Reproductive Decision-Making in the Context of Hiv Aids a Case Study Of The Gyidim Community In The Agogo Sub-District

Abstract

The study was undertaken in the Gyidim community of the Agogo sub-district of the Ashanti-Akim North district of the Ashanti region. The overall objective of the study was to acquire empirical data aimed at understanding the impact of HIV/AIDS on reproductive decision-making for programme strategizing and policy decisions. The Gyidim community is largely governed by their strong religious beliefs that favour, large family 'size, promote polygynous marriages and strongly oppose contraceptive use including condoms and pre-marital sex The community also has negative perceptions on HIV/AIDS transmission and infection. A cross-sectional descriptive study design was used injthis study to assess the knowledge, attitudes, belief and practices on HIV/AIDS of this community and to explore its impact on the reproductive decision-making of the men and women in the reproductive age group. Both quantitative and qualitative data collection methods were used in acquiring the relevant information on the study variables. A total of 249 individuals (92 males and 157 females) were interviewed in a household survey using structured questionnaires. In addition Focus Group discussion guide was used in seeking in-depth information from six (6) unmarried and married groups of men (15-60years), and women (15-49years), in the community. The study findings show that the knowledge, Attitude and perceptions of the Gyidim community, on HIV/AIDS, did not influence their reproductive decisionmaking. However, the findings on this community show the strong influence of religious beliefs on their reproductive decisions such as marital status, childbearing, condom use, and sexual behavior. Though the study findings indicates that their knowledge and attitude level to HIV/AIDS is high, and though the majority of the study population are aware that the main mode of HIV transmission is through heterosexual intercourse, they do not perceive themselves at risk of HIV and as such lack knowledge and skills on the use of the condom as a means of protection against STD/HIV/AIDS and unwanted pregnancy. The community, although polygynous, do not attach polygamous behaviour to the risks of HIV/AIDS. They believe that premarital sex, fornication or sex outside marriage, and contraceptive use including condom use to prevent pregnancy or HIV infection is against the law of God. •••'.• ■ ■■{ - As to decisions on marital status and sexual behaviour, when one partner is infected, majority of respondents indicated that they woald divorce when test results reveal that one partner is discordant but continue to live together as couples without sexual intercourse if both partners were infected. The issue of . \ .. . , .... .... ... . . . _ divorce stems from the negative perception that HlVis contracted "through v • 4 ■ • promiscuity and therefore it is a punishment from God for-immorality. The avoidance of sex within marriage when couples find that they are both HIV positive appears only as a proposition; probably the decision would change when the reality dawns on the community. It further revealed that knowledge of a woman’s HlV positive status is likely to influence a couple’s child bearing decision but unlikely to influence contraceptive use especially condom. Although the religion frowns on premarital sex and has stringent sanctions for t those who flout the law, the study findings show that a number of unmarried youth are sexually active. However, the youth are in favour of condom use and are prepared to protect themselves against HIV/AIDS. In view of the findings of this study, it is recommended that strictly confidential and youth-friendly services be made accessible to the sexually active youth within the Gyidim community.. It will be necessary to empower such young people with life skills as well as information to enable them avoid unwanted sex. It is strongly recommended that education on the relation between HIV and STDs should be provided for the people of the Gyidim community. The fight to reduce the spread of HIV infection is likely to be successful if they are implemented within the general framework of reducing individuals’ vulnerability to infection. Thus the Gyidim community’s stand against premarital sex should be considered in HIV/AIDS intervention programmes and messages on condom use and keeping to one partner should be tactfully introduced and explained, particularly where the community is polygynous. Again, risks involved in polygynous relationships could be a useful strategy for intervention programmes It is also believed that the use of life testimonies of HIV infected persons could go a long way in changing perceptions held about People Lining with HIV/AIDS. Promoting Voluntary Counselling and Testing (VCT) services could also go a long way in helping people identify their status and seek the needed counselling to prevent the spread of HIV/AIDS. An effort should be made to educate and motivate religious leaders to engage their followers in discussions that will lead to a better understanding of the consequences of HIV/AIDS. To conclude, we believe t^iat the DHMT and District Assembly could use these findings to intensify education among the people in the Gyidim community towards changing the negative perception and behaviour on sexuality and Reproductive Health and making reproductive health decisions based on their knowledge, and perceptions on HIV/AIDS