes to and management of HIV/AIDS among health workers in Ghana: the case of Cape Coast municipality

Health Care Workers as key players in the prevention and management of diseases and important opinion and community leaders have become targets for studies, more so with the outbreak of HIV. Their perceptions, attitudes and practices have implications for the management of diseases in both health centres and communities. This study reports some of the results of in-depth interviews with Health Care Workers in the Cape Coast municipality (Ghana) on their perception of risk of exposure to HIV, attitudes to known persons with HIV/AIDS, counselling and confidentiality. Results indicate a general fear of infection given the working environment and conditions such as the insufficient supply of basic items, and inadequate information on the sero-status of some patients. Although aware of the basic precautions needed to avoid infection, some health workers did not follow them. There was also a lack of consensus among them on the issues of confidentiality and responsibility towards a discordant partner. The main arguments were those of the general debate between safeguarding individual rights and protecting the common good. It is important for the medical establishment to debate the issue so that the rights of some individuals are not compromised

Experimental research on sexual networking in some selected areas of Ghana

Despite increasing evidence that West Africa is at a critical stage in its experience of the AIDS pandemic, there is a lack of specific information about the sexual behaviour of people in the society. To provide such information, 360 individuals were surveyed. Results indicate that the nature of sexual contacts within Ghanaian society has the potential to promote the spread of STDs and AIDS. Polygyny, central in Ghanaian socio-cultural organization, underlies the male tendency to seek multiple sexual partners. Early widowhood, the general instability of marriage and the high level of remarriage, also suggest that there is a high level of sexual networking within the society. Although Ghanaian society accepts sexual networking, and some people are even casual about the AIDS scare, it appears that people are changing their sexual habits in response to the campaign on AIDS, which seems to have succeeded in instilling fear

Postpartum sexual abstinence in the era of AIDS in Ghana: prospects for change

Postpartum sexual abstinence for females has been identified as one of the socio-cultural factors with the potential for creating conditions for the sexual spread of HIV in areas where it is practised. In general, women are expected to abstain from sex after childbirth in order to ensure the survival of the mother and child. Men are not similarly expected to abstain and that has been used to rationalize polygyny. With changes in socio-economic conditions making it more difficult now than before to maintain two or more wives, particularly in urban areas, some men will abstain like their wives for fear of HIV infection; but such men may press their wives to resume sex early. Some women, on the other hand, may give in to the demands of their husbands by reducing the prescribed duration of postpartum abstinence. If this happens without the use of effective modern contraception, fertility may be affected. Some may also enter short or long-term relationships outside marriage, hoping that they will be safe from sexually transmitted infection. Using data from the Ghana segment of the Social Dimensions of AIDS Infection Survey, the study examines the responses of women who reported postpartum sexual abstinence and that of their partners. Both men and women reported abstaining, but some women were aware that their partners did not abstain as they did. Some of the women knew the sexual partners of their partners. Mostly it was men who made the first move to resume sex. For any behavioural change to occur, attitudes towards socially-constructed practices such as postpartum sexual abstinence will need to be changed by intensive education of both men and women and also through community support

Demographic Data for Development: Ghana

The attempts of African countries to develop their economies and to democratize their political systems have led to a renewed interest in the use of demographic and socioeconomic data for decision-making and planning. This new direction calls for clear, timely, reliable, and relevant data. At the international level, initiatives such as the African Charter on Statistics, PARIS 21, and the Health Metrics Network have emerged to provide direction and technical support for strengthening initiatives and activities that harmonize measures and improve data collection processes. This report on Ghana is part of a four-country study involving Ethiopia, Ghana, Senegal, and Uganda. The countries were chosen based on their upcoming censuses, identified statistical capacities, active engagement in the production of data, and participation in many of the international data initiatives. The main aim of the case studies is to provide a broad picture of the demand for and access to data, quality of available data, and the perceived supply of demographic data among policymakers and other stakeholders

Livelihood and the risk of HIV/AIDS infection in Ghana: the case of female itinerant traders

Itinerant trading is the second major economic activity for women who constitute an important chain in the distribution of goods in West Africa. Historically they have played important roles in the political economy of Ghana. With the outbreak of AIDS these women, some of whom move far away from home sometimes for days or even weeks, stand the risk of being infected with HIV through their activities. Using a combination of methods including a survey, focus-group discussions and conversations with key informants, we examine how the trade is organized, the characteristics of the traders, and the risk factors that are likely to predispose them to contracting the AIDS virus. Itinerant women traders appear highly vulnerable, as women and as highly mobile people. This state of affairs, occasioned by the extremely difficult conditions in which the women work, is exploited for the sexual gratification of the men with whom they come into contact. The attempt to reduce the spread of AIDs through education has to target itinerant women traders at the points of transaction

Determinants of unintended pregnancies in rural Ghana.

BACKGROUND: Unintended pregnancies may carry serious consequences for women and their families, including the possibility of unsafe abortion, delayed prenatal care, poor maternal mental health and poor child health outcomes. Although between 1993 and 2008, unintended births decreased from 42% to 37% in Ghana, the rate of decline is low, whilst levels are still very high. This raises the need to understand factors associated with unintended pregnancies, especially among women in rural settings where the rates and risks are highest to help improve maternal health. METHOD: We collected data from 1,914 pregnant women attending antenatal clinic between January 2012 and April 2012 in four health facilities in the Mfantseman Municipal of the Central Region of Ghana. We used bivariate and multivariate logistic regression analyses to explore how socio-demographic characteristics, past reproductive health experiences, partner characteristics and relations, awareness and past experience with contraceptives, influenced the status of women's current pregnancy (whether intended or unintended). RESULTS: The mean age of the 1,914 respondents in this study was 25.6 ± 6.5 years. Seventy percent (70%) said the pregnancies they were carrying were unintended. The odds of carrying unintended pregnancy among women with five or more children were higher than those with one to two children [AOR 6.06, 95% CI (3.24-11.38) versus AOR 1.48, 95% CI (1.14-1.93)]. Women with other marital arrangements showed significantly higher odds of carrying unintended pregnancy compared to those married by ordinance (Muslim or Christian wedding). Women not living with their partners exhibited increased odds of having unintended pregnancies compared to women who lived with their partners (AOR 1.72, 95% CI: 1.28 - 2.30). Awareness of traditional methods of family planning (withdrawal and rhythm) was associated with lower odds of having unintended pregnancy compared to non-awareness (AOR 0.66, 95% CI (0.49-0.89). CONCLUSIONS: In this study, important risk factors associated with unintended pregnancies were: parity, living arrangements with partner, marriage by ordinance and awareness of traditional, non-pharmacological contraceptive methods. Family planning interventions targeting different groups of women, especially during the postpartum period, would be essential to reduce rates of unintended pregnancies and promote positive health outcomes

Sex composition of living children in a matrilineal inheritance system and its association with pregnancy intendedness and postpartum family planning intentions in rural Ghana.

BACKGROUND: Sex composition of living children within the context of "sex preference" and its association with various reproductive health outcomes has been extensively studied in South and South East Asia. Although sex preference has been observed in sub-Saharan Africa, there is paucity of research on sex composition of living children and its association with reproductive health behaviours and outcomes, particularly in a matrilineal inheritance system. The purpose of the study was to explore the existence of sex preference in a matrilineal inheritance system. Specifically, the study sought to better understand the issues by examining the sex composition of living children and how it is associated with reproductive outcomes such as pregnancy intendedness and intention to use postpartum family planning among women in a matrilineal area of Ghana. METHODS: This was a cross sectional study conducted at four selected health facilities in the Mfantseman municipality of the Central Region of Ghana. Out of the 1914 pregnant women attending antenatal clinic selected using total enumeration, from 2nd January to 30th April 2012, 1091 with living children and complete socio-demographic data were recruited for this study. Descriptive, chi square and multivariate logistic regression analyses were conducted. RESULTS: The mean age of the 1091 respondents in this study was 28.2 ± 6.0 years with mean gestational age of 26.7 ± 6.6 weeks. Whilst 78% of the women had at least a son, 71% had at least a daughter, with those having only sons exceeding those with only daughters by 6.3%. Also, majority of the women with more sons than daughters did not intend their current pregnancies. These observations, coupled with a sex ratio of 109 males to 100 females, inferred the existence of son preference. The levels of unintended pregnancy and intention to use postpartum family planning were high (70% and 78% respectively). There was an association between sex composition of living children and unintended pregnancy but no association between sex composition of living children and intention to use postpartum family planning. Women with only sons were 50% less likely to have unintended pregnancies compared to those with equal number of sons and daughters [AOR 0.5, 95% CI (0.3-0.8)]. Similarly, women over 30 years were 80% less likely to have unintended pregnancies compared to those 15-19 years [AOR 0.2, 95% CI (0.1-0.6)]. The women with parity of 5 or more and resident in Anomabo were more likely to have unintended pregnancy compared to those with parity of up to two [AOR 3.8, 95% CI (1.7-8.59)] and those resident in Saltpond [AOR 1.8, 95%CI (1.1-2.8), respectively. In addition, the women resident in Anomabo were more likely to have intention to use postpartum family planning compared to those in Saltpond [AOR 1.8, 95% CI (1.0-3.3)]. CONCLUSION: There was persistence of more sons than daughters born in a predominantly matrilineal inheritance system and sex composition of living children had significant association with pregnancy intendedness but not with intention to use postpartum family planning