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

2.2. HIV-AIDS SITUATION IN WEST AFRICA AND GHANA

Since HIV-AIDS is nowadays the common most well known scourge that frightens humanity and that justify for many people the necessity of premarital check-up which is one of the preventive measures to reduce the spread of the infection, most young adults are likely to opt for HIV premarital check-up only because of fear of being married to an HIV seropositive fiancé(e). Therefore it is fair to elucidate in this paper the particular magnitude of this scourge in the region.

4.1.2. 2.2.1. In West Africa

Although varying in scale and intensity, the epidemic in West Africa appears to have stabilized in most countries. Median HIV prevalence measured among women in 112 antenatal clinics in the sub region remained at an average 3% to 4% between 1997 and 2002.³⁷ Overall, HIV prevalence is lowest in the Sahel countries and highest in Burkina Faso, Côte d'Ivoire and Nigeria--the latter having the third-largest number of people living with HIV in the world (after South Africa and India). In the two countries flanking it--Ghana and Benin--HIV prevalence is in the 2% to 4% range with little change noted over time ³⁷.

A variety of factors (economic changes and cooperation, transportation links, periods of instability and war...) experienced across the West African sub region have all contributed to increased mobility and, subsequently, the cross-border spread of HIV in Ghana. ²⁹

4.1.3. 2.2.2. In Ghana

In Ghana HIV prevalence was in the 2% to 4% range (median prevalence of 3.6%) in 2003 ²⁹ versus 0.4% to 7.4% range (median prevalence of 3.1%) in 2004 ³⁸ with little change noted over time ³⁷. By the end of 2003, close to 4 percent (3.6%) of the country's adult population was estimated to be HIV infected. This corresponds to about 395,000 Ghanaians aged 15-49 years, most of who do not even know they carry the virus. HIV prevalence differs from Region to Region, the least being in the Upper West (1.8% in 2003 versus 1.7% in 2004) and the highest in the Eastern Region (6.6% in 2003 versus 6.5% in 2004).

Being among regions with high HIV prevalence, Brong Ahafo Region including Kintampo District recorded a prevalence of 3.6% in 2003 ²⁹ versus 4.5% in 2004 ³⁸ , suggesting an increasing trend of the epidemic in the region.

In Ghana, as in the rest of Africa, two main transmission mechanisms account for most new HIV infections: Heterosexual contact (80%) and mother-to-child transmission `MTCT`(15%). Other mode of contamination through contaminated blood (transfusions, sharing of needles or blades...) account for 5% ²⁹.

Although the probability of transmitting HIV during intercourse can be quite low ³⁹, a number of factors increase the risk of infection dramatically. One is the presence in either partner during unprotected sex of a sexually transmitted infection (STI), such as syphilis or gonorrhea. These diseases cause genital ulcers and sores that facilitate the penetration of the virus during the coitus. The 2003 sentinel surveillance results showed that a significant number of Ghanaian young adults suffer from STIs, and many have multiple sexual partners but don't use condoms to protect themselves ²⁹. It is estimated that most new HIV infections in Ghana are due to heterosexual contact ²⁹. Programmes designed to reduce the spread of HIV should focus on reducing transmission through unsafe sexual contact. HIV Premarital screening meets this strategy.

HIV Premarital examinations will also impact on HIV Mother-To-Child Transmission.

HIV has spread more slowly in Ghana than in many other African countries. For example, in several southern African countries, HIV prevalence among people 15-49 years old is now estimated at more than 15%. No one is quite sure why the epidemic has spread more slowly in Ghana and in some other West African countries. What should be kept in mind is that many eastern and southern African countries had prevalence rates in the late 1980s similar to those currently found in Ghana and that the situation worsened very rapidly ²⁹. All this demonstrates how an unchecked HIV-AIDS epidemic including uncontrolled marriages could still result in much higher increased HIV prevalence levels in Ghana, hence the necessity of preventive measures among which is HIV premarital examination in order to reduce particularly HIV prevalence in new couples and their future offspring. Ghana should not wait until it reaches much higher HIV prevalence to now formalize HIV premarital counseling and testing like it was in Ethiopia ⁴⁰.

The threat of HIV/AIDS and the concern for Africa's future generation were earlier reflected in the 1992 Organization of African Union (OAU) Declaration on AIDS in Africa. It is pertinent to extensively quote a part of this Declaration as quoted by UNDP ⁴¹., thus:

«... The hope of Africa is its younger generation who still has a chance to escape infection, we must seize this opportunity and ensure that today's girls and boys, who will be the mothers and fathers of tomorrow's children, are safe from HIV...»

This declaration strongly implies the necessity of preventive interventions to protect younger African people from the threatening HIV-AIDS infection. In fact more than 7,000 young people are newly infected with HIV each day throughout the world⁴². In Africa alone, an estimated 1.7 million young people are infected annually.^43,44

Some countries including Ghana are now acknowledging the importance of targeting youth in their HIV prevention and care strategies and include VCT and premarital HIV testing for youth in their agenda. Preventing HIV among young people through VCT and HIV PCT is particularly urgent in sub-Saharan Africa, where in many countries young people comprise more than 30 percent of the population and general HIV prevalence rates is often high.⁴⁴ National guidelines for the Republic of Ghana state that it shall «seek to ensure the expansion of the access of young people to youth-friendly facilities and services including HIV and STI (sexually transmitted infection) prevention, management and testing, counseling and the provision of care and support services.»³⁵

In Ghana there is near universal awareness of HIV-AIDS, 98 % among females and 99 % among males in the whole country, the level of awareness of HIV-AIDS in Brong Ahafo Region (Kintampo District included) being 99.5% and 100% respectively in women and men. However, risk perception is still low: about one-third of the population believes they are not personally vulnerable to HIV infection. ^29,53 This high HIV awareness rate is a strong opportunity upon which prevention programs could be based.