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

Chapter One

INTRODUCTION

I.1. BACKGROUND INFORMATION

1.1.1. MARRIAGE AND ITS REPRODUCTIVE HEALTH IMPLICATION

Legal relationship between a husband and a wife ^{1, 2, 3}, marriage can maintain good sexual reproductive health if it is safe or rather create ill-sexual reproductive health in couples, if it is unsafe.⁴ In fact a marriage may be legal-and miserable; religious-and diseased. This is partly due to the colossal ignorance of the public in regard to sex and health implication of marriage, and partly due to the fact that marriage is mainly controlled by lawyers and priests or pastors- most of who take no regard for the health status of would-be couples and their offspring- than by would-be couples themselves and medical doctors.⁴ Health aspects related to marriage union require enlightened interventions from health policy-makers and practitioners to ensure that marriage is safe for both partners and their offspring, that it is not leading them to some diseases.⁴ In fact marriage union can expose to several diseases such as STI including HIV-AIDS, genetic diseases (such as sickle cell anemia or thalassemia in children), rhesus incompatibility, among others ^4,5,6,7,8. According to WHO, «safe sex is a consensual sexual contact with a partner who is not infected with any sexually transmitted pathogens and involving the use of appropriate contraceptive measures to prevent pregnancy unless the couple is intentionally attempting to have a child» ^7,9.

In her book in early 1922, Ettie A. Rout⁴ recognized venereal diseases as the chief obstacle to safe (healthy) marriage, fact that is still true and even far true nowadays with the incurable HIV-AIDS which has come to endanger further the humanity. Therefore one of the main means recommended by WHO to promote sexual reproductive health and safe marriage in new couples is prior medical control of marriage in paying close attention and care about the health status of would-be couples as a prerequisite to pass through before the official celebration of marriage. ^{3, 4, 5, 6} Indeed most STIs/HIV-AIDS transmission in new couples and their offspring could be avoided by strict adherence to safe marriage practices through prenuptial medical counseling and testing of would-be couples¹⁰. That is why, according to WHO, a number of countries require individuals who are about to enter into marriage to undergo an examination designed to confirm or infirm the absence of specific diseases, including those transmitted sexually such as HIV-AIDS and that if evidence of an infectious disease is found, the marriage cannot be contracted until the affected would-be couple has undergone treatment and is no longer infective ¹¹.

One of the countries where premarital examination and counseling is regular is China where law on premarital examination legally requires every Chinese man and woman planning to get married to undergo a medical check -up before they tie the knot. ^12,13

1.1.2. SCOPE AND OBJECTIVES OF PREMARITAL SCREENING

Pre-marital screening is a comprehensive group of tests specially designed for those who are planning to get married ¹⁴. Generally, premarital check-up is broadly designed to detect many types of diseases or health-related problems in would-be couples and when possible to take preventive or therapeutic intervention and/or provide appropriate counseling to help them decide. The main specific objectives of premarital examination commonly recommended and that medical practitioners are called to carry out in would-be couples, not exhaustively nor exclusively, are as follows:

1) To assess the copulation ability of would-be couples ^5,14,15

2) To assess the fertility or fecundability ability of would-be couples ^5,14,15,16

3) To detect Sexually Transmitted Infections (STIs), including HIV/AIDS among would-be couples ^{2,3,5,11,14,15,17,18}.

4) To detect the possibility of blood incompatibility reactions between would-be couples, mainly negative rhesus factor in women when the would-be husband is rhesus positive ^{3,6,14,15,19,20,21,22}.

5) To detect genetic diseases in would-be couples susceptible to be hereditarily transmitted to children, e.g. sickle cell anemia, Thalassemia... ^{3,5,7,14,15,21,23,24}.

6) To detect diseases or factors in would-be couples susceptible to cause congenital abnormalities or serious pathologies to children, e.g. Toxoplasmosis,

Rubella... ^{5,6,7,12,13,14,15,16,18,21,23}.

7) To detect chronic diseases in would-be couples that can destabilize life in family, such as diabetes mellitus, cardiac diseases, mental deficiency etc ^5,6,14,15,21.

8) To establish a pre gestational health status baseline as part of the engaged woman (would-be mother)'s health profile, determining in advance her obstetrical prognosis and assess her readiness for child bearing ^{6,13,14,15,18,20,22,25}.

9) To verify whether or not there is an ongoing unknown/hidden and illegitimate premarital pregnancy in engaged woman ²⁶.

10) To give counseling and health education on safe sexuality and family planning ²⁷.

11) To exceptionally conduct vaccination for some Preventable Disease, such as Hepatitis B and Rubella vaccine ^15,27. This is rarely done.

12) Finally, most controversially, premarital examination in some part of the world , particularly in China, also routinely aims to verify whether or not a woman's hymen is still intact, even though doctors say that it is not a reliable guide to virginity ¹².

These objectives demonstrate how complex and vast the scope of premarital examination is and how it can vary from a country to another depending on the prevailing burden of diseases or health-related problems generated from marriage and on the national strategies chosen to address them.

For academic purpose and due to time and financial constraints this study will deal only with premarital check-up on HIV-AIDS. This is because a VCT service is planned to be implemented in Kintampo District in the near future²⁸. Thus this preliminary study aims to unveil the knowledge and perceptions of unmarried young adults on Premarital HIV VCT and to provide useful information to policy-makers and health authorities for appropriate methods and strategies to promote premarital HIV counseling and testing in Kintampo.