Although the adult prevalence of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) is currently much lower in Ghana (2.2%) than in most other African countries, the disease has become firmly established within the general population and shows no sign of stabilizing.1
By June 2002, Ghana had recorded a total of 58,013 HIV/AIDS cases since 1986 and greater than 90% were in the 15–49 age group.2
Currently, it is estimated that 320,000 Ghanaians are living with HIV/AIDS.3
Heterosexual transmission is the dominant route of HIV infection and accounts for 80% of new infections.4–6
Of the cumulative AIDS cases recorded in the country, 64% are females, while 36% are males.4,6
Approximately 40% of pregnant women in Africa are infected with HIV4
and without antiretroviral intervention, 21%–43% transmit the infection to their babies during pregnancy, labour and delivery.7–8
Over 90% of the 1.1million children less than 15 years living with HIV in sub-Saharan Africa by the end of 2000 acquired the infection from their mothers.9
Mother-to-child transmission (MTCT) is the second most important route of HIV transmission in sub-Saharan Africa.
Voluntary counselling and testing (VCT) has been identified as an effective tool in reducing HIV transmission.10
It has been shown to provide behaviour change and emotional support for those who test positive for HIV11
and to be feasible and acceptable in reducing perinatal transmission of the virus.12
VCT, supported with pre- and postnatal antiretroviral therapy (ART) of HIV positive women and their infants, and appropriate infant feeding are effective in reducing MTCT of HIV.13,14
Studies show that in many African settings, pregnant women will accept VCT if it is offered. The median acceptance rate of VCT in these studies was 69% (range 33%–95%).15,16
Acceptance of VCT has been found to be conditionally based on benefits such as availability of antiretroviral drugs and infant feeding counselling.17
In contrast to a study conducted in France, the reasons for VCT acceptability in African countries were not based on social and public advocacy but on the confidence that the women held in the health care workers.
In many African countries, pregnant women are accustomed to following the advice of their health care workers.17
Unfortunately, in some settings, VCT is offered but is refused by women due to social and cultural stigmas attached to HIV. This prevents treatment intervention for the unborn child.18
In Africa, these include fear of stigmatization, divorce and fear of losing confidentiality19
, limited decision making power by women 20
, and fear of discrimination during delivery, separation from spouse, and domestic violence.21
We conducted this study to assess acceptance or refusal of VCT for HIV (and ART if positive) among pregnant women in Kumasi in two different eras, namely, before and after the introduction of VCT and ART intervention in antenatal clinics in the region. In the first study, women who were willing to accept HIV testing after counselling were tested. We also collected and analyzed data on the reasons for acceptance or refusal of VCT by the women in order to understand the factors related to acceptance of VCT and ART. This is essential in overcoming barriers that prevent success of MTCT prevention intervention.