2001 ETH: Study on Factors Affecting Accessibility and Acceptabilty of Voluntary Counseling and Testing Services for HIV/AIDS in Bahir Dar Town, Northwest Ethiopia
Author: Dejene, M.
The prevalence of HIV/AIDS in Bahir Dar town, as estimated from the sero survey result of ANC attendants of Bahir Dar Health center, indicated that the town has the highest sero prevalence rate (20.8 percent) of the whole country. Furthermore, the sero surveys on HIV prevalence conducted among sex workers in Ethiopia from 1988 to 1999 showed that the rate for Bahir Dar town was the highest during the whole period and has shown a progressive rise i.e., from 35.9 percent in 1988 to 69.4 percent in 1991.
Purpose / Objective
This study was done with the main purpose of filling the knowledge gap in identifying the factors that affect the accessibility and acceptability of VCT services, and the result obtained from the study is utilized to forward recommendations that can be implemented by FGAE North Western branch.
A sample size of 478 (323 for females in the age group 15-49 & 155 for males in the age group 12-24) was derived from randomly selected households in two randomly selected Kebeles from Bahir Dar town for a questionnaire. For the qualitative study, a total of seven focus group discussions (home- and hotel-based commercial sex workers, male and female youth, street children, youth male and female college students, and MCH followers) were conducted.
Key Findings and Conclusions
A considerably high proportion of the study population (92.7%) knows about (heard about) HIV/AIDS. Radio, television and anti-AIDS clubs were identified as the major source of information on HIV/AIDS. More than 85% of the respondents have access to a functioning radio at home.
Discussion about HIV/AIDS within family and between partners is found to be low. In this regard, only 59% of the respondents reported that HIV/AIDS has been raised as an issue and discussed with family members.
The level of perceived vulnerability to HIV/AIDS is very low among the study population, where only 50.2% feel at risk for HIV/AIDS. Despite the low level of perceived risk vulnerability to HIV/AIDS, a considerable proportion of the respondents (85.5%) indicated that they have modified their behavior to avoid the risk of HIV infection. Many people do know about condom but only 28.3% ever used it.
Abstaining from sex, avoiding pregnancy, looking for medical care, teaching others, and using condom are the most frequently-mentioned measures to be taken by the respondents if they themselves are identified as HIV positive. The level of knowledge and awareness on the importance of condom to prevent HIV/AIDS is said to be moderately prevalent. Users could get condom, usually Hiwot Trust, easily, at the least possible price, everywhere including small shops. This is confirmed by female sex workers (bar- and home-based) of Bahir Dar town who use condoms whenever they practice sex with clients. They have enough stock of condoms whether or not their clients came with it.
About 83% of the respondents know about whether one can check his/her HIV status and almost a similar proportion know where the VCT service is available. Radio and Health personnel are indicated as the major source of information about the availability of the service. Out of those who claimed to be aware of the VCT service, the overwhelming majority (83%) said that hospital is the preferred site for the service.
More than ninety four percent of the respondents felt that VCT service is necessary. The desire to know HIV status and avoiding risk behavior are the two common reasons cited by the majority of those who know about the service. Almost half of the respondents said that everybody should be tested for HIV while commercial sex workers, youth, and couples before marriage are the other groups indicated to need the VCT service most.
Practically all (99.3%) of the respondents said that using the VCT service is not something to be afraid of. However, a quarter of them is not ready to tell of their decision to be tested to anyone. Nearly three fourths of the respondents believe that people will have a negative attitude towards those who are willing to be tested and will disseminate rumors against them if they know that they have gone for the test. The person will be considered as having the virus, he/she will be considered as having promiscuous behavior or having multi-partner sexual contact, he/she will be regarded as a person having no confidence on what he/she did before, he/she will be outcast by the community, are some of the rumors and fears that people mentioned about the person who would go for HIV test.
Some hotel-based female sex workers and female street children said that they are not ready to go for VCT even if it is provided free of charge. They believe that free medical service would not come up with reliable results. One female sex worker said that, "since the physicians are providing service without pay; I do not think we will get a reliable result from the HIV test. This is the information and experience we had for any type of medical service rendered freely".
The male students from higher academic institutions are not willing to go to a VCT service. They indicated that the result would either be negative or positive; the initiative, by itself, has a negative connotation or implication that would lead to them being labelled as a potential victim of HIV/AIDS which, in turn, will affect the image and reputation of the student thereafter.
Some of the attitude questions posed to the respondents indicated the level of affirmative attitude of the respondents towards people living with HIV/AIDS is not as widespread as that of the level of awareness about the disease. For instance, about 13% of the respondents who claimed to be aware of HIV/AIDS reported that they are not willing to have any type of contact with People Living With HIV/AIDS (PLWHA), while about 12% believed that PLWHA should be isolated from the rest of the community.
The low level of risk perception and the associated negative attitude observed among the respondents towards PLWHA could be a good indication of the fact that an apparently high level of awareness about the disease is not sufficient enough to bring the desired level of change in perception and attitude about the disease. In this regard, much has to be done to educate the people about the modes of HIV transmission. It is also identified that there is a high level of awareness about condom and a moderate level of condom utilization among the target population.
The high level of awareness about condom but the reported low utilization rate, coupled with the widespread misconceptions about its protection capacity, is an indication of the fact that high risk behavior capable of propagating the disease is still widely practiced in the area. This calls for a well-organized and vigorous IEC through meetings and/or discussion sessions. The commercial sex workers should also be trained on how to disseminate information and education pertaining to HIV/AIDS and the skill to negotiate on how to perform safe sex.
The hospital is the commonly mentioned place where majority of survey respondents have identified as a site where VCT service is provided. However, health facilities like the health center and FGAE clinic, where the service is not actually available, are also mentioned by 41.6% of the respondents as a site where the service is available. This reflects the fact that many people have incomplete (inadequate) knowledge about the whereabouts of the service and many believe that VCT service is synonymous with the conventional blood testing facility where HIV testing takes place without other related services.
These findings suggest that the demand for the service is high in Bahir Dar (particularly among the study population). In this regard, the need for organized and well-equipped VCT centers, in an attempt to address the felt needs, should be given prime attention.
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