Skip to main content
Log in

Desire for, and Uptake of HIV Tests by Ghanaian Women: The Relevance of Community Level Stigma

  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Voluntary counseling and testing (VCT) has been recognized as the crux of HIV surveillance, prevention and treatment programs. Since 2000, Ghana government has launched a number of HIV prevention and treatment programs intended to increase VCT services. Despite these efforts, uptake of testing is still low, though many women reported interest in getting tested. The disconnect between intention and action is attributable to several factors, including HIV-related stigma. The study used data from the 2003 Ghana Demographic and Health Survey and fitted complementary log-log models to regress women’s desire for and uptake of an HIV test on levels of personal and community stigma. Consistent with findings from previous research, the study revealed significant associations between a number of socio-demographic and socio-cognitive variables and the desire for and uptake of an HIV test by Ghanaian women. Most significantly, the study showed that widespread stigma in the community exert greater negative effects on individuals who endorse stigmatizing beliefs and predispositions, compared to their peers with more favorable attitudes. Since community level educational and risk reduction programs have demonstrable influences on reducing HIV stigma, it is imperative that the Ghana government’s ongoing anti-stigma campaigns and other HIV prevention programs take cognizance of the role of community stigma in influencing HIV testing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. Women who want to be tested are fewer (than those who have ever tested) because women who are HIV-infected (positive) were excluded from the testing intention sample. This is because desire for an HIV test is likely to be considered by those who are not only sexually active, but those who do not yet know their sero-status.

  2. The five indicators are: whether one can reduce risk/chances of getting AIDS by (1) not having sex at all, (2) always using condoms during sex, (3) having one sex partner with no other partner, and whether (4) a healthy person can have AIDS, (5) AIDS is transmitted from mother to child. A varimax factor rotation produced loadings of 0.70–0.90 for these five variables.

References

  1. World Health Organization (WHO). (2007). Guidance on provider-initiated HIV testing and counselling in health facilities (p. 60). Geneva, Switzerland: World Health Organization and Joint United Nations Program on HIV/AIDS.

    Google Scholar 

  2. Ghana Health Service. (2007). HIV sentinel survey 2006 report. Accra, Ghana: National AIDS/STI Control Programme.

    Google Scholar 

  3. World Health Organization. (2007). Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector. Progress report. Switzerland, Geneva: World Health Organization.

    Google Scholar 

  4. Akwara, P. A., et al. (2005). An in-depth analysis of HIV prevalence in Ghana: Further analysis of demographic and health surveys data. Calverton, Maryland, USA: ORC Macro Inc.

    Google Scholar 

  5. Mwamburi, D. M., et al. (2005). Factors associated with wanting to know HIV results in South Africa. AIDS Patient Care STDS, 19(8), 518–525.

    Article  PubMed  Google Scholar 

  6. Bond, L., Lauby, J., & Batson, H. (2005). HIV testing and the role of individual- and structural-level barriers and facilitators. AIDS Care, 17(2), 125–140.

    Article  PubMed  Google Scholar 

  7. Chesney, M. A., & Smith, A. W. (1999). Critical delays in HIV testing and care. American Behavioral Scientist, 42(7), 1162–1174.

    Article  Google Scholar 

  8. Ford, K., et al. (2004). Voluntary HIV testing, disclosure, and stigma among injection drug users in Bali, Indonesia. AIDS Education and Prevention, 16(6), 487–498.

    Article  PubMed  Google Scholar 

  9. Obermeyer, C. M., & Osborn, M. (2007). The utilization of testing and counseling for HIV: A review of the social and behavioral evidence. American Journal of Public Health, 97(10), 1762–1774.

    Article  PubMed  Google Scholar 

  10. Nyblade, L., et al. (2003). Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia (p. 62). Washington, DC: International Center for Research on Women.

    Google Scholar 

  11. Campbell, C., Nair, Y., & Maimane, S. (2006). AIDS stigma, sexual moralities and the policing of women and youth in South Africa. Feminist Review, 83, 132–138.

    Article  Google Scholar 

  12. Kalichman, S. C., & Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections, 79(6), 442–447.

    Article  PubMed  CAS  Google Scholar 

  13. Joint United Nations Programme on HIV/AIDS (UNAIDS). (2002). A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. Geneva, Switzerland: UNAIDS.

    Google Scholar 

  14. Goffman, E. (1963). Stigma: Notes on the management of a spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  15. Sandelowski, M., Lambe, C., & Barroso, J. (2004). Stigma in HIV-positive women. Journal of Nursing Scholarship, 36(2), 122–128.

    Article  PubMed  Google Scholar 

  16. Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57, 13–24.

    Article  PubMed  Google Scholar 

  17. Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41(3), 303–315.

    Article  PubMed  CAS  Google Scholar 

  18. Deacon, H. (2006). Towards a sustainable theory of health-related stigma: Lessons from the HIV/AIDS literature. Journal of Community & Applied Social Psychology, 16(6).

  19. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.

    Article  Google Scholar 

  20. Mill, J. E. (2001). I’m not a “basabasa” woman: An explanatory model of HIV illness in Ghanaian women. Clinical Nursing Research, 10(3), 254–274.

    Article  PubMed  CAS  Google Scholar 

  21. Ulasi, C. I., et al. (2009). HIV/AIDS-related stigma in Kumasi, Ghana. Health Place, 15(1), 255–262.

    Article  PubMed  Google Scholar 

  22. Anarfi, J. K., & Awusabo-Asare, K. (1995). Social dimensions of AIDS infection in Ghana. Stockholm: Swedish Agency for Research and Economic Co-operation with Developing Countries (SAREC).

    Google Scholar 

  23. Ankomah, A. (1998). Condom use in sexual exchange relationships among young single adults in Ghana. AIDS Education and Prevention, 10(4), 303–316.

    PubMed  CAS  Google Scholar 

  24. Nzioka, C. (1996). Lay perceptions of risk of HIV infection and the social construction of safer sex: Some experiences from Kenya. AIDS Care, 8(5), 565–579.

    Article  PubMed  CAS  Google Scholar 

  25. Sambisa, W. (2008). AIDS stigma and uptake of HIV testing in Zimbabwe, in DHS working papers. Macro International Inc & and Carolina Population Center, University of North Carolina at Chapel Hill (p. 66).

  26. Odimegwu, C. O. (2003). Prevalence and predictors of HIV-related stigma and knowledge in Nigeria: Implications for HIV/AIDS prevention initiatives. Boston, Massachusetts: Takemi Program in International Health.

    Google Scholar 

  27. Aggleton, P., et al. (2005). HIV-related stigma, discrimination and human rights violations: Case studies of successful programmes. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS).

    Google Scholar 

  28. Catania, J., Kegeles, S., & Coates, T. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Education Quarterly, 17(1), 121–141.

    Google Scholar 

  29. Babalola, S. (2007). Readiness for HIV testing among young people in northern Nigeria: The roles of social norm and perceived stigma. AIDS and Behavior, 11(5), 759–769.

    Article  PubMed  Google Scholar 

  30. Ghana Statistical Service (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Macro International. (2004). Ghana demographic and health survey 2003. Calverton, Maryland: GSS, NMIMR, and ORC Macro.

  31. Gage, A. J., & Ali, D. (2005). Factors associated with self-reported HIV testing among men in Uganda. AIDS Care, 17(2), 153–165.

    Article  PubMed  CAS  Google Scholar 

  32. Glick, P., & Sahn, D. E. (2007). Changes in HIV/AIDS knowledge and testing behavior in Africa: how much and for whom? Journal of Population Economics, 20(2), 383–422.

    Article  Google Scholar 

  33. Kaufman, C. E., et al. (2004). Communities, opportunities, and adolescents’ sexual behavior in KwaZulu-Natal, South Africa. Studies in Family Planning, 35(4), 261–274.

    Article  PubMed  Google Scholar 

  34. McQuestion, M. J. (2003). Endogenous social effects on intimate partner violence in Colombia. Social Science Research, 32, 335–345.

    Article  Google Scholar 

  35. StataCorp. (2007). Stata statistical software: Release 10. College Station, TX: StataCorp LP.

    Google Scholar 

  36. Long, S. J., & Long, J. F. (2005). Regression models for categorical dependent variables using Stata. College Station, Texas: Stata Press.

    Google Scholar 

  37. Piegorsch, W. W. (1992). Complementary log regression for generalized linear models. The American Statistician, 46(2), 94–99.

    Article  Google Scholar 

  38. Tenkorang, E. Y., & Owusu, G. A. (2010). Correlates of HIV testing among women in Ghana: Some evidence from the Demographic and health surveys. AIDS Care, 22(3), 296–307.

    Article  PubMed  Google Scholar 

  39. Peltzer, K., et al. (2009). Determinants of knowledge of HIV status in South Africa: Results from a population-based HIV survey. BMC Public Health, 9, 174.

    Article  PubMed  Google Scholar 

  40. Downing, M., et al. (2001). Drug users talk about HIV testing: Motivating and deterring factors. AIDS Care, 13, 561–577.

    Article  PubMed  CAS  Google Scholar 

  41. Mbago, M. C. (2004). Socio-demographic correlates of desire for HIV testing in Tanzania. Sex Health, 1(1), 13–21.

    Article  PubMed  Google Scholar 

  42. Vaessen, M., Thiam, M., & Le, T. (2005). The demographic and health surveys. In P. Cheung (Ed.), Household sample surveys in developing and transition and developing countries. United Nations: New York: Department of Economic and Social Affairs.

    Google Scholar 

  43. Hadjipateras, A. (2004). Unraveling the dynamics of HIV/AIDS related stigma and discrimination: The role of community based research. Case studies of northern Uganda and Burundi. London, United Kingdom: Agency for Co-operation and Research in Development.

    Google Scholar 

  44. Brown, L., Macintyre, K., & Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15(1), 49–69.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The author would like to thank Measure DHS for access to Ghana Demographic Health Survey’s unrestricted survey data files (http://www.measuredhs.com/accesssurveys/), which it is authorized to distribute, at no cost, for legitimate academic research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emmanuel F. Koku.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koku, E.F. Desire for, and Uptake of HIV Tests by Ghanaian Women: The Relevance of Community Level Stigma. J Community Health 36, 289–299 (2011). https://doi.org/10.1007/s10900-010-9310-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-010-9310-1

Keywords

Navigation