COMMUNITY HEALTH NURSING TRAINING COLLEGE

AKIM ODA

A RESEARCH PROJECT

ON

ASSESSING THE UPTAKE OF HIV TESTING AND COUNSELLING

AMONG THE YOUTH IN AKIM ASENE TOWN

ON

SEPTEMBER, 2023

ABSTRACT

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As an effective vaccine and cure for HIV is absent, testing and counseling for HIV remains an

essential intervention in the control of the infection. However, uptake of this service in Ghana is

very low especially among the youth. This study sought to assess the factors influencing the

uptake of HIV testing and counseling services among the youth in the Akim Asene town in Akim

Oda Municipality. The objective of this study was to assess the uptake of HIV testing and

counselling among the youth aged 15-24 years in the Akim Asene town.

A cross sectional survey among youth groups aged between 15 and 24 was conducted using a

questionnaire at Akim Asene town. The study adopted simple random sampling to select

participants. Data was collected on demographic profile, personal related and health system

related factors that influence uptake of HIV testing and counselling.

The results show that more than half of young people (51%) patronized HIV Testing and

Counselling (HTC) services. But the rest (49%) noted fear of discrimination, fear of negative

outcomes, fear of stigma and self-trust, as barriers to uptake of HTC. It has was found that the

sex of an individual influences whether or not young people will consider taking HTC services.

Again, marital status and educational status are other demographic factors that have been found

to have significant impact on HTC among young people. The most important factor related to

testing and counseling for HIV, was identified as knowing where the HTC services are provided.

The results of this research show that nearly half of the youth have never patronized HTC

services due to reasons such as fear of discrimination, fear of a positive HIV test. Also factors

such as stigma, fear of positive results and discrimination were identified as barriers to HTC

uptake among the youth.

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 CHAPTER ONE

INTRODUCTION

Background to Study
The burden of HIV/AIDS has proved to be a great source of concern around the globe in recent

past. It is also the main cause of death and threat to national development. The disease has a

negative impact on economic, political, as well as social development of every country with high

levels of infection (Yahaya, Jimoh, & Balogun, 2010). The most affected region in the world is

Africa south of the Sahara, with approximately 25.6 million people living with HIV (UNAIDS,

2016).

People with HIV or those at risk of HIV do not have access to protection, care and treatment, and

are not cured. More than half of all new HIV infections are among the youth (aged 15-24)

(Millage, 2009). AIDS not only affects the health of individuals but also affects families,

communities and economic growth and development. Many countries suffering from HIV are

also suffering from infectious diseases and other serious problems (“Global Statistics | HIV.gov,”

n.d.).

Studies show that Africa has a youth dominated population (Sommers, 2011), while youth

between 15 and 24 years accounted for about 40% of the total new case of HIV infection

(UNAIDS, 2015). The probability of infecting young women is twice that of the young men in

Sub Saharan Africa ((UNAIDS), 2018). The continuing growth of young populations in the

country with a high HIV burden can lead to further transmission of epidemics except the use of

strategies based on evidence aimed at youth and affordable (Asante, 2013). Even though the

annual number of AIDS-related deaths dropped by 35% during the 2005-2013 period, deaths in

adolescents (10-19 years) living with HIV increased by 50% from 2005 to 2012. In this age of

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ART, there has been a sharp decline in deaths from AIDS. However, HIV remains the second

leading cause of death among adolescents worldwide (Wood, Ballenger, & Stekler, 2014).

Apparently, it was among the ten causes of death among adolescents in 2000. HIV-related deaths

among adolescents have more than tripled since 2000 (“WHO | Adolescent health

epidemiology,” 2014).

Evidence shows that of the 35 million people living with HIV worldwide, 19 million are unaware

of their HIV status. Prevalence of HIV among young women is estimated to be three times

higher than for men in sub-Saharan Africa (UNAIDS, 2014). Transmission of HIV among the

youth has become a public health problem in sub-Saharan Africa. This is the leading cause of

death among young people (10-24 years) in Africa and is the second leading cause of death

worldwide (AVERT, 2017).

Young people aged below 25 years make up about 60% of Africa’s population (UN, 2017).

Young people are still the most endangered group of individuals in the world, representing more

than 5 new HIV / AIDS cases and the biggest hope of transforming the flow of AIDS, the future

of the infectious disease will be affected by their actions (AVERT, 2017).

Many strategies for prevention, treatment as well as care for HIV require knowledge about the

HIV status of the individual. The importance of testing and counseling for HIV (HTC) has led to

more HTC service development. However, lack of access to services and resources is a challenge

for teens who try to access services (WHO, 2012).

HTC is an important strategy for HIV prevention and allows young people to evaluate their

behaviors and their consequences. It highlights the relevance of responsible sexual behavior as

well as the consequences of reckless sexual behavior. Understanding one’s HIV status is one of

the surest ways of behavioral change, treatment, care, support, and tolerance. However, HIV

4
testing is not encouraging because it is a subject of discrimination (UNAIDS, 2014). Lack of

knowledge about one’s status can lead to delay in seeking treatment. The course of education

affects the impact of ART on protection and life, and the delay in using protections from

individuals living with HIV and their partners.

Problem Statement
Worryingly, over half of the people living with HIV do not know their infection status (Erena,

Shen & Lei. 2019). Meanwhile, there is an increasing proportion of the infection among

adolescents and young adults, with over a third of all new infections from this age group in SSA

(Idele, Gillespie, Porth, Suzuki, Mahy, & Kasedde, 2014). Disturbingly, the high proportion of

HIV infection among the youth is not in keeping with their uptake of testing. In fact, only 10% of

males and 15% females aged 15 to 24 years get tested and know their HIV status (Mafigiri,

Matovu, Makumbi, Ndyanabo, Nabukalu, & Sakor, 2017). Therefore, a large majority remain

reservoir and high risk of transmitting the infection to their peers (Mafigiri, et al., 2017). The

cumulative effect of HIV is substantial, ranging from stigmatization, acute and chronic ill-health

and HIV/AIDS-related deaths as well as the socio-economic burden on the household,

community and the country (Alliance, 2016). Sub-Saharan Africa forms only 12% of the global

population and yet accounts for over half of the burden of HIV infection (Idele, et al., 2014). In

SSA, where most adolescents and adults living with HIV reside, only 1 in 5 HIV positive

adolescent girls know their HIV status. Moreover, globally, an estimated one-third of all new

HIV infections occur in those aged 15 to 24 years (Mafigiri, et al., 2017). The increased

incidence of HIV with growing population and limited access to uptake of testing and

counselling services will inevitably lead to substantial HIV burden in the years ahead (Asaolu,

Gunn, Center, Koss, Iwelunmor, & Ehiri, 2016).

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The need for HIV Testing and Counselling (HTC) as an effective tool of prevention of HIV and

AIDS among the youth cannot be underestimated. Although HIV testing has often been used as a

diagnostic tool to confirm symptomatic AIDS, it is increasingly becoming difficult for most of

the population, particularly the youth to go for HIV Testing and Counselling (UNAIDS, 2016).

Hence, the intended commitment by world leaders to end the HIV and AIDS menace by the year

2030 seems to be back firing even though more persons living with HIV and AIDS appear to be

on ART (UNAIDS, 2016). The potential of reducing HIV and AIDS in Ghana for example is

undermined by the low patronage of testing and counselling among the youth (21% of females

and 14% of males). Even among those who utilize HTC, only 17% of females and 12% of males

return for their results. (Kwapong, Boateng, Agyei-Baffour, & Addy, 2014). According to

Oppong Asante (2013), a study in Ghana showed that 78% of the respondents had never

undergone any HIV testing and majority of the respondent were not accessing the available HTC

services.

A recent systematic review reported that approaches evaluating uptake and positivity rate of HIV

testing services had not been tailored to the needs of persons aged 5 to 19 years. Specific barriers

adolescents, in particular, face have not been well integrated within the regular service delivery

(Vieira, Rasmussen, Oliveira, Gomes, Aaby, & Wejse, 2017). Despite the staggering statistics, a

very low proportion of young men and young women in SSA know their HIV status (Vieira, et

al., 2017). Barriers to HIV testing include lack of awareness of available services, perceived low

personal risk, fear of a positive test result (including associated negative consequences and

stigma), concerns about confidentiality, costs of testing and lack of sufficient knowledge about

HIV/AIDS (Khawcharoenporn, Mongkolkaewsub, Naijitra, & Khonphiern, 2019). The current

trend and dynamics of HIV infection in SSA, particularly among young people living with the

infection but who remain undiagnosed paints a gloomy picture on the outlook of HIV prevention

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and control in SSA. In spite of the burden of HIV/AIDS in adolescents and young adults, little

has been devoted to the promotion of HIV testing, counselling, and linkage with appropriate care

among this special population (Oppong Asante, 2013). Although there is availability of effective

antiretroviral therapy globally, the impact of chemotherapy may not fully be realized if effort is

not strengthened to increase uptake of HIV testing and counselling among the youth.

Undoubtedly, HIV testing and counselling has the potential to improve early detection, prompt

linkage to appropriate intervention, improved treatment outcomes, and reduction in new

infections. It is particularly necessary to engage young people in sub-Saharan Africa to identify

and address challenges affecting access to HIV counselling and testing. Such understanding may

also inform future research, practice, and policy regarding interventions that address young

people’s unique barriers to HIV testing and counselling. Though, there has been a persistent

decline in the prevalence rate generally in Ghana, same cannot be said of Akim Asene since the

prevalence rate keeps increasing over the last few years. Becoming, the rural site with the highest

prevalence rate in HIV Sentinel survey conducted in Ghana for the year 2021. The pattern of the

disease in the Akim Asene is disturbingly unpredictable and has therefore become imperative to

conduct research on HIV testing and counselling among the youth in Akim Asene.

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Research objectives
The research objectives will be divided into general and specific objectives

General objectives
The main objective was to assess the uptake of HIV testing and counselling among the youth of
Akim Asene town.

Specific Objectives
1. To determine the knowledge and awareness of the youth of Akim Asene on HIV Testing and
Counselling.

2. To determine the proportion of youth who have ever tested for HIV in Akim Asene town.

3. To assess the factors associated with uptake of HIV testing and counselling among the youth
of Akim Asene town.

Research Questions
1. What is the knowledge level on HIV testing and counselling of the youth of Akim Asene

Town?

2. What is the proportion of the youth who have ever tested for HIV in Akim Asene Town?

3. What are the factors associated with uptake of HIV testing and counselling among the

youth of Akim Asene Town?

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Operational definition of terms
Confidentiality: Confidentiality is trusting individuals not to reveal secret or private information

to anyone else.

Counseling: A confidential dialogue between a client and a counselor targeted at giving the

client advice and support on psychological or personal matters, usually in a professional context.

HIV testing: Obtaining bodily specimen for the purpose of performing a medical test or several

medical tests to determine the HIV status of a person.

HIV testing and counseling: The process by which an individual is tested for HIV and then

counseled to prepare him or her emotionally for the results of the test.

Youth: The youth as used in this study refers to any person (male or female) aged 15 to 24 years

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 CHAPTER 2

LITERATURE REVIEW

INTRODUCTION
This chapter reviews literature on previous studies conducted to assess the uptake of HIV testing

and counselling. The proportion of HIV testing and counselling and factors about knowledge of

HIV testing and counselling, personal, socio-demographic and health system that influence

uptake of HIV testing were reviewed.

Proportion of HTC Services Utilization

The provision of HIV testing and counseling (HTC) is an important part of any national program

for HIV prevention. It has been found that people living with HIV do not know their status are

most likely to transmit the infection to others. Studies have reported that HTC has played an

important role in identifying infected individuals and provides them the opportunity to benefit

from therapeutic intervention (Menna, Ali, & Worku, 2015).

HIV testing and counseling (HTC) is still extremely important in accessing facilities for

treatment and prevention of HIV infection. In addition, sexually risky behaviours, known for

enhancing HIV transmission are commonly reported during teenage years but HTC presents

itself as an opportune intervention to help promote healthy sexual practices. Studies have shown

that young people, labeled sexually active, tend to be exposed to sexual intercourse in sub-

Saharan Africa before the age of 15 hence the need to emphasize on the essence of effective

HTC among this group. WHO recognizes the vulnerabilities for HIV-infected people, thus

developing specific guidelines for HTC's among teenagers in 2013. The Guidelines outlined the

importance of generating effective interventions to improve comparable access to HTC

(Govindasamy et al., 2015).

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The survey, conducted by reviewing data on the National Program for HIV / AIDS Control in

Ghana between 2007 and 2010 from all HIV tests conducted in the country reported that 16 % of

the total population in 2010 has ever tested for HIV. Similarly, Ghana's Demographic and Health

Survey of 2008 (GDHS) shows that the proportion of women and men 15-49 years old who

tested for HIV was 21% and 14% respectively.

According to Yawson (2014), some studies conducted across Africa have reported varied HIV

testing and counseling (HTC) uptake by sex. The study found that women in southern Africa use

HTC's service more than men, compared to countries such as Nigeria, Ethiopia, Zambia and

Tanzania, where men use HTC higher than women. They found that high women's tests were

consistent with earlier findings in Ghana, suggesting high readiness for HIV testing among

pregnant women. The research also reports that little HIV testing among men is well known in

Ghana.

Again, Yawson (2014) reported in his study on patients with HIV in Ghana that more women

were getting tested for HIV in hospitals than their male counterparts. Similarly, data from the

annual reports of the NACP between 2007–2010 reported that females make up 58.2% of all

individuals who tested for HIV in health facilities across the country, giving a female to male

ratio (F: M ratio) of 1.4. Another study conducted in a community setting in 2010, also recorded

an F: M ratio of 1.4 for HIV testing. This ratio reported in the NACP annual report excluded the

figures for PMTCT. The overall female to male ratio of HIV testing including PMTCT data in

Ghana was found to be 2.8. The study suggests that it is important for men to use HTC in Ghana

in some societies because they are the head of the family and decide to limit the resources that

are useful for the prevention and care of HIV. It is important to increase male participation in

HTC in an effort to fight HIV infection in Ghana (Yawson et al., 2014).

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According to a study by Ogaji, Oyeyemi, & Ibrahim, (2013) on awareness, willingness and use

of HTC services by students of a university in south-south Nigeria, 72% of Nigerian tertiary

students desired to have an HIV test; an increase from 43% observed in 2005 according to the

HIV/AIDS and Reproductive Health Survey (NARHS) report. The study however reported low

uptake of HTC services of 14.4% and 14.7% of females and males respectively.

Factors Associated with Uptake of HIV Testing and Counseling Services

The factors that influence uptake of HIV Testing and Counselling are varied and can be

categorized under socio-demographic factors, health system-related factors, personal-related

factors and knowledge regarding.

Socio-demographic Factors Influencing HTC

A survey conducted by Kaai, Bullock, Burchell, & Major ( 2012) on the factors affecting HIV /

AIDS services, testing and counseling among homosexuals in the United Kingdom and Canada

identified age as a dominant demographic variable that is most commonly associated with HTC.

The research also showed that there was a difference in the nature of the association. The

difference was observed when comparing three surveys that reported that respondents between

the ages of 40-45 were more likely to support HTC, while three other studies found respondents

under the age of 25 or 30 were tested for HIV. The variation from this study was due to the

sample of the tests. It was found that early studies were modeled on younger people, while the

other three studies were referring to older people.

In both situations however, the results suggested that middle-aged study participants had the

highest testing rates with the young and older populations recording lower rates. The study also

showed other demographic factors, such as ethnicity, living in an urban area with more than one

million inhabitants, earning a low income, being a female as well as having higher education had

an effect on HTC uptake among heterosexuals. The researchers identified three studies that

12
outlined marital status as a predictor of HTC uptake. According to the review study, two of the

studies that found association between marital status and HTC revealed that it was more likely

for single people to test for HIV compared to those married couples or those cohabitating. Their

study provided a reasonable explanation that immigrants from Eastern Africa (meaning 35.7

years old) who were more likely to marry compared to two Canadian studies which had

respondents who were mainly younger and single (Kaai et al., 2012). Addis et al. (2013)

examined voluntary behavioral practices concerning HIV testing among students in North-West

Ethiopia and identified links between higher education, employment and HIV testing. The study

also found an important link between religion and HTC use among men living in urban areas,

indicating that Muslims are less inclined to test for HIV. The study explains that the religious

association may be the result of religious beliefs that can prevent HIV infection. For example, in

Islam, although polygamy is more tolerant to men, divorce is easier. The study also says that

Islam also prohibits the use of alcohol associated with an increased risk of sexual intercourse.

Another explanation for the relationship between religion and HTC is that all Muslims are

circumcised and circumcision is believed to reduce HIV transmission. The study explained that

Muslim men tend to have a reduced risk of HIV infection hence less temptation to undertake an

HIV test (Addis et al., 2013).

Research shows demographic factors such as gender, age, education, poverty, are under one

umbrella, and economic conditions as affecting HTC attitudes. Meanwhile, other studies found

that those aged 18 to 29 were more likely to be late for HTC services than their older

counterparts. It is also found that poverty is related to HIV testing and counselling behavior, as

demonstrated in many studies of health behaviors.

In a study conducted in Nigeria by Bwambale et al. (2008), poverty was a major barrier to seeing

healthcare professionals for HTC services. The relationship between poverty behaviors and

13
health needs was also supported in a study in Bangladesh. Other literature suggests that highly

educated people are more likely to report HIV infection than those who are less educated.

Kalanzi, (2013) study showed that 63% of college-educated people had HIV compared to 47% of

those who had only one high school having tested for HIV. This is because of the educational

potential to allow more financially-accessible people to access testing services, as well as

knowledge of the nature of the prevention and suppression of the disease. The results from the

study show that university students are likely to be tested for HIV compared to the general

public. The research found 62% of the university students reporting having tested for HIV

compared to 49% from the general public that had tested for HIV (Kalanzi, 2013).

The study further explained that respondents who were single were about six times more

probable to have tested HIV relative to those who were married or in relationships. The results of

the study found a significant link between knowing where the HIV test can be found, being aged

between 17-20 years, with the likelihood of testing for HIV. It was found that men are about

three times more likely to test for HIV in the near future than women.

Health System-Related Factors Influencing Uptake of HIV Testing and

Counselling
Kaai et al. (2012) reported in their study that receiving HTC as part of a medical examination

(eg, the inclusion of an HIV test by providing other services that occur in a sexual health clinic

or facilities) or prenatal antenatal care (male referring to pregnancy of his spouse or wife) was

the most frequently reported health system-related facilitator in 33% of the reports that were

reviewed. Respondents as reported in the study cited unsuitability of testing (e.g., inconvenient

inaccessible, and not private) venues as hindrances to HTC uptake in 30% of the reviewed

studies.

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Many of these studies that have been examined showed that participants mostly from small

communities avoided STI clinics because they feared their neighbours may see them and reveal

their risk behavior to others (Kaai et al., 2012). The study cited a similar study, indicating a lack

of trust in the health services of the aboriginal population due to the poor experiences and

difficulties and those newcomers face as they visited the health care system. According to the

findings of studies by Leta, Sandøy, & Fylkesnes (2012) on factors affecting voluntary HIV

counseling and testing among men in Ethiopia, studies from Sub-Saharan Africa have

documented that uptake of HTC increases when provided under hospital-based, home-based and

work place-based compared to clinic-based HTC. This shows that there are some hindrances of

facility-related HTC use.

Tsegay, Edris, & Meseret (2013) in their study for the evaluation of voluntary counseling and

testing services among students from Debre Markos University in Ethiopia showed that the

availability of ART was a positive factor of HTC uptake. They reported that students who are

aware that ART will be available in the HTC site were 3.12 times more likely to utilize HTC

service as opposed to their counterparts who are not aware of the availability of ART in the HTC

site. The research also reports that the provision of ART will greatly extend the lives of infected

students and ultimately motivate students to create a positive attitude and accept the services of

HTC. The survey data showed that increasing use of ART will lead to increased acceptance by

students, who saw risks related to HIV/AIDS test result were 2.4 times more inclined to utilize

HTC service as opposed to their counterpart (Tsegay et al., 2013).

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Personal-Related Factors Influencing Uptake of HIV Testing and Counselling
Kaai et al. (2012) studied the factors influencing HIV testing and counseling among

heterosexuals in United Kingdom and Canada, and reported that there were several factors

related to privacy and HTC. The study grouped these factors into six broad categories: risk

perceptions, fear of HIV-related stigma and other fears, diseases or symptoms of HIV, HTC

education, mandatory or partner recommended HTC, and culture. The study identifies the most

commonly-thought-out individual risk factors that act as a hurdle to HTC uptake. This factor was

personal-related or privacy factors. It was reported that this was quoted in 70% of 77 studies that

were examined during their study. Kaai et al. (2012) also found that perceived risk was HTC's

greatest predictor by using a healthcare model.

According to Strauss, Rhodes, and George (2015), at individual level, one main conclusion that

affects the patronage of HTC is the importance of HIV testing and knowledge. The study further

explains that lack of knowledge can be a major barrier to HIV testing. The study also identifies

potential behaviors of young people that affect their desire and their beliefs to test for HIV. They

added that those who are known to be at higher risk for unhealthy sexual behaviors may be more

likely to be tested for HIV. Again, the study explained that students who had never participated

in sexual activity and believed they were not infected with HIV were less inclined to be tested

for HIV. However, the study found that the history of HTC as well as frequent visits to health

centers for young people sustained HIV testing. This study highlights the fear of discrimination

against HIV, which is a major obstacle to HTC uptake.

Concerns about privacy are also related to discrimination. Direct trust associated with HTC's

healthcare provider is a key determinant of HTC acquisition. Additionally, the long-queue

challenges, long trips and less work time in healthcare facilities, affect students’ ability to access

HTC's services. HTC cost is seen as the key determinant of an HIV test, especially among

16
students. The study reveals that the offer of HTC without charge, the performance of HTC's

mobile service, greatly facilitates HIV testing among young people (Strauss et al., 2015).

In a study in which Addis et al. (2013) examined the knowledge, behaviors and practices of

volunteering for HIV testing and counselling among students in Ethiopia, they found that the

main reason for those who never had HTC in the past was the fear of a positive HIV test result

and stigma and the resultant discrimination. The authors therefore stressed on the need for more

work to be done in creating awareness regarding stigma and discrimination and the possibility of

living longer with the virus as long as HIV positive individuals live their lives as per physicians

and counselors instructions.

The study conducted by Asante (2013) among students in Ghanaian universities found that more

than 90% of students had knowledge of locations for HIV test, but just 45% had ever tested for

HIV. The findings were found in line with previous research that noted that most pubic

university students did not participate in HIV testing. The resistance of students to test for HIV

was associated with anxiety, fear, stigma as well as discrimination encountered during the

counseling and testing of HIV. The study reported that fear of stigma has shown to influence the

youth not to practice preventive behaviours and also an increase in knowledge about HIV does

not predict behavioral change. The study revealed that more than 90 percent of the participants

were unmarried (single and “in relationship”) which is a health concern, because 56 percent of

men and 39 percent of women were interested in future HIV testing. Although having knowledge

of where to test for HIV can greatly increase the likelihood of the test, it does not affect people's

will to seek out HTC services in the future. The study reported that a lack of resources for HIV

testing and consultations at private and public universities in Ghana could be a factor in the

current behaviors.

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Knowledge Factors Regarding Uptake of HIV Testing and Counselling
HTC is a process by which a person passes through a consultation that will allow him to make

the decision to receive an HIV test. The decision to get tested must be entirely the choice of the

individual with the assurance of confidentiality. HTC has been found to be effective in

coordinating behavioral change, including both HIV prevention and care seeking behaviour.

HTC plays an important role in changing unprotected sex drive and reducing HIV and STIs

(Addis et al., 2013).

According to Kalichman, Eaton and Cherry (2010), practical education on HIV infection is

necessary, but not enough to promote HIV testing. Knowledge about using HIV / AIDS and

HTC has a positive relationship. Students with HIV knowledge are 3.69 times more likely to use

HTC than people who do not know about HIV. Moreover, knowledge about HIV, knowledge

about HTC and attitude towards HTC showed association with practice on HTC for HIV which

indicates the relation of one with the other. Therefore, changing knowledge and attitudes will

facilitate the acquisition of HTC services (Addis et al., 2013). Gadegbeku & Saka (2013) in their

study about the attitude of the youth towards HTC in Accra reported that despite the fact that

HTC services have several advantages, acceptance of this service in many countries (including

Ghana) especially where HIV is highly stigmatized and access to these services and support for

people who test serous positive are limited. The study further revealed that although 95% of

respondents knew their sero-status could be checked, only 37% had really heard about

availability of HTC services. Out of the 37% who were aware of this service few (6%) had

actually been to the HTC centre either to visit a friend (2%) or to check their status (4%). This

indicates that the level of awareness and utilization of this service by young people surveyed is

low. Kaai et al. (2012) found that enough educated participants on HTC were more inclined to

test for

18
HIV than those with little information. The study reports that many studies have shown that

respondents were tested for HIV because they wanted to start a new sexual relationship, or just

out of curiosity.

From the various literature reviewed, it is clear that HTC uptake is very low especially among

adolescents. Varying reasons have been attributed to this phenomenon. There is therefore the

need for more work to be done to come to a general conclusion as to factors that affect this low

uptake among the youth.

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 CHAPTER 3

RESEARCH METHODOLOGY

This chapter focuses on the procedure that will be used in the collection of data to achieve the

study objectives. It comprises the setting or study area, study design, target population, sampling

procedure, sample size, data collection methods, data analysis techniques, validity and reliability

of instrument that will be used and ethical consideration.

Background of the study area

The study was conducted in Akim Asene town. Information from sub section 3.1.1 through to

3.1.5 were obtained from (Ghana Population and housing Census, 2010).

The community is one of the many sub-communities in the Birim Central Municipality of the

Eastern Region of Ghana. The community is located in the Western part of the Municipality. It

shares boundaries with Akim Aboabo, Akim Oda, Akim Wenchi and Akim Anamase. It has a

total land mark of 790km² which is mostly undulating and hilly (GSS, 2021).

Socio-economic and Cultural Structure

The community has a multi-ethnic group background with the Akyem ethnic group been the

majority, few Ewes, Krobos and other Northern ethnic groups are also represented. In terms of

Religion, Christians are the majority accounting for about 95% of the population, the rest are

Muslims, traditional worshipers and others (GSS, 2021). The community falls under the Akyem

Kotoku traditional council.

The major economic activities of the people in the community just like that of the general

Municipality are agriculture (50.9%), trade and commerce (20.1%), industry (13.1%) and

services (hotel, banking etc.), Majority of the people are farmers of crop and animal rearing, a

few traders and hand full of government workers. Most of the youth are into transport business

(DMTDP; 2010).

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Population size and distribution
Akim Asene has a total population of 4,869 representing about 6% of the total population of the

Birim Central Municipality. Males constitute almost 48% while female population is about 52%.

It is predominantly an urban community with few rural settings.

The study population included all females (aged between 18 and 80 years) selected across the

length and breadth of Akim Asene and were used as respondents for the study.

Study design
A cross sectional survey was conducted on factors influencing uptake of HIV Testing and

Counselling among the youth between 15 and 24 years. This design was used because it allowed

both the exposure and outcome variables to be measured at the same point in time.

The study design of cross sectional simple descriptive quantitative research was used for this

study. This was considered most suitable design since it gave a detailed description of the

knowledge level on effects of breast cancer among women at Akim Aboabo in the Birim Central

Municipality of the Eastern Region of Ghana. Data was collected from both secondary and

primary sources for this study. Secondary data was mainly collected from annual performance

reports, internet libraries, newspapers, journals and academic articles. Primary sources of data

employed quantitative data collection techniques

Sample size and sampling method

The sample size of 309 was estimated for this study. This estimated proportion of HIV Testing

and Counselling was used as a precision because there is no such study conducted in the Akim

Asene town. Ten percent non-response rate was used because HIV studies are sensitive and the

youth especially below 18 years may not be willing to speak to issues concerning the topic.

Simple Random sampling method was used to select respondents from the target population for

the study. The sampling technique was considered appropriate for this study because the sample

frame cannot be determined as well as who will be willing to act as a respondent during the data

21
collection period. Asene town was zone. After the houses were given numbers. The numbers

were then written on paper, folded and was picked randomly. The number that were picked, we

entered the house to administer the questionnaire.

Data collection techniques and Tools

A structured questionnaire was designed and used to collect the data using face-to-face

interview. The questionnaire was constructed using both closed ended questions. The questions

in the questionnaire were constructed to reflect the variables of the study. Questions covered

demographic characteristics of respondents, respondents’ knowledge regarding HIV testing and

counselling and factors that influence uptake of HIV testing and counselling. The questions were

constructed in English and translated into Twi during the administration process. The tool was

pretested among 20 eligible youth in the Akim Oda municipal and some few ambiguities

corrected to reflect the objectives of the study and to ensure that accurate information is provided

by participants. The questions were constructed in simple English and Twi to enable easy

translation by data collectors in the Twi language. A day’s training was organized for data

collectors where the tool was interpreted in Twi to enable them ask the right questions. The

questionnaire was pretested on ten (10) respondents in the study area who will not be part of the

main study and modifications were made on the basis of feedback from the pilot study. The

questionnaires were administered by the principal investigators themselves.

Data analysis techniques

The data that were collected were edited manually to correct any duplications. The edited data

were coded and statistically analyzed using Stata software version 15. Basic descriptive statistics

were performed and the results presented in frequencies and percentages using tables and charts.

22
The relationship between variables was further analyzed using logistic regression analysis to

show the strength of the association between the dependent variable and independent variables

and this has also been presented in tables.

Ethical considerations
Permission to conduct the study was sought from the Municipal, District and sub-district health

management team as well as the Community Health Nurses Training College of Akim Oda.

The interview was conducted on one-on-one basis in an environment that is devoid of distraction

and provided privacy for the participants. The objectives of the study were explicitly explained

to each participant and their informed consent sought before they answer the questions.

Participants who gave their consent to participate in the study were given a consent form to

sign/thumbprint before they were interviewed.

For participants below 18 years, an assent form was provided for their parents/guardians to

consent by signing/thumb printing before they were interviewed. Participants were also made to

understand that participation in the study was voluntary and that every participant had the right

to withdraw at any time during the study. Confidentiality of data collected were ensured by using

identifiers rather than names of participants and the participants were equally assured that the

data collected were only used for academic purpose. The participants were assured of the safety

of every information collected by ensuring that it was stored in an electronic format on different

personal computers and as hard copies under key and lock in fire-proof cabinets. Apart from

those involved in this study such as the data collectors and supervisor, no other party was given

access to the data that were collected. The study involved only the administration of

questionnaires with no risk to the participants.

Therefore, no compensation package was given to the participants. The administration of the

questionnaires lasted about 30 minutes per participant and they were told before the start of each

interview session. Participants in the study were provided with no material benefits from the
23
study, however, their participation in the study helped them acquire some understanding of HIV

and its transmission, the benefits of testing for and knowing their HIV status and where to get

tested for HIV in the Municipality and beyond.

Limitations of the Study

As a result of bad road network, small sample sizes and attitude of respondents among others, the

results of the study may not be fully reflective. Also, the survey questionnaire for data collection

will be read and interpreted to some of the respondents due to their low level of education. Due

to this, the researcher in a way has influenced the minds of the respondents. Therefore the

findings of this study cannot be generalized.

24
 CHAPTER FOUR

RESULTS AND DISCUSSIONS

RESULTS
This chapter presents the findings in relation to the objectives of the study. It begins with the

demographic characteristics of respondents who participated in the study. The proportion of

youth that were sampled from the population (Akim Asene town) who had ever been tested for

HIV is also presented graphically. Other issues considered in this chapter include factors

influencing uptake of HIV testing and counselling among the youth as well as barriers to HIV

testing.

Background Characteristics of Respondents

Majority (56.0%) of the respondents who participated in the study were females. Among the

youth who were sampled in the municipality, 50.6% of females indicated that they have ever

tested for HIV while 49.4% males had also been tested for HIV (Table 1). 74.4% of the youth

were between 16 and 22 years. This same age group (16 – 22 years) had the highest number of

youth who had ever been tested for HIV. Majority (37.5%) of respondents were Protestants while

a few number of youth were practicing other forms of religion. However, youth who are

Catholics had the highest (44.3) HIV test patronization. African Traditionalists were the least

category of youth to have ever been tested for HIV. There was a higher (80.9%) number of

single youth than the married (19.1%). This same trend can be identified in the number of youth

who had ever been tested for HIV. Majority of the youth had some form of education (either a

secondary education or a post-secondary education). Youth with secondary education had the

25
highest (51.3%) HIV test patronization rate while those with no form of education had the least

(23.4%) rate of HIV test patronization. Majority (80.6%) of the youth were students and were

also the highest group of individuals who had ever been tested for HIV.

Table 1: Socio-demographic Characteristics of Respondents

Variable Number of Respondents Number ever tested for HIV

N = 309 (%) n = 158 (%)

Sex
Male 136 (44.0) 78 (49.4)
Female 173(56.0) 80 (50.6)
Age (years)
Below 15 28 (9.1) 9 (5.7)
16 – 22 230 (74.4) 119 (75.3)
23 and above 51 (16.5) 30 (19.0)
Religion
Catholic 106 (34.3) 70 (44.3)
Protestant 116 (37.5) 48 (30.4)
Muslim 57 (18.4) 30 (19.0)
African Traditional Religion 21 (6.8) 10 (6.3)
Other 9 (2.9) -
Marital Status
Single 250 (80.9) 120 (75.9)
Married 59 (19.1) 38 (24.1)
Educational Status
Never attended 75 (24.3) 37 (23.4)
Secondary education 170 (55.0) 81 (51.3)

26
Tertiary or post- secondary education 64(20.7) 40(25.3)
Occupation
Student 249 (80.6) 126 (79.7)
Farmer 7 (2.3) 5 (3.2)
Business 10 (3.2) 10 (6.3)
Professional 43 (13.9) 17 (10.8)

Proportion of Youth who ever tested for HIV

Majority (51%) of the youth indicated that they have ever gone in for HIV testing. This number

is slightly higher (49%) than those respondents who had never been tested for HIV in the

municipality.

Yes
No
49%
51%

Figure 1: Proportion of youth ever tested for HIV

Socio-economic factors influencing Uptake of HIV testing and counselling

among the Youth
Results on Table 2 indicate that 69.9% of respondents have ever heard of HTC services.

However, 48.1% of the youth who have ever heard of HTC services had ever been tested for

HIV, compared to 51.9% of the youth who had never heard of HTC services. The hospital

(50.0%) remains the highest avenue where the youth had their source of knowledge about HTC

27
services. Other avenues of information about HTC services include friends (25.0%), private

clinic/hospital (9.3%), NGO (12.5%) and other sources (3.2%). 56.3% of respondents who had

their knowledge about HTC services from the hospital had ever been tested for HIV.

Moreover, 9.5% of the youth who were educated about HTC services at private clinics/hospitals

also indicated that they have ever been tested for HIV.

Knowledge of where HTC services are provided plays a key role in the uptake of HIV testing

and counselling. Majority (79.0%) of the youth indicated that they know where to get access to

HTC services in the municipality. This translates to a higher (82.9%) number of youth being

tested for HIV compared to 17.1% of the youth who have no knowledge of where HTC services

are provided. The cost of accessing HTC services indicated that 79.5% of the youth were offered

the service for free while others paid amounts ranging from GHC 1.00 – 10.00. Expectedly,

respondents who were offered the service for free were the highest (75.9%) number of

individuals to have ever tested for HIV.

Marital requirement was found to be the highest (55.0%) reason for testing for HIV among the

youth. However, respondents who indicated that medical reasons accounted for their testing for

HIV, were the highest (40.5%) group of people to have ever been tested for HIV. Among

respondents who have never been tested for HIV, majority (79.5) indicated that they were willing

to get tested for HIV while 20.5% declined. Voluntary counselling and testing was identified as

the main (39.9%) type of HIV testing in the municipality. 44.3% of the youth who had ever been

tested for HIV had availed themselves voluntarily to be counselled and tested for HIV.

Majority (67.6%) of the youth iterated that they believe that HIV testing is important while

32.4% indicated otherwise. 75.9% of those who had ever been tested for HIV knew the

importance of the exercise while 24.1% do not know the relevance of testing for HIV. Among

28
respondents who know the importance of testing for HIV, 48.8% indicated that knowing one’s

status was important and 6.7% noted that testing for HIV is important to prevent HIV

transmission. Other reasons given were know about HIV (4.8%), self-confidence (4.8%) and

know my blood group (35.0%). Among those who have ever been tested for HIV, 40.5% know

the importance of knowing their HIV status while 38.6% know the importance of getting tested

to prevent HIV transmission.

Majority (63.4%) of the youth indicated that HIV testing was convenient for them. 69.6% of

youth who found that HIV testing was convenient had ever been tested for HIV while 30.4% of

youth who indicated that HIV testing was not convenient for them had ever been tested.

Among respondents who indicated the inconvenience of HIV testing, majority (49.6%) noted the

lack of confidentiality as a major reason. Other factors such as distance from their home to the

HTC service centre (31.9%), services not always available (11.5%), and lack of privacy (7.1%)

were some of the reasons given for the inconvenience of the HIV testing.

Table 2: Socio-economic factors influencing Uptake of HIV testing and counselling among
the Youth
Variable Number of Respondents Number ever tested for HIV
N = 309 (%) n = 158 (%)
Ever heard about HTC
Yes 216 (69.9) 104 (65.8)
No 93 (30.1) 54 (34.2)
If yes, source of knowledge
Hospital 108 (50.0) 89 (56.3)
Friends 54 (25.0) 26 (16.5)
Private clinic/Hospital 20 (9.3) 15 (9.5)
NGO 27 (12.5) 28 (17.7)
Others 7 (3.2) –

29
Know where HTC services are provided
Yes 244 (79.0) 131 (82.9)
No 65 (21.0) 27 (17.1)

If yes, cost of HTC

Free 194 (79.5) 120 (75.9)
GHC 1.00 – 5.00 16 (6.6) 38 (24.1)
GHC 6.00 – 10.00 34 (13.9) –
Reasons for testing for HIV
Medical reason 97 (31.4) 64 (40.5)
Marital requirement 135 (55.0) 61 (38.6)
Fear of HIV 50 (20.7) 32 (20.3)
Parental pressure 19 (6.1) 1 (0.6)
Others 8 (2.6) –
Intention to test
Yes 120 (79.5) –
No 31 (20.5) –
Type of HIV testing
Voluntary counselling and testing 63 (39.9) 70 (44.3)
Know your Status 25 (15.8) 40 (30.4)
During pregnancy 21 (13.3) 38 (25.3)
Provider-initiated testing 14 (8.9) 15 (9.5)
Others 34 (21.5) 25 (15.8)
Importance of HIV testing
Yes 209 (67.6) 120 (75.9)
No 100 (32.4) 38 (24.1)
If important, why
Know your status 102 (48.8) 64 (40.5)
Prevent HIV transmission 14 (6.7) 61 (38.6)

30
Know about HIV 10 (4.8) 32 (20.3)
Self-confidence 10 (4.8) 1 (0.6)
Know my blood group 73 (35.0) –

Convenience of HIV testing

Yes 196 (63.4) 110 (69.6)
No 113 (36.6) 48 (30.4)
If no, reasons for inconvenience
Lack of confidentiality 56 (49.6) 83 (52.5)
Distance too far 36 (31.9) 22 (13.9)
Services not always available 13 (11.5) 25 (15.8)
Lack of privacy 8 (7.1) 28 (17.7)

Demographic factors influencing Uptake of HIV testing and counselling

among the Youth
The demographic characteristics of respondents indicated diverse findings (Table 3). Females

were more likely than males to patronize HIV testing and counselling services in the

municipality. Thus sex of the individual is a significant factor in determining whether or not a

youth would consider HIV testing and counselling services. None of the age was significant in

the model. Moreover, none of the religions was also significant in determining the uptake of HIV

and counselling among the youth. However, married individuals were more likely to consider

HIV testing and counselling compared to individuals who are single. Individuals with tertiary or

post-secondary education were more likely to adopt HIV testing and counselling compared with

individuals with no level of education. None of the categories of occupation was however not

significant in determining uptake of HTC services.

31
Table 3: Demographic factors influencing Uptake of HIV testing and counselling among
the Youth
Variable Odds Ratio 95% C.I p – value
Sex
Male 1 -
Female 1.22 0.714 – 1.30 0.028
Age (years)
Below 15 1 -
16 – 22 0.79 0.409 – 1.246 0.75
23 and above 1.41 0.809 – 1.593 0.086
Religion
Catholic 1 -
Protestant 0.34 1.122 – 0.646 0.31
Muslim 0.75 0.503 – 0.889 0.082
African Traditional Religion 0.83 0.244 – 1.086 0.91
Other 0.51 0.311 – 0.967 0.134
Marital Status
Single 1 -
Married 0.93 0.081 – 1.322 0.03
Educational Status
Never attended 1 -
Secondary education 0.78 0.52 – 1.242 0.19
Tertiary or post- secondary education 1.42 0.846 – 1.749 0.04
Occupation
Student 1 -

32
Farmer 0.89 0.594 – 1.022 0.49
Business 0.76 0.363 – 1.404 0.07
Professional 0.98 0.759 – 1.221 0.52

Barriers to HIV testing

The fear of stigma is the main barrier to HIV testing in the municipality (Figure 3). Other factors

that hinder HIV testing in the municipality are fear of discrimination, fear of positive results, and

partner and self-trust.

70
60
60
50
40
30
30
Percentage%

20
20
10 5
0
a on lts t.
m ati su rus
s tig in re l f- t
of rim ve se
r isc iti d
f ea d pos an
ro
f f er
a ro rtn
fe f ea pa

Axis Title

Series 1

Figure 2: Barriers to HIV testing

Suggestions to enhance HTC Services

Suggestions that have been proposed by the youth to promote the uptake of HIV testing and

counselling service are provision of HTC services in churches, mosques, and communities,

service providers should be respectful, compassionate and humble, and a mass campaign to

recommend HIV testing to people in the municipality.

33
 Chart Title
60 55
49
40

20 10
0
Percentage%

es bl
e le
rch m eop
hu hu to
p
/c d
s an ng
i tie te sti
un na te
m is o HI
V
co s
in pa en
d
C om m
HT ,c m
id
e ul co
ov ectf Re
Pr sp
re
be Axis Title

Series 1 Series 2 Series 3

Figure 3: Suggestions to enhance HTC services

Discussions
HIV Testing and Counselling (HTC) remain pivotal in accessing HIV treatment and prevention

services. This study sought to assess the factors influencing uptake of HIV testing and

counselling among the youth in Akim Asene Township. A cross sectional survey was conducted

on factors influencing uptake of HIV Testing and Counselling among the youth between 15 and

24 years. The following discussions focus on the three specific objectives for the study

Proportion of Youth that has ever tested for HIV in the Akim Asene town.
Generally, majority of the youth indicated that they had ever tested for HIV. This number is

slightly higher than those respondents who had never been tested for HIV in the town. Findings

from the study indicated also that about half of female population indicated that they have ever

tested for HIV while a little below half of males had also been tested for HIV (Table 1). This

finding compares with the 2008 Ghana Demographic and Health Survey (GDHS) report that

indicated that the proportion of females and males aged 15-49 years that have ever tested for

HIV was 21% and 14% respectively. This is an indication that females within the township are

34
more likely to know their HIV status compared to their male counterparts. This finding further

collaborates a study conducted by Yawson et al (2014), which found that females in Southern

African countries were using HTC services more than males relative to countries such as

Nigeria, Ethiopia, Zambia and Tanzania, where male utilization of HTC was higher than

females. They found the high female testing to be in line with previous findings in Ghana, which

showed high readiness for HIV testing among pregnant women. Again, Yawson et al., (2014)

reported in their study on HIV patients in Ghana that more females were getting tested for HIV

in hospitals than their male counterparts.

The distribution of the age group of respondents indicated that respondents aged between 16 – 22

years had the highest number of youth who had ever been tested for HIV. Considering recent

studies that have demonstrated that, young people who are labelled as sexually active tend to be

exposed to early sex in sub-Saharan Africa (SSA) before the age of 15 years (Govindasamy et

al., 2015), it is not surprising to witness majority of respondents within this age group availing

themselves for HIV counselling and testing. A study conducted by Kaai, Bullock, Burchell, and

Major (2012) however suggested that middle-aged respondents had the highest testing rates with

the young and older populations recording lower rates.

It is also interesting to observe that whereas this study found that youth who are African

Traditionalists were the least category of respondents to have ever been tested for HIV, findings

from a study conducted by Addis et al. (2013) cited Muslims as being less likely to be tested for

HIV. However, youth who are Catholics had the highest (44.3%) HIV test patronization rate in

the township. This finding could be as a result of higher adherence to religious beliefs, which

may protect one against the contraction of HIV.

35
The study also established that single youth were more likely than the married to ever been tested

for HIV. In their 2013 study conducted among university students in North west Ethiopia, Addis

et al., reported that a large proportion of the students who were single (59%) were more likely to

take an HIV test than those “in-relationship” (25%) and married (16%).

Knowledge and Awareness of the Youth of Akim Asene on HIV Testing and
Counselling.
Majority (67.6%) of the youth iterated that they believe that HIV testing is important while

32.4% indicated otherwise. 75.9% of those who had ever been tested for HIV knew the

importance of the exercise while 24.1% do not know the relevance of testing for HIV. Among

respondents who know the importance of testing for HIV, 48.8% indicated that knowing one’s

status was important and 6.7% noted that testing for HIV is important to prevent HIV

transmission. Among respondents who have never been tested for HIV, majority (79.5%)

indicated that they were willing to get tested for HIV while 20.5% declined. According to a study

by Ogaji, Oyeyemi and Ibrahim (2013) on awareness, willingness and use of HTC services by

students of a university in south-south Nigeria, 72% of Nigerian tertiary students desired to have

an HIV test; an increase from 43% observed in 2005 according to the HIV/AIDS and

Reproductive Health Survey (NARHS) report. Moreover, a study by Asante (2013), among

university students in Ghana found out that over 90% of the students had knowledge about where

to get an HIV test however, only 45% had tested for HIV. This finding was found consistent with

previous studies Asante (2013) where it was reported that majority of public university students

had not taken an HIV test. This study thus reiterates the importance of knowing one’s HIV status

in promoting responsible lifestyles among the youth in the municipality.

Several factors interplay to influence a person’s decision to voluntarily or otherwise make a

decision to have an HIV test. Voluntary counselling and testing was identified as the main

36
(39.9%) type of HIV testing in the municipality. 44.3% of the youth who had ever been tested for

HIV had availed themselves voluntarily to be counselled and tested for HIV. Majority (63.4%) of

the youth indicated that HIV testing was convenient for them. 69.6% of youth who found that

HIV testing was convenient had ever been tested for HIV while 30.4% of youth who indicated

that HIV testing was not convenient for them had ever been tested. Among respondents who

indicated the inconvenience of HIV testing, majority (49.6%) noted the lack of confidentiality as

a major reason. Fear of positive results, stigmatization, discrimination, fear of losing one’s job

and fear of death from AIDS the decision to test for HIV becomes a difficult one for most

people. This finding is consistent with Strauss et al (2015) where respondents in the study also

complained about lack of confidentiality and fear of discrimination as barriers to HTC uptake.

The decisions to go for an HIV test is also determined by the fact that people are knowledgeable

of the importance of the test and know where to go for the test. Most people may have the

intention to test for HIV but have inadequate information about where to get tested or cannot

afford the cost of the test. This finding is supported by Bwambale et al (2008) which identified

poverty as a major barrier to seeking HTC services.

Barriers to HIV testing

Gadegbeku and Saka (2013) in their study about the attitude of the youth towards HTC in Accra

reported that despite the fact that HTC services have several advantages, acceptance of this

service in many countries (including Ghana) especially where HIV is highly stigmatized and

access to these services and support for people who test positive are limited. The fear of stigma

was found to be the main barrier to HIV testing in the municipality. Other factors that hinder

HIV testing in the municipality are fear of discrimination, fear of positive results, and partner

and self-trust. Finally, findings from the study demonstrated that the choice to undergo HIV and

AIDS counselling is determined by several factors beyond factors that were examined in this

37
study. There was no difference between those who have tested and those who have not tested

with reference to their perceived vulnerability to HIV, benefits of HTC, severity of HIV and

barriers to HTC.

CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS

Introduction
This chapter presents the conclusions drawn from the study and also recommendations made in
view of the findings

Conclusion
The findings of the study show that a little over half of the youth had ever tested for HIV.

However, the rest citing fear of discrimination, fear of positive results, fear of stigma and partner

and self-trust as factors prevent them from patronizing uptake of HIV testing and counselling

services. Sex of an individual was found to significantly influence whether a youth would

consider uptake of HTC services. Again marital status and educational status were some

demographic factors found to be significant determinants of HIV testing and counselling among

the youth.

Recommendations
In line with the findings from this study the following recommendations are made
Public Health Practitioners need to sensitize people that everybody is at risk of being infected

with HIV. Evidence from available studies indicates that people with low risk perception are less

likely to test for HIV. Public Health practitioners should employ the use of radio and television

in their campaign to help reach a wider audience with their message HTC.

The Ghana Health Service needs to introduce new strategies such as door-to-door rapid HIV

same day results test. This will increase the rate of testing especially among those who avoid the

hospital for fear of being recognized by known people.

38
Furthermore, the Ministry of Health and Ghana Health Service should incorporate counselling

services with blood donation points to counsel blood donors. Most people who go to test in order

to donate blood miss the opportunity of being counselled effectively.

Additionally, health workers should provide quality care and ensure privacy and confidentiality

in dealing with clients seeking testing and counselling services. The supervisors should give

quarterly in service training and refresher courses to providers of the service on interpersonal and

communication skills as well as ethics of nursing.

39
 APPENDIX I: RESEARCH QUESTIONNAIRE
COMMUNITY HEALTH NURSING TRAINING COLLEGE, AKIM ODA

DEPARTMENT OF NURSING

RESEARCH QUESTIONNAIRE

PARTICIPANT INFORMATION SHEET

TOPIC: ASSESSING THE UPTAKE OF HIV TESTING AND

COUNSELLING AMONG THE YOUTH IN AKIM ASENE TOWN
Dear respondents,

We are final year nursing students from Akim Oda Community Health Nursing Training

College. This survey is aimed at assessing the uptake of HIV testing and counselling among the

youth in Akim Asene town in the Eastern region of Ghana.

In meeting these objectives, you have been duly selected as a member of the sample to provide

relevant objective data needed to satisfy the objective of this survey. This questionnaire will take

approximately 30 minutes to be completed. Your answers to these questions will strictly remain

confidential. Neither your name nor any personal information will be used in the report and is for

academic purpose only and participation is voluntary.

Declaration by Respondents

Are you willing to participate in this study? (Please tick) Yes [ ] No [ ]

Signature:………………………………………………….

Date:………………………………………………….

40
Having consented to participate in this study, I entreat you to answer the following questions.
Kindly answer to the best of your knowledge and remember you can always choose to opt out.
Thank you.

INTERVIEW GUIDE
ASSESSING THE UPTAKE OF HIV TESTING AND COUNSELLING AMONG
THE YOUTH IN AKIM ASENE TOWN
SECTION A: PERSONAL DATA
1. Sex
a. Female ()
b. Male ()
2. Age (in years)
a. 15-17 ()
b. 18-20 ()
c. 21-24 ()
3. Religious affiliation
a. Orthodox ()
b. Protestant ( )
c. Muslim ( )
d. African Traditional ( )
e. Other (specify) ………
4. Marital status
a. Single ()
b. Married ( )
c. Divorced/separated ( )
d. Widow/widower. ( )
5. Education status
a. Never attended school ( )
b. Primary education ( )

41
c. Secondary education ( )
d. Tertiary/post-secondary education.
6. Occupation ( )
a. Student ( )
b. Farmer ( )
c. Business ( )
d. Professional ( )
e. Other (specify) ……………..
SECTION B: KNOWLEDGE REGARDING HTC
7. Have you ever heard about HTC?
a. Yes ( )
b. No ( )
8. If yes in Q7, where did you hear it from?
a. Hospital ( )
b. Friends ( )
c. Private clinic/hospital ( )
d. NGO ( )
e. Other (specify)………...
9. Do you know where HTC services are provided?
a. Yes ( )
b. No ( )
10. Have you ever tested for HIV and know your status?
a. Yes ( )
b. No ( )
11. If yes to Q10, how much did you pay for testing?
a. Free ( )
b. GH₵1.00-5.00 ( )
c. GH₵5.00-10.00 ( )
d. >10.00 ( )
12. What reason accounted for you testing for HIV?
a. Medical reason ( )

42
b. Marital requirement ( )
c. Fear of the disease (AIDS) ( )
d. Parental pressure ( )
e. Others (specify)……………….

13. If no to Q10, do you intend to test for HIV?

a. Yes ( )
b. No ( )
14. If yes to Q10, which of the following types of HIV testing was provided for you?
a. Voluntary counselling and testing ( )
b. Know Your Status ( )
c. During pregnancy (PMTCT) ( )
d. Provider-initiated testing ( )
e. Others (specify)…………. ( )
15. Do you think that it is important for you to test for HIV?
a. Yes ( )
b. No ( )
16. If yes to 15, what is the importance of HTC in your opinion?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
SECTION C: PERSONAL –RELATED FACTORS
17. What reason can you give that might prevent you from taking a test for HIV?
a. Fear of stigma ( )
b. Fear of discrimination ( )
c. fear of positive results ( )
d. Partner and self-trust ( )
e. Other(s) specify ( )
SECTION D: HEALTH SYSTEM-
RELATED FACTORS
18. Do you think the place where HTC services are provided is convenient for you?

43
a. Yes ( )
b. No

44