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Addressing Hiv/Aids Pandemic in the Ejura-Sekyedumase

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Addressing Hiv/Aids Pandemic in the Ejura-Sekyedumase ADDRESSING HIV/AIDS PANDEMIC IN THE EJURA-SEKYEDUMASE DISTRICT: A STUDY OF KNOWLEDGE, ATTITUDES AND SEXUAL BEHAVIOUR AMONG UNMARRIED 15-24 YEAR-OLDS by Seth Agyemang, B.A. (Hons.) A Thesis submitted to the Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, in partial fulfilment of the requirements for the degree of DOCTOR OF PHILOSOPHY Faculty of Social Sciences, College of Art and Social Sciences February 2009 ©2009, Department of Geography and Rural Development CERTIFICATION I hereby declare that this submission is my own work towards the PhD and that, to the best of my knowledge, it contains no material previously published by another person nor material which has been accepted for the award of any other degree of the University, except where due acknowledgement has been made in the text. Seth Agyemang ……………………………... ………………………… (Candidate) Signature Date Certified by: Prof. Dr. Dr. Daniel Buor …………………………….. ………………………… (Lead Supervisor) Signature Date Dr. (Mrs.) Eva Tagoe-Darko …………………………….. ………………………… (Co-supervisor) Signature Date Mr. Joseph Koomson …………………………….. ………………………… (Head of Department) Signature Date ii ABSTRACT Statistics show a rising incidence of HIV/AIDS infection in the Ejura-Sekyedumase District of the Ashanti Region in Ghana. In spite of this development, many people in the district have limited knowledge and serious misconceptions about the disease. Some deny its existence, while others attribute it to factors such as curses, witchcraft and mosquitoes. Discussions with parents, opinion leaders and young people also confirmed that premarital sex is on the ascendancy in the area, contributing to the increase in the pandemic. The research therefore sought to examine the effects of knowledge of HIV/AIDS and attitudes on the sexual behaviour of unmarried people aged 15-24 years in the study area. Both quantitative and qualitative data were employed. The quantitative data was obtained through questionnaire administered on a random sample of 450 unmarried people aged 15-24 years. The qualitative data was obtained through in-depth interviews and focus group discussions. The effects of knowledge and attitudes on sexual behaviour were and the testing of the hypotheses were done using the chi square tests, with p≤0.05 as the level of significance. Other modes of analysis were frequency tables and bar graphs. There were four hypotheses for the study: (1) Knowledge of HIV/AIDS is significantly higher among people living in urban areas compared to those living in the rural areas. (2) Higher knowledge of HIV/AIDS results in less sexual activity. (3) Positive attitudes towards premarital sex results in less sexual activity, and (4) The higher the level of self-perceived risk of acquiring HIV/AIDS, the lower the level of sexual activity. The study used a modified form of the Health Belief Model as its conceptual framework. The results showed that 47.3% of the respondents had had sex. The mean and the median ages at first sexual intercourse were 17.5 years and 18 years respectively. The iii most important sources of information on HIV/AIDS were radio and television. Three of the four hypotheses were justified. Knowledge of HIV/AIDS was significantly higher in the urban area compared to the rural areas (p=.000). Secondly, high self-perceived risk of getting HIV/AIDS was associated with less premarital sex (p=.000). Thirdly, positive attitudes towards premarital sex resulted in less sexual activity (p=.007). However, the hypothesis on the relationship between knowledge of HV/AIDS and sexual behaviour could not be justified as the result was not significant (p=.058). Other results were that education had a positive effect on knowledge and several attitude variables. Sexual activity was lower among respondents who perceived a higher self-efficacy to abstain from premarital sex (p=.000), and among those who believed they could refuse sex for money (p=.007). Condom use at last sexual intercourse was also higher among respondents who perceived a higher self-efficacy to insist on condom use (p=.012) and among those who believed that condoms are effective in preventing HIV/AIDS (p=.009). Contributions to knowledge by the research include the provision of a comprehensive conceptual framework and justification for a combination of qualitative and quantitative methods in studying knowledge, attitudes and sexual behaviour. The findings call for increased access to formal education to defuse false perceptions and beliefs about HIV/AIDS, sustained education and communication on HIV/AIDS, HIV/AIDS education in health settings, accessibility to condoms, and financial/economic empowerment. Unmarried people also need practical skills to be able to translate knowledge on HIV/AIDS into behavioural change. Some areas for further studies have also been suggested. iv TABLE OF CONTENTS TITLE PAGE………………………………………………………………………………i CERTIFICATION…………………………………………………………………………ii ABSTRACT……………………………………………………………………………...iii TABLE OF CONTENTS………………………………………………………………….v LIST OF TABLES………………………………………………………………………..ix LIST OF FIGURES………………………………………………………………………xi LIST OF MAPS……………………………………………………………………….....xii LIST OF ABBREVIATIONS…………………………………………………………...xiii DEDICATION…………………………………………………………………………..xiv ACKNOWLEDGEMENT……………………………………………………………….xv CHAPTER ONE 1.0 BACKGROUND TO THE STUDY 1.1 INTRODUCTION………………………………………………………………....1 1.2 PROBLEM STATEMENT AND JUSTIFICATION FOR THE STUDY………….4 1.3 RESEARCH QUESTIONS………………………………………………………..9 1.4 RESEARCH OBJECTIVES...……………………………………………………10 1.5 RESEARCH HYPOTHESES...…………………………………………………..10 CHAPTER TWO 2.0 LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK 2.1 INTRODUCTION..……….……………………………………………………...11 2.2 THE NATURE AND IMPACT OF HIV/AIDS………………………………......11 2.2.1 The Nature of HIV/AIDS…….……..……………………………………………11 2.2.2 Impact of HIV/AIDS ……... …………………………………………………….13 2.2.2.1 Demographic Impact…………………………………………….………………13 2.2.2.2 Social Impact……….…..………………….…………………………………….13 2.2.2.3 Economic Impact………………………………….……………………………..16 2.3 PATTERNS OF SEXUAL BEHAVIOUR AND IMPLICATIONS FOR HIV/AIDS…………………………………………………………………..19 2.4 DETERMINANTS OF SEXUAL BEHAVIOUR AND HIV/AIDS TRANSMISSION………………………………………………………………...22 2.4.1 Poverty, sexual behaviour and HIV/AIDS transmission………………………….22 2.4.2 Education, sexual behaviour and HIV/AIDS transmission……………………….24 2.4.3 Modernisation, sexual behaviour and HIV/AIDS transmission………………….27 2.4.4 Culture, sexual behaviour and HIV/AIDS transmission………………………….30 2.4.5 Influence of parents on sexual behaviour………………………………………...34 2.4.6 Peer pressure and sexual behaviour........................................................................35 2.4.7 Substance abuse and sexual behaviour…………….……………………………..36 2.4.8 Place of residence and sexual behaviour…………………………………………36 2.5 RELATIONSHIP BETWEEN KNOWLEDGE OF HIV/AIDS AND SEXUAL BEHAVIOUR…………………………………………………………37 2.6 RELATIONSHIP BETWEEN ATTITUDES AND SEXUAL BEHAVIOUR…………………………………………………………………….50 v 2.7 METHODOLOGICAL APPROACHES TO KNOWLEDGE, ATTITUDES AND SEXUAL BEHAVIOUR STUDIES………………………………………..57 2.8 THEORIES AND MODELS OF SEXUAL BEHAVIOUR……..………………..68 2.8.1 Individual Level Theories………………………………………………………...69 2.8.1.1 Social Cognitive Theory…………………………………………………………69 2.8.1.2 Theory of Reasoned Action……………………………………………………...70 2.8.2.3 Stages of Change Model………………………….……………………………...71 2.8.1.4 AIDS Risk Reduction Model……………….……………………………………72 2.8.2. SOCIAL THEORIES AND MODELS………………………………..…………..73 2.8.2.1 Diffusion of Innovation Theory…………………………….……………………74 2.8.2.2 Theory of Gender and Power………………………………………………….....75 2.8.2.3 Social Network Theory……………………..…………………………………....75 2.8.3. STRUCTURAL AND ENVIRONMENTAL THEORIES………………………...76 2.8.3.1 Theory for Individual and Social Change or Empowerment Model.…………….76 2.8.3.2. Social Ecological Model for Health Promotion…................................................77 2.8.3.3 Socioeconomic Factors……………………………………..................................78 2.9 CONCEPTUAL FRAMEWORK FOR THE STUDY…………...........................79 2.9 SUMMARY…………………………………………………………………........85 CHAPTER THREE 3.0 BACKGROUND TO THE STUDY AREA 3.1 INTRODUCTION………………………………………………………………..87 3.2 LOCATION, SIZE AND ADMINISTRATIVE STRUCTURE…………………..87 3.3 PHYSICAL CHARACTERISTICS………………………………………………91 3.3.1 Weather and Climate……………………………………………………………...92 3.3.2 Vegetation and soils……………………………….……………………………...92 3.3.3 Geology, Relief and Drainage…….………………………………………………93 3.4 DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS…………..94 3.4.1 Population size and distribution ………………………….………………………94 3.4.2 Cultural characteristics….………………………………………………………...95 3.4.3 Education………………………………………………………………………....96 3.4.4 Employment and economic activities…………………………………………….96 3.4.5 Health and health care…………………………………………………………….98 3.4.6 Transportation ……………………………………………………….………….100 3.5 SUMMARY….………………………………………………………………….101 CHAPTER FOUR 4.0 RESEARCH METHODOLOGY 4.1 INTRODUCTION………………………………………………………………102 4.2 THE RESEARCH DESIGN…………………………………………………….102 4.3 OPERATIONALISATION AND MEASUREMENT OF THE STUDY VARIABLES.........................................................................................................103 4.3.1 Measurement of knowledge of HIV/AIDS……………………………………...105 4.3.2 Measurement of attitudes………………………………………………………..106 4.3.1 Measurement of sexual behaviour……………………………………………....108 vi 4.4 SAMPLING……………………………………………………………………..109 4.5 DATA COLLECTION…………………………………………………………..111 4.6 DATA PROCESSING AND ANALYSIS……………………………………….113
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