Magister Public Health - MPH / Since the advent of the HIV pandemic, efforts have been made to find and implement interventions to reduce the risk of transmission of the infection in various risk groups. Mother to child transmission is responsible for a great majority of childhood HIV infections. Interventions have been developed which reduce considerably the risk of mother to child transmission to babies born to women who are infected. To be able to access these interventions, pregnant women first have to know their status by being tested at antenatal clinics. Initial testing protocols in most countries were based on the opt-in, client-initiated approach. However, in many countries, this did not result in many women getting tested and being able to access interventions. Accordingly, many countries have now adopted the routine opt-out approach as a way of increasing testing rates among women attending antenatal clinics. Ghana has had a PMTCT programme since 2004 initially based on opt-in testing. In 2007, there was a change in this testing regimen to the opt-out approach. The aim of this study was to assess the quality, acceptability and factors influencing the acceptability of the use of routine verbal opt-out strategy for HIV testing during pregnancy for women attending antenatal clinics in the Kassena-Nankana district of northern Ghana. A cross-sectional analytical study design was used in this study. The study was conducted in the Kassena-Nankana district of northern Ghana using a structured questionnaire in face to face exit interviews with pregnant women after they had completed their first antenatal clinic visit. A total of 251 women aged between 15-49 years were interviewed after informed consent had been obtained from them. Data was captured with Epidata and analysed with EpiInfo. Cross-tabulations and logistic regression analyses were done. Of the 251 respondents who were interviewed in this survey, 85% of them were aware of MTCT, 82% knew at least one PMTCT strategy, 92% felt they had experienced good quality counselling that day at the ANC and 81% thought that the opt-out testing was acceptable. The perception of the women in the study about the quality of counselling they were given, their exposure to radio and their ethnicity were significantly associated with their acceptability of opt-out testing for HIV. While majority of the respondents felt that the quality of the counselling they received was good and a majority also felt that the opt-out strategy was acceptable, there were concerns about the quality of counselling provided. Recommendations include the need to improve counselling practices in the antenatal clinics by providing more structured information to the women. The District Health Management Team also needs to provide more information to people in the communities about PMTCT using radio as a medium.

The limited success of HIV-testing facilities in South Africa means that many people are not accessing necessary antiretroviral treatment services. This study investigates the practical implications of HIV exceptionalism inherent in Voluntary Counselling and Testing (VCT). A semi-structured interview schedule was used to survey participants for their perspectives on barriers to HIV-testing uptake as well as the effects of exceptionalist practices at VCT clinics. Responses showed marked perceptions of gender differences in people's willingness to test and several important barriers including problems of access to services. Significantly, exceptionalism displayed in certain clinic procedures was thought to contribute to stigma, and attempts to normalise HIV practice in order to combat the effects of stigma were being informally implemented. Participants' views on routine opt-out testing were explored. The researcher recommended further investigation on how HIV testing and treatment policies can be normalised so as to reduce stigma and increase testing uptake. / Social Work / M.A. Sociology (Social Behaviour Studies in HIV/AIDS)

The limited success of HIV-testing facilities in South Africa means that many people are not accessing necessary antiretroviral treatment services. This study investigates the practical implications of HIV exceptionalism inherent in Voluntary Counselling and Testing (VCT). A semi-structured interview schedule was used to survey participants for their perspectives on barriers to HIV-testing uptake as well as the effects of exceptionalist practices at VCT clinics. Responses showed marked perceptions of gender differences in people's willingness to test and several important barriers including problems of access to services. Significantly, exceptionalism displayed in certain clinic procedures was thought to contribute to stigma, and attempts to normalise HIV practice in order to combat the effects of stigma were being informally implemented. Participants' views on routine opt-out testing were explored. The researcher recommended further investigation on how HIV testing and treatment policies can be normalised so as to reduce stigma and increase testing uptake. / Social Work / M.A. Sociology (Social Behaviour Studies in HIV/AIDS)