i REGIONAL INSTITUTE FOR POPULATION STUDIES AT THE UNIVERSITY OF GHANA, LEGON. DETERMINANTS OF PEOPLE’S ATTITUDE TOWARDS PEOPLE LIVING WITH HIV/AIDS (PLWHA) IN GHANA BY RICHARD AMARTEY KWASHIE THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF PH.D. DEGREE IN POPULATION STUDIES January, 2014 University of Ghana http://ugspace.ug.edu.gh ii ACCEPTANCE NOTE Accepted by the Faculty of Social Studies, University of Ghana, Legon, in fulfillment of the requirement for the degree in Ph.D (Population Studies) Supervisors of Thesis: ………………………………….. Prof. J. K. Anarfi ………………………………… Date ………………………………….. Prof. Samuel Nii Ardey Cudjoe ………………………………… Date …………………………………. Prof S. O. Kwankye ………..………………………… Date University of Ghana http://ugspace.ug.edu.gh iii DECLARATION I hereby declare that, except for references to others people’s work which have been duly acknowledged, this work is the result of my own research and that it has neither in part nor in whole been presented elsewhere for another degree. ……………………………. Richard Amartey Kwashie (Candidate) ………………….. Date University of Ghana http://ugspace.ug.edu.gh iv DEDICATION I dedicate this thesis to my wife, Caroline and my children, Pearl, Constance, Theophilus, Esther and Jemima. University of Ghana http://ugspace.ug.edu.gh v ACKNOWLEDGEMENTS A number of individuals have helped a great deal to ensure the completion of this thesis. In fact, it has been the grace of God that has seen me this far. I wish to also thank the University of Ghana for first giving me the permission to do this course. Also, I express my profound gratitude to my supervisors namely Prof. J.K. Anarfi, Prof. E.O Tawiah, Prof. Samuel Nii Ardey Cudjoe and Prof. S. O. Kwankye and Dr. (Mrs) Delali Badasu for their guidance and invaluable suggestions as well as providing the needed encouragement particularly in very difficult times. Furthermore, I wish to thank all the colleagues and staff of RIPS who co-operated with me in diverse ways while doing this course. I must particularly mention Mr. Henry Tagoe, Mr. Eric August and Mrs. Rebecca Agbadzivor for their assistance in the data cleaning and analysis as well as providing secretarial services at very crucial periods of this project. I cannot forget my immediate family namely, my wife, Caroline and my children, Pearl, Constance, Theophilus, Esther and Jemima for assisting me when I had to combine academic and church duties. Their sacrifices during these eight years I undertook this study, will ever be remembered. To all these persons and others who in diverse ways assisted me complete this research, I pray that God will bless them. I must, however, emphasize that I am solely responsible for any errors and criticisms that may arise as a result of this study. Once again I pray for God’s blessing for all those who assisted during these eight years that I undertook this research. January, 2014 R.A. Kwashie University of Ghana http://ugspace.ug.edu.gh vi TABLE OF CONTENTS TITLE PAGE Title Page - - - - - - - - - i Acceptance Note - - - - - - - - ii Declaration - - - - - - - - - iii Dedication - - - - - - - - - iv Acknowledgements - - - - - - - - v Table of contents - - - - - - - - vi List of Tables - - - - - - - - - xi List of figures - - - - - - - - - xv Abbreviations and List of Acronyms - - - - - - xvi Abstract - - - - - - - - - xvii CHAPTER ONE: INTRODUCTION 1.1 Background to the Study - - - - - - 1 1.2 Statement of the Problem - - - - - - 3 1.3 Rationale of the Study - - - - - - 8 1.4 Objectives - - - - - - - - 9 1.5 Organization of the study - - - - - - 10 CHAPTER TWO: LITERATURE REVIEW 2.1 Introduction - - - - - - - - 11 2.1.1 Comprehensive Knowledge about AIDS - - - - 11 2.1.2 Knowledge of HIV Prevention Methods - - - - 14 2.1.3 Misconception about AIDS - - - - - - 18 2.1.4 Knowledge of HIV Transmission - - - - - 20 2.1.5 Attitude towards PLWHA - - - - - - 22 2.1.6 Comprehensive Knowledge about AIDS and Attitude Towards PLWHA - - - - - - - - 27 2.1.7 Knowledge about HIV Prevention Methods and Attitude Towards PLWHA - - - - - - - - 28 2.1.8 Misconception about AIDS and Attitude Towards PLWHA - - 28 2.1.9 Knowledge of HIV Transmission and Attitude Towards PLWHA - 29 University of Ghana http://ugspace.ug.edu.gh vii 2.2 Conceptual Framework - - - - - - 29 2.3 Hypotheses - - - - - - - - - 32 2.4 The Methodology of the Study - - - - - 33 2.4.1 Sources of Data - - - - - - - 33 2.4.2 Measurement of Variables - - - - - - - 37 2.4.3 Method of Analysis - - - - - - - 42 2.5 Definition of Concepts - - - - - - - 44 2.6 Limitations of the Study - - - - - - - 45 CHAPTER THREE: CHARACTERISTICS OF THE RESPONDENTS 3.1 Introduction - - - - - - - - 46 3.2 Sex - - - - - - - - - 46 3.3 Age - - - - - - - - - 47 3.4 Level of Education - - - - - - - - 48 3.5 Marital Status - - - - - - - - 49 3.6 Religious Affiliation - - - - - - - 50 3.7 Ethnicity - - - - - - - 51 3.8 Wealth Index - - - - - - - 53 3.9 Occupation - - - - - - - - 54 3.10 Type of Place of Residence - - - - - - 55 3.11 Comprehensive Knowledge about AIDS - - - - 56 3.12 Knowledge of HIV Prevention methods - - - - 56 3.13 Misconception about AIDS - - - - - - - 58 3.14 Knowledge of HIV Transmission - - - - - - 59 3.15 Attitude towards PLWHA - - - - - - - 60 3.16 Summary - - - - - - - - - 60 CHAPTER FOUR: SOCIO- DEMOGRPAHIC CHARACTERISTICS OF THE RESPONDENTS AND COMPREHENSIVE KNOWLEDGE ABOUT AIDS 4.1. Introduction - - - - - - - - - 61 4.2. Comprehensive Knowledge about AIDS - - - - - 63 4.2.1 Sex and Comprehensive Knowledge about AIDS - - - 63 University of Ghana http://ugspace.ug.edu.gh viii 4.2.2 Age and Comprehensive Knowledge about AIDS - - - 64 4.2.3 Level of Education and Comprehensive Knowledge about AIDS - 65 4.2.4 Marital Status and Comprehensive Knowledge about AIDS 66 4.2.5 Religious Affiliation and Comprehensive Knowledge about AIDS - 67 4.2.6 Ethnicity and Comprehensive Knowledge about AIDS - 69 4.2.7 Wealth Index and Comprehensive Knowledge about AIDS - 71 4.2.8 Occupation and Comprehensive Knowledge about AIDS - - 72 4.2.9 Type of Place of Residence and Comprehensive Knowledge about HIV 73 4.3 Knowledge of HIV Prevention Methods - - - - 74 4.3.1 Sex and Knowledge of HIV Prevention Methods - - - 75 4.3.2 Age and Knowledge of HIV Prevention Methods - - - 76 4.3.3 Level of Education and Knowledge of HIV Prevention Methods - 77 4.3.4 Marital Status and Knowledge of HIV Prevention Methods - 78 4.3.5 Religious Affiliation and Knowledge of HIV Prevention Methods 79 4.3.6 Ethnicity and Knowledge of HIV Prevention Methods - - 81 4.3.7 Wealth Index and Knowledge of HIV Prevention Methods - - 82 4.3.8 Occupation and Knowledge of HIV Prevention Methods - - 83 4.3.9 Type of Place of Residence and Knowledge of HIV Prevention Methods 85 4.4 Misconception about AIDS - - - - - - 86 4.4.1 Sex and Misconception about AIDS - - - - - 86 4.4.2 Age and Misconception about AIDS - - - - - 87 4.4.3 Level of Education and Misconception about AIDS - - - 88 4.4.4 Marital Status and Misconception about AIDS - - - 89 4.4.5 Religious Affiliation and Misconception about AIDS - - - 90 4.4.6 Ethnicity and Misconception about AIDS - - - - 92 4.4.7 Wealth Index and Misconception about AIDS - - - 93 4.4.8 Occupation and Misconception about AIDS - - - - 94 4.4.9 Type of Place of Residence and Misconception about AIDS - 96 4.5 Knowledge of HIV Transmission - - - - - - 97 4.5.1 Sex and Knowledge of HIV Transmission - - - - 97 4.5.2 Age and Knowledge of HIV Transmission - - - - 98 4.5.3 Education and Knowledge of HIV Transmission - - - 99 University of Ghana http://ugspace.ug.edu.gh ix 4.5.4 Marital Status and Knowledge of HIV Transmission - - - 100 4.5.5 Religious Affiliation and Knowledge of HIV Transmission - - 101 4.5.6 Ethnicity and Knowledge of HIV Transmission - - - 103 4.5.7 Wealth Index and Knowledge of HIV Transmission - - - 104 4.5.8 Occupation and Knowledge of HIV Transmission - - - 105 4.5.9 Type of Place of Residence and Knowledge of HIV Transmission - 106 4.6 Summary - - - - - - - - - 107 CHAPTER FIVE: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS AND ATTITUDE TOWARDS PLWHA 5.1 Introduction - - - - - - - - - 109 5.2 Sex and Attitude towards PLWHA - - - - - - 110 5.3 Age and Attitude towards PLWHA - - - - - - 111 5.4 Level of Education and Attitude towards PLWHA - - - - 114 5.5 Marital Status and Attitude towards PLWHA - - - - 116 5.6 Religious Affiliation and Attitude towards PLWHA - - - 118 5.7 Ethnicity and Attitude towards PLWHA - - - - 120 5.8 Wealth Index and Attitude towards PLWHA - - - - 122 5.9 Occupation and Attitude towards PLWHA - - - - 125 5.10 Type of Place of Residence and Attitude towards PLWHA - - 127 5.11 Summary - - - - - - - - - 129 CHAPTER SIX: COMPREHENSIVE KNOWLEDGE ABOUT AIDS AND ATTITUDE TOWARDS PLWHA 6.1 Introduction - - - - - - - - - 130 6.2 Comprehensive knowledge about AIDS and Attitude towards PLWHA - 130 6.3 Knowledge of HIV Prevention Methods and Attitude towards PLWHA - 132 6.4 Misconception about AIDS and Attitude towards PLWHA - - - 133 6.5 Knowledge of HIV Transmission and Attitude towards PLWHA - - 134 6.6 Summary - - - - -- - - - - 135 University of Ghana http://ugspace.ug.edu.gh x CHAPTER SEVEN: DETERMINANTS OF THE ATTITUDE OF THE RESPONDENTS TOWARDS PLWHA 7.1 Introduction - - - - - - - - - 136 7.2 Socio-Demographic Determinants of Attitude towards PLWHA - - 136 7.2.1 Sex - - - -- - - - - - 137 7.2.2 Age - - - - - - - - - 138 7.2.3 Education - - - - - - - - 139 7.2.4 Marital Status - - - - - - - - 140 7.2.5 Religious Affiliation - - - - - - - 141 7.2.6 Ethnicity - - - - - - - - 142 7.2.7 Wealth Quintile - - - - - - - 142 7.2.8 Occupation - - - - - - - - 143 7.2.9 Place of Residence - - - - - - - 144 7.2.10 Comprehensive Knowledge about AIDS - - - - 145 7.3 Summary - - - - - - - - - 148 CHAPTER EIGHT: SUMMARY, CONCLUSION AND RECOMMENDATIONS 8.1 Introduction - - - - - - - - 149 8.2 Summary - - - - - - - - 151 8.3 Conclusion - - - - - - - - - 153 8.4 Recommendations - - - - - - - - 153 REFERNECES - - - - - - - - - 155 University of Ghana http://ugspace.ug.edu.gh xi LIST OF TABLES TABLES PAGE 2.1 Distribution of Respondents interviewed in Tema and at Agomanya 37 3.1 Distribution of Respondents by Sex- - - - - - 47 3.2 Distribution of Respondents by Age - - - - - 48 3.3 Distribution of Respondents by Marital Status - - - 50 3.4 Distribution of respondents by Ethnicity - - - - 52 3.5 Distribution of Respondents by Occupational Groups - - 54 3.6 Distribution of Respondents by Comprehensive Knowledge about AIDS 56 4.1 Percentage Distribution of Respondents by Sex and Comprehensive Knowledge about AIDS - - - - - - 64 4.2 Percentage Distribution of Respondents by Age Group and Comprehensive Knowledge about AIDS - - - - 65 4.3 Percentage Distribution of Respondents by Level of Education and Comprehensive Knowledge about AIDS - - - - 66 4.4 Percentage Distribution of Respondents by Marital Status and Comprehensive Knowledge about AIDS - - - - 67 4.5 Percentage Distribution of Respondents by Religious Affiliation and Comprehensive Knowledge about AIDS - - - 69 4.6 Percentage Distribution of Respondents by Ethnicity and Comprehensive Knowledge about AIDS - - - - 70 4.7 Percentage Distribution of Respondents by Wealth Index and Comprehensive Knowledge about AIDS- - - - - 72 4.8 Percentage Distribution of Respondents by Occupation and Comprehensive Knowledge about AIDS - - - - 73 4.9 Percentage Distribution of Respondents by Type of Place of Residence Comprehensive Knowledge about AIDS - - - - 74 4.10 Percentage Distribution of Respondents by Sex and Knowledge of HIV Prevention Methods - - - - - - - 75 University of Ghana http://ugspace.ug.edu.gh xii 4.11 Percentage Distribution of Respondents by Age Group and Knowledge of HIV Prevention Methods - - - - - - 77 4.12 Percentage Distribution of Respondents by Level of Education and Knowledge of HIV Prevention Methods - - - - 78 4.13 Percentage Distribution of Respondents by Marital Status and Knowledge of HIV Prevention Methods - - - - - - 79 4.14 Percentage Distribution of Respondents by Religious Affiliation and Knowledge of HIV Prevention Methods - - - - 80 4.15 Percentage Distribution of Respondents by Ethnicity and Knowledge of HIV Prevention Methods - - - - - - 82 4.16 Percentage Distribution of Respondents by Wealth index and Knowledge of HIV Prevention Methods - - - - - - 83 4.17 Percentage Distribution of Respondents by Occupation and Knowledge of HIV Prevention Methods - - - - - - 84 4.18 Percentage Distribution of Respondents by Type of Place of Residence and Knowledge of HIV Prevention Methods - - - 86 4.19 Percentage Distribution of Respondents by Sex and Misconception about AIDS - - - - - - - 87 4.20 Percentage Distribution of Respondents by Age Group and Misconception about AIDS - - - - 88 4.21 Percentage Distribution of Respondents by Level of Education and Misconception about AIDS - - - - - 89 4.22 Percentage Distribution of Respondents by Marital Status and Misconception about AIDS - - - - - - 90 4.23 Percentage Distribution of Respondents by Religious Affiliation and Misconception about AIDS - - - - - - 91 4.24 Percentage Distribution of Respondents by Ethnicity and Misconception about AIDS - - - - - - 93 4.25 Percentage Distribution of Respondents by Wealth Index and Misconception about AIDS - - - - - - 94 4.26 Percentage Distribution of Respondents by Occupation and Misconception about AIDS - - - - - - 95 University of Ghana http://ugspace.ug.edu.gh xiii 4.27 Percentage Distribution of Respondents by Type of Place of Residence and Misconception about AIDS - - - - - - - 96 4.28 Percentage Distribution of Respondents by Sex and Knowledge of HIV Transmission - - - - - -- - - - 98 4.29 Percentage Distribution of Respondents by Age Group and Knowledge of HIV Transmission - - - - - - - - 99 4.30 Percentage Distribution of Respondents by Level of Education and Knowledge of HIV Transmission - - - - - - 100 4.31 Percentage Distribution of Respondents by Marital Status and Knowledge of HIV Transmission - - - - - - - - 101 4.32 Percentage Distribution of Respondents by Religious Affiliation and Knowledge of HIV Transmission - - - - - - 102 4.33 Percentage Distribution of Respondents by Ethnicity and Knowledge of HIV Transmission - - - - - - - - - 103 4.34 Percentage Distribution of Respondents by Wealth Index and Knowledge of HIV Transmission - - - - - - - - 104 4.35 Percentage Distribution of Respondents by Occupation and Knowledge of HIV Transmission - - - - - - - - 106 4.36 Percentage Distribution of Respondents by Type of Place of Residence and Knowledge of HIV Transmission - - - - - - 107 5.1 Percentage Distribution of Respondents by Sex and Attitude towards PLWHA - - - - - - - - - 111 5.2 Percentage Distribution of Respondents by Age Group and Attitude towards PLWHA - - - - - - - - - 113 5.3 Percentage Distribution of Respondents by Level of Education and Attitude Towards PLWHA - - - - - - - - 116 5.4 Percentage Distribution of Respondents by Marital Status and Attitude towards PLWHA - - - - - - - - 118 5.5 Percentage Distribution of Respondents by Religious Affiliation and Attitude Towards PLWHA - - - - - - - - 120 5.6 Percentage Distribution of Respondents by Ethnicity and Attitude towards PLWHA - - - - - - - - - 122 University of Ghana http://ugspace.ug.edu.gh xiv 5.7 Percentage Distribution of Respondents by Wealth Index and Attitude towards PLWHA - - - - - - - - 124 5.8 Percentage Distribution of Respondents by Occupation and Attitude towards PLWHA - - - - - - - - - 126 5.9 Percentage Distribution of Respondents by Type of Place of Residence and Attitude towards PLWHA - - - - - - - 128 6.1 Percentage Distribution of Respondents by Comprehensive Knowledge about AIDS and Attitude towards PLWHA - - - - - 131 6.2 Percentage Distribution of Respondents by Knowledge of HIV Prevention Methods and Attitude towards PLWHA - - - - - 133 6.3 Percentage Distribution of Respondents by Misconception about AIDS and Attitude towards PLWHA - - - - - - - 134 6.4 Percentage Distribution of Respondents by Knowledge of HIV Transmission and Attitude towards PLWHA - - - - - 135 7.1 Result of Multiple Regression Analysis on Attitude towards PLWHA by Characteristics of Respondents - - - - - - - 146 University of Ghana http://ugspace.ug.edu.gh xv LIST OF FIGURES FIGURES PAGE 2.1 Conceptual Framework showing the Interrelationships between some background variables of the respondents and their Attitude towards PLWHA - - - - - - - - 32 3.1 Distribution of Respondents by Level of Education - - - - 49 3.2 Distribution of Respondents by Religious Affiliation - - - 51 3.3 Distribution of Respondents by Wealth Index - - - - 53 3.4 Distribution of Respondents by Type of Place of Residence - - - 55 3.5 Distribution of Respondents by Knowledge of HIV Prevention Methods 57 3.6 Distribution of Respondents by Misconception about AIDS - - 58 3.7 Distribution of Respondents by Knowledge of HIV Transmission - - 59 3.8 Distribution of Respondents by Attitude Towards PLWHA - - 60 University of Ghana http://ugspace.ug.edu.gh xvi LIST OF ABBREVIATIONS AND ACRONYMS AIDS - Acquired Immune Deficiency Syndrome CDHS - Cambodia Demographic and Health Survey FHI - Family Health International GDHS - Ghana Demographic and Health Survey GHS - Ghana Health Service GAC - Ghana AIDS Commission GSS - Ghana Statistical Service HIV - Human Immunodeficiency Virus ICRW - International Center for Research on Women IEC - Information Education Communication IFHS - India Family and Health Survey IRIN - Integrated Regional Information Network KDHS - Kenya Demographic and Health Survey LDHS - Liberia Demographic and Health Survey MDHS - Malawi Demographic and Health Survey MIDHS - Marshal Island and Demographic and Health Survey NACP - National AIDS Control Programme PLWHA - People Living with HIV/AIDS SDA - Seventh Day Adventist STI - Sexually Transmitted Infection STIs - Sexually Transmitted Infections TB - Tuberculosis TDHS - Tanzania Demographic and Health Survey UNAIDS - United Nations Joint Programme on AIDS UNDP - United Nations Development Plan UNFPA - United Nations Population Fund UDHS - Uganda Demographic and Health Survey VCT - Voluntary Counselling and Testing WHO - World Health Organization University of Ghana http://ugspace.ug.edu.gh xvii ABSTRACT The study on attitude towards PLWHA was conducted as part of the effort at understanding some of the problems that face PLWHA in Ghana, with the general objective of examining the magnitude of the problem of attitude towards PLWHA. A total of 4916 women aged 15-49 years and 4568 men aged 15-59 years were interviewed in the 2008 Ghana Demographic and Health Survey (GDHS), however 5472 respondents consisting of 2816 women aged 15-49 years and 2656 men aged 15-59 years were used for the analysis because they responded to the questions on HIV. The qualitative method was used to collect the primary data for the study. In-depth interview was used to collect data from PLWHA in Tema and Agomanya. The study targeted 150 PLWHA, 80 at Agomanya (45 women and 35 men) and 70 in Tema (40 women and 30 men), but the number was limited to 60, 25 from Tema (14 women and 11 men) and 35 from Agomanya (21 women and 14 men) because these were the PLWHA who were willing to co- operate. The women were aged 20-54 years whiles the men were aged 21-57 years. Purposive sampling was used to collect data for the study, that is, interviewing people who have been diagnosed as having the disease. Univariate, biavariate and multivariate analyses techniques were used in analyzing and presenting the result. The univariate methods such as frequency distributions were used to describe the distribution of respondents by selected socio-demographic characteristics, comprehensive knowledge about AIDS (Knowledge of HIV prevention methods, misconception about AIDS and Knowledge of HIV transmission) and attitude towards PLWHA. The bivariate analysis seeks to investigate the association between the independent variables, (socio- demographic characteristics) and the intermediate variables (Comprehensive knowledge about AIDS, Knowledge of HIV prevention methods, misconception about AIDS and Knowledge of HIV transmission), Independent and dependent variables (attitude towards PLWHA). Bivariate analysis was also conducted between the intermediate variable (Comprehensive knowledge about AIDS, its components which are knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission) and the dependent variable (attitude towards PLWHA). The chi-square test was used to test the differences between proportions at alpha level of 0.05. Ordered logistic regression model was used to determine the socio-demographic factors that predict respondents attitude towards PLWHA controlling for the level of comprehensive knowledge of respondents about AIDS. The outcome variable for the regression model is attitude towards PLWHA. The independent variable (socio- demographic factors) are sex, age, level of education, marital status, religious affiliation, ethnicity, wealth index, occupation and type of place of residence. Comprehensive knowledge about AIDS is a scale measurement made up of knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission was treated as the intermediate variable. The multivariate analysis also revealed that sex, marital status, education, wealth index and comprehensive knowledge about AIDS are statistically significant in predicting attitude towards PLWHA. The findings from the multivariate analysis also confirms the result from the bivariate analysis and the qualitative data. University of Ghana http://ugspace.ug.edu.gh xviii The study also confirmed all the three hypotheses namely: (i) Education is positively related to positive attitude towards PLWHA (ii) Wealth index is positively related to positive attitude towards PLWHA (iii) Comprehensive knowledge about AIDS is positively related to positive attitude towards PLWHA The study found out that the explanatory factors that contributed to attitude towards PLWHA are sex, education, marital status, wealth index and comprehensive knowledge about AIDS. In addition to these factors, age, religious affiliation, ethnicity, occupation and type of place of residence have been found to be important factors in understanding attitude towards PLWHA. Based on the findings of the study the following recommendation are made: 1) Erreneous beliefs and misconceptions are obstacles in fighting against stigmatization and discrimination and also tend to encourage the spread of HIV disease. Since more than 60 per cent of the respondents have some misconception about AIDS, programme implementor should promote and sustain their IEC (Information Education Communication interventions. 2) To control the spread of the disease, it is crucial to address stigmatization discrimination against those with the disease. As a result of reduced stigma, those infected may be more likely to access the health system earlier without fear of being sigmatized, judged, blamed or discriminated against. Attempt at promoting positive attitude towards PLWHA should continue to be a major component of GAC’s programmes. The use of community leaders in communication and education effort is a key strategy for disseminating accurate information about AIDS to most people. 3) Since education is significantly associated with attitude towards PLWHA, it is essential for the Ministry of Education in Ghana to incorporate appropriate HIV education and information about other sources of the disease into school curricular. But the out of school population should also be targetted for education on HIV 4) Lastly, community and church mobilization, political involvement, policy development and health education are important and necessary to challenge misconception about the disease and change stigmatizing, discriminating and negative attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 1 CHAPTER ONE INTRODUCTION 1.1 Background to the Study Globally, an estimated 35.3 (32.2 ± 38.8) million people were living with Human Immundeficiency Virus (HIV) in 2012. An increase from previous years, as more people are receiving the life-saving antiretroviral therapy. There were 2.3 (1.9 ± 2.7) million new HIV infections globally, showing a 33.0 per cent decline in the number of new infections from 3.4 (3.1 ± 3.7) million in 2001, (United Nations Joint Programme on HIV/AIDS (UNAIDS), 2013). At the same time the number of Acquired Immune Deficiency Syndrome (AIDS) deaths is also declining with 1.6 (1.4 ± 1.9) million AIDS deaths in 2012, down from 2.3 (2.1 ± 2.6) million in 2005 (UNAIDS, 2013). Sub ± Saharan Africa bears the greatest burden with more than two thirds (69 per cent) of all persons infected with HIV. An estimated 1.8 million persons (330,000 in children less than 15 years) became infected with HIV in Sub± Saharan Africa, out of the 2.5 million globally, whiles 1.7 million deaths are estimated to have occurred globally from HIV and AIDS during 2011, 70.6 per cent of which occurred in Sub ± Saharan Africa, (National AIDS/STI Control Programme, (NACP), 2013). In Ghana, although HIV prevalence is low, it is firmly established within the whole society, and sub±populations with higher prevalence and risk of transmission constitute a reservoir for sustaining the epidemic. According to Ghana’s HI9 and AI'6 (stimates and Projections report for 2011, the estimated number of persons living HIV and AIDS in Ghana in 2012 was 222,124 made up of 123,485 females and 98,639 males giving a female: male ratio of University of Ghana http://ugspace.ug.edu.gh 2 1.3:1. In the same year, there were an estimated 28,508 children living with HIV and 1,083 children newly infected out of a total 10, 961 new infections (females: 5,127 and males 5,834). Also 12,658 annual AIDS deaths were projected to occur for the same year (NACP, 2013). The Median HIV prevalence for 2012 is 2.1 per cent. The prevalence at regional level ranged from 0.9 per cent in the Northern Region to 3.6 per cent in the Eastern Region (NACP, 2013). HIV prevalence in urban areas was higher than in rural areas. The mean and mean HIV prevalence of urban communities were 2.8 per cent and 2.6 per cent respectively, and 1.7 per cent for rural sites. The highest prevalence within urban sites was 10.1 per cent in Agomanya followed by Obuasi and Korle Bu in that order, and the lowest was in Nalerigu (NACP, 2013). Since its inception in the early 1980s, HIV continues to have a tremendous effect in the world. Nowhere is this felt more than in Sub-Saharan Africa where the tremendous impact has not only been on morbidity and mortality, but also on family structure, social organizations, and economics. The first case of AIDS was reported in Ghana in March 1986 with 43 cases (Anarfi and Awusabo-Asare, 1993). It has been demonstrated that increased knowledge about AIDS is not a predictor for behavioural change although knowledge about the disease is a prerequisite for change (Onah et. al., 2004). According to UNAIDS, only 44.0 per cent of men and 38.0 per cent of women aged 15 to 24 in Ghana correctly identify ways to prevent HIV (UNAIDS, 2007). In spite of the above, of those aged 15-24 years, 3.9 per cent of men and 7.4 per cent of women had sexual intercourse and the percentage of young people aged 15-24 years who used condoms the last time they had sex with a casual partner was 52.0 per cent (men) and 33.0 per cent (women) (UNAIDS, 2007). There is no doubt that the above has implications for propagation of HIV in the country. University of Ghana http://ugspace.ug.edu.gh 3 The United Nations Integrated Regional Information Networks (IRIN) on Africa also indicated that the Ghanaian government’s AI'6 programme is in danger of failure due primarily to stigma and failing health system (IRIN, 2005). Identifying the predictors of attitude towards People Living with HIV/AIDS (PLWHA) and designing effective interventions may be key to ensuring successful AIDS prevention and treatment programme and thus successful reversal of the AIDS epidemic. The purpose of this research is to determine the predictors of attitude towards PLWHA and to find out from the PLWHA how they are treated by the members of the community. 1.2 Statement of the Proble m Right from the early stages, the AIDS epidemic has been accompanied by fear, ignorance, and denial, leading to stigmatization of and discrimination against PLWHA and their family members (International Center for Research on Women (ICRW), 2002). The fear of being identified with HIV prevents people from finding out their sero-status, changing unsafe behaviour, and caring for people living with AIDS. A study in Ghana found that stigma against HIV-positive people and fear of mistreatment prevented people from participating in voluntary counseling and testing programmes. They refuse to go to hospital when they are sick for fear that they may be diagnosed HIV positive and become victims of stigmatization (United Nations Development Programme (UNDP), 2005). The stigma and its resulting discrimination also intensify the pain and suffering of both PLWHA and their families. It must be noted that at the onset of the AIDS epidemic, the disease was mainly found among groups who are already socially marginalized and discriminated against (Letamo, 2003). These groups included homosexuals, injection drug users and commercial sex workers. To University of Ghana http://ugspace.ug.edu.gh 4 anybody belonging to these groups, AIDS means additional stigmatization whether or not they are infected. People living with the disease may become implicitly associated with stigmatized behaviours, regardless of how they actually became infected. The stigmatized find themselves ostracized, rejected, shunned and many experience sanctions, harassment, and even violence because of their infection or association with AIDS (Antwi and Atobrah 2009). Discrimination against them may stem from fear due to lack of knowledge about how HIV can or cannot be transmitted. Since discrimination often includes public restrictions and some forms of punishment, it can be more frequently identified (UNDP, 2005). The illness, AIDS is as much about social phenomena as it is about biological and medical concerns. Across the world, the global pandemic of AIDS has shown itself capable of triggering responses of compassion, solidarity and support, bringing out the best in people, their families and communities. But the disease is also associated with stigma, ostracism, repression and discrimination as individuals affected (or believed to be affected) by HIV have been rejected by their families, their loved ones and their communities. This rejection holds true in the rich countries of the global North as it does in the poorer and developing countries of the global South. In Ghana, and many countries of Sub-Saharan Africa, HIV transmission occurs primarily through heterosexual intercourse. In these countries, HIV is widely viewed as a consequence of sexual immorality or immoral behaviours, thus, infected individuals are considered responsible for acquiring the disease. In some cases, the infection is perceived as a punishment given by God to perpetuators of sin like prostitution, drug use or homosexuality (Ayanraci, 2005). Discrimination against PLWHA is an important issue in Ghana in view of its socio- economic, demographic and health effects on the country. Stigmatization of PLWHA in Ghana University of Ghana http://ugspace.ug.edu.gh 5 presents social, economic, demographic and health problems with serious implications for the development of the nation. The social implications of stigmatization attached to being a PLWHA are dire, and are expressed in various forms of antisocial behaviour including PLWHA doing all that they can to conceal their HIV status; some avoid going to hospital for treatment; PLWHA resort to social disengagement. Some members of the community refuse to go to hospital when they are sick for fear that they may be diagnosed HIV positive and become victims of stigmatization. Attitude towards PLWHA can range from a simple gossip to outright discrimination, resulting in job loss, house eviction, rejection, isolation and even killing of an HIV infected person. It can stem from legislative, employment policies, hospital policies, cultural beliefs or individual behaviours, thoughts and attitudes (Boer and Emons, 2004). Attitude towards PLWHA have been linked to misconception about the disease, fear by the disease due to its manifestation and fatality, and to the association of AIDS with stigmatized/marginalized individuals in the community (Boer and Emons, 2004). In Ghana, HIV positive persons therefore hide their HIV-seropositive status to reduce AIDS - related attitude, stigma and discrimination and to retain the care and support of family members. Ironically this secrecy hinders uptake of treatment and of support services that can be provided by a family member (Mill, 2003). People who feel stigmatized or discriminated against are more likely to have poor health outcomes, socio-psychological problem and suicidal thought (Katz and Nevid, 2005). Therefore, tackling attitude towards PLWHA will involve tackling the problem of knowledge of transmission and prevention of HIV and some characteristics of the people in the society. University of Ghana http://ugspace.ug.edu.gh 6 Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problem (World Health Organization (WHO) , 2000). Obesity is stigmatized in much of the modern world (particularly the western world) though it is widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world. (Woodhouse, 2008). Like AIDS, the social stigma of obesity has created negative psychological impact and has caused disadvantages for overweight and obese people. (Haslam et.al., 2005). The social stigma often spans one entire life, starting from young age and lasting into adulthood. Obese people are considered as weak±willed, lazy and less intelligent compared to their thinner counterparts. The AIDS stigma is commonly experienced around the world by those with epilepsy (Boer 2010). It can affect people economically, socially and culturally (Boer 2010). In India and China epilepsy may be used as justification to deny marriage (WHO, 2013). Before 1970 the United Kingdom had laws which prevented people with epilepsy from marrying (WHO, 2013). In some areas of the world epilepsy is believed to be contagious which it is not (Newton, 2012). Others still believe those with epilepsy to be cursed (Newton, 2012). The stigma may result in some people with epilepsy denying that they have ever had seizures. (Neligan et.al., 2011) Because AIDS affects people in their prime working ages, stigmatization and discrimination against such persons have led to some businesses suffering severe effects. In high prevalence countries, the stigmatization and discrimination of PLWHA is leading to the consumption of business profit because of three primary factors: increased operating costs, decreased productivity and declining market. (UNDP, 2005). University of Ghana http://ugspace.ug.edu.gh 7 In Ghana, more than 80 per cent of AIDS cases are found among adults aged 15-49 years (NACP & GAC, 2004 ). Since this is the most economically productive segment of the population, discrimination against such people can have a negative consequence for socio- economic development of the country. This is because such workers might have difficulty keeping their job if they are found to be HIV positive and face stigmatization. Since Ghana is an agricultural producing country, stigmatization of PLWHA in the agricultural sector will threaten agricultural production and food security. Discrimination of PLWHA can disrupt agricultural production and undermine the country's export capacity and thus its ability to earn foreign exchange. There exists little research in Ghana dealing with how PLWHA or suspected of having HIV/AIDS are perceived and treated because of their illness. However, it is quite evident from studies done elsewhere that PLWHA are unfairly treated and/or discriminated against because of their actual or suspected HIV/AIDS status (ICRW, 2002). The present study examined the factors that determine the stigmatization of PLWHA in Ghana. In examining stigmatization of PLWHA it is important to find out the following: i. Does people’s socio- demographic characteristics have implication for attitude towards PLWHA? ii. Is there any relationship between people’s knowledge of AIDS prevention methods and attitude towards PLWHA? iii. Do people’s misconception about AIDS have implication for attitude towards PLWHA? iv. Do people’s comprehensive knowledge about AIDS have implication for attitude towards PLWHA? University of Ghana http://ugspace.ug.edu.gh 8 It is clear that the issue of stigmatization of PLWHA is a complex one and will require a comprehensive research such as the current study in order to resolve the complex questions that surround it. It is hoped that the findings of the study in Ghana will inform and guide policy programmes aimed at reducing stigmatization of PLWHA in the country. 1.3 Rationale of the Study The study is important and timely for a number of reasons. The first is the acknowledgement that people’s attitude towards PLWHA has become a problem of national interest and concern, as a result of this, the GAC highlights the attitude towards PLWHA as one key area that requires attention. A research of this nature is therefore relevant in bringing to the fore the various dimensions of attitude towards PLWHA to attract increased government attention and support. The importance of a study of this magnitude can therefore not be underestimated. The current study is also important because Ghana has benefited from a number of pilot surveys conducted by the NACP, Ghana Health Service (GHS) and (GAC). The study therefore offers an opportunity to examine people’s attitude towards PLWHA in Ghana to guide future programmes that focuses on attitude towards PLWHA. The study is also timely and important on account of effort by the NACP, the GAC and other related organizations in reducing the problem of discrimination against PLWHA. This is because since Sexually Transmited Infection (STI) and AIDS infection occurs mostly among Ghanaians in their reproductive age group, a research of this nature could assist a great deal in offering concrete recommendations for the implementation of the HIV programme with special reference to people’s attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 9 It is also important to indicate that, the 2008 GDHS did not collect qualitative information on the experience of PLWHA in their family, community, at their place of work and in the use of public facilities such as, hospitals, schools and transport, to permit a thorough analysis of the problem of people’s attitude towards PLWHA in Ghana. This has created a research gap which this study attempts to fill. 1.4 Objectives The general objective of the study is to examine the determinants of people’s attitude towards PLWHA in Ghana. The specific objectives are: i. To examine the relationship between the respondents socio- demographic characteristics and their attitude towards PLWHA. ii. To examine respondents knowledge of HIV prevention methods and their attitude towards PLWHA. iii. To examine the respondents misconceptions about AIDS and their attitude towards PLWHA. iv. To examine respondents knowledge of HIV transmission and their attitude towards PLWHA. v. To examine the respondents comprehensive knowledge about AIDS and their attitude towards PLWHA. vi To make policy recommendations on addressing the problem of negative attitude towards PLWHA in Ghana based on the findings of the study. University of Ghana http://ugspace.ug.edu.gh 10 1.5 Organisation of the Study The study is organized into eight chapters. The first chapter, which is the introduction, provides the background to the study, the problem statement, the rationale for the study, the objectives and the organization of the study. Chapter two shows the literature review, conceptual framework, the methodology of the study, definition of concepts and the limitations of the study. Chapter three discusses characteristics of the respondents in the study with respect to their sex, age, level of education, marital status, religious affiliation, ethnicity, wealth status, occupation, place of residence, comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS, Knowledge of HIV transmission and attitude towards PLWHA. Chapter four examines the relationship between the socio- demographic characteristics of the respondents and comprehensive knowledge about AIDS. Chapter five shows the relationship between socio- demographic characteristics and attitude towards PLWHA among the respondents. It also uses qualitative data on how PLWHA are treated by the members of the community to support or refute the findings of the quantitative data Chapter six examines the comprehensive knowledge about AIDS and attitude towards PLWHA. Chapter seven examines determinants of the respondent’s attitude towards PLWHA using ordered logistic regression model. Finally, chapter eight provides a summary of the key findings of the study. It also makes relevant conclusions and recommendations. University of Ghana http://ugspace.ug.edu.gh 11 CHAPTER TWO LITERATURE REVIEW 2.1 Introduction Attitude towards PLWHA has attracted much research throughout the world in recent times. This stems from the increasing number of people who have been infected by HIV, the attitude towards them and its effect on their socio-economic development and the wider society. 7he literature reviewed covers determinants of people’s attitude towards people living with the disease. The conceptual framework and the methodology are derived from the literature review and they are also presented in this chapter. 2.1.1 Comprehensive Knowledge about AIDS Comprehensive knowledge about AIDS is defined as knowing that both condom use and limiting sexual partners to one HIV-negative person are HIV prevention methods, being aware that a healthy-looking person can have HIV and rejecting the two most common local misconceptions that AIDS can be transmitted by mosquito bites and by supernatural means. A study by Deborah and Lahiri (1997), in India on awareness and knowledge of AIDS among India women: evidence from 13 states indicated that rural, poorly educated and poor women are the least likely to be AIDS ±aware and if aware have the poorest understanding of the syndrome. Another study in Ghana by Anarfi (1997) on vulnerability to sexually transmitted disease: street children in Accra revealed that knowledge about AIDS was significant among males (96.7 per cent) than females (87.8 per cent). University of Ghana http://ugspace.ug.edu.gh 12 Another study by Ulasi et. al., (2009) on HIV related stigma in Kumasi, Ghana, indicated that the sex, age, marital status, religious affiliation and occupation of the respondents are associated with their knowledge of someone living with AIDS or someone who has died of AIDS. The respondents with the knowledge was higher among the males (70.3 per cent) and lower among the females (29.7 per cent). Also, 64.7 percent of the respondents aged at least 30 years have the knowledge while 35.3 per cent of those younger than 30 years of age have the same knowledge. By marital status, the proportion was 65.0 per cent among the married respondents and 35.0 per cent among the single. With regards to education, the proportion was highest among the respondents with greater than secondary education (55.9 percent) and lowest among those with less than a secondary education (44.1 per cent). The proportion among the Christians and Moslem was 70.3 per cent and 29.7 per cent respectively. The percentage among the employed and the unemployed was 57.1 per cent and 42.9 per cent respectively. The 2010 Tanzania Demographic and Health Survey (TDHS) also reported that education, wealth and place of residence are related to comprehensive knowledge about AIDS (National Bureau of Statistics and Macro International Inc., 2011). As expected, the proportion with knowledge of the disease increased from 32.0 per cent to 62.0 per cent among women with no education and higher education respectively, while the proportion increased from 26.0 per cent to 59.0 per cent among men with no education and higher education respectively. With wealth quintile, the proportion increased from 39.0 per cent to 59.0 per cent among women with the lowest and highest quintile respectively. Similarly, the proportion increased from 33.0 per cent to 58.0 per cent among men with the lowest and highest quintile respectively. By place of residence, the proportion was 57.0 per cent among women in the urban areas and University of Ghana http://ugspace.ug.edu.gh 13 49.0 per cent among those in the rural areas while the proportion was 58.0 per cent among the men in the urban areas and 41.0 per cent among those in the rural areas. However, there are no clear pattern between sex, age, marital status, religious affiliation, ethnicity and occupation and comprehensive knowledge about AIDS. Another study by Bin et. al., (2010) on Sexually Transmitted Disease (STD) HIV-related knowledge, attitude and practices and influencing factors among people of childbearing age in Shanghai, China, observed that wealth and level of education were factors influencing knowledge about AIDS. The 2010 Malawi Demographic and Health Survey (MDHS) also reported that sex, wealth status, place of residence and education of the respondents are associated with their comprehensive knowledge about AIDS. For example, 41.0 per cent of the women and 45 per cent of the men have comprehensive knowledge about the disease. With regards to place of residence, the proportion was 54.6 per cent among the women in the urban areas and 37.9 per cent among those in the rural areas. Similarly, among the men, it was 55.5 per cent in the urban areas and 49.1 percent among those in the rural areas. The proportion of the respondents with comprehensive knowledge about AIDS generally rises with increasing level of education and wealth quintile. For example, the percentage increased from 29.8 percent among women with no education to 70.1 per cent among those with more than secondary education. In the case of the men, the proportion increased from 27.0 percent among the respondents with no education to 57.0 per cent among those with secondary education before decreasing slightly to 53.0 per cent among those with more than secondary education. In terms of wealth quintile, the proportion rose from 33.3 per cent among women in the lowest quintile to 53.3 percent among those in the highest quintile. Similarly, among the men University of Ghana http://ugspace.ug.edu.gh 14 the percentage increased from 35.5 per cent among the respondents in the lowest quintile to 53.4 per cent among those in the highest quintile. 'iscrimination and stigmati]ation of PLWHA depend on people’s comprehensive knowledge of how the disease is prevented, transmitted and misconceptions about the disease. A study by Oljira et. al., (2012) on the assessment of comprehensive AIDS knowledge level among in-school adolescent in Eastern Ethiopia noted that gender and family wealth of the respondents are associated with their comprehensive knowledge of AIDS. 2.1.2 Knowledge of HIV Prevention Method s Controlling the spread of HIV is one of the major objectives in the fight against HIV infection. The challenge is to substantially reduce new HIV infection among the sexually active population thereby reducing the problem of discrimination and stigmatization of PLWHA. This is done through the promotion of safer sexual behaviour including abstinence, condom use and promoting sex with a single partner who is not infected and who has no other partners. The essence of this section is therefore to determine the factors that affect knowledge of HIV prevention methods. In his study on the vulnerability of sexually transmitted disease amongst street children in Accra, Anarfi, (1997) noted that sex was significantly associated with safer sex. Male respondents (10.8 per cent) indicated that using a condom as protective measure against HIV than females (8.9 per cent). Also, 30.0 per cent of the males mentioned that avoiding casual sex was another preventive measure against HIV/AIDS compared with 28.8 percent of their female counterparts. The study further stated that 10.3 per cent of the males mentioned that the use of own blades as a preventive measure than females 8.5 per cent. Another study conducted by University of Ghana http://ugspace.ug.edu.gh 15 Ntozi et. al., (2000) in Uganda on AIDS awareness and sexual behaviors indicated that knowledge of sexual abstinence as a protective measure was significantly associated with education and occupation. The result of the 2006 India Family Health Survey (IFHS) also shows that sex, education, religion, ethnicity, wealth index, occupation and type of place of residence are related to knowledge of HIV prevention methods. The proportion among the women was 32.3 per cent compared to 64.9 per cent among the men. Knowledge of HIV prevention methods increases with rising level of education. It rose from 10.0 per cent among the women with no education to 76.2 per cent among those with 12 or more years completed education. Similarly, among the men the proportion rose from 29.0 per cent among those with no education to 89.7 per cent among those with 12 or more years completed education. In terms of religion, the proportion was lower among Christians and highest among those who belong to the Jain religion. With the women, the proportion among the Christians was 44.8 per cent compared to 72.5 per cent among those in the Jain religion. Similarly, among the men, the proportion of the Christians was 64.1 per cent compared to 91.7 per cent among those who belong to the Jain religion. In the case of ethnicity, the proportion rose from 16.7 per cent among women who belong to the scheduled tribe to 43.4 percent among those who belonged to other backward class. Among the men, it rose from 44.7 percent among those who belong to the scheduled tribe to 71.1 per cent among those who belong to other backward class. By wealth quintile, the proportion increased from 7.6 per cent among women in the lowest quintile to 64.2 per cent among those in the highest wealth quintile. Similarly, the percentage increased from 34.1 per cent among men in the lowest quintile to 85.8 per cent among those in the highest quintile. Knowledge of HIV prevention methods was lower among University of Ghana http://ugspace.ug.edu.gh 16 women who are unemployed (38.8 per cent) and higher among those in the professional occupations (76.4 per cent). Similarly, the percentage was lower among the men who are unemployed (82.8 per cent) and higher among those in the professional occupation (92.5 per cent). The proportion of respondents with knowledge of HIV prevention methods was lower among women in the rural areas (23.5 per cent) and higher among those in the urban areas (50.5 percent). Similarly, the proportion was lower among the men in the rural areas (57.1 per cent) and higher among those in the urban areas (78.5 per cent). However, the survey found no definite pattern between marital status and knowledge of HIV prevention methods. The 2007 Liberia Demographic and Health Survey (LDHS) also reported that sex, education, wealth index, place of residence, are significantly associated with knowledge of HIV prevention methods. Thus, knowledge is far higher among the men than women for each of the three specified methods. It is 66.3 per cent among the men and 44.3 per cent among the women. The proportion increased from 37.0 per cent among the women with no education to 56.8 per cent among those with secondary and higher education. Similarly, the proportion rose from 53.3 per cent among those with no education to 76.6 per cent among those with secondary and higher education among the men. In terms of wealth quintile, the proportion is highest among the women in the highest wealth quintile (55.1 per cent) and lowest among those in the lowest wealth quintile (33.8 per cent). Similarly, the proportion is highest among the men in the highest wealth quintile (75.2 per cent) and lowest among those in the lowest wealth quintile (54.0 per cent). The proportion rose from 37.0 per cent among the women in the rural areas to 54.2 per cent among their counterparts in the urban areas. Similarly, the proportion rose from 60.4 per cent among the men in the rural areas to 75.0 per cent among their counterparts in the urban areas. University of Ghana http://ugspace.ug.edu.gh 17 The 2007 Marshal Island Demographic and Health Survey (MIDHS) also reported that sex, age, education, wealth quintile and place of residence of the respondents were significantly associated with their knowledge of HIV prevention methods. The result shows that knowledge of HIV prevention methods was higher among the men (86.7 per cent) than the women (67.0 per cent). Also, 69.4 per cent of the women aged 25 years and above have knowledge of HIV prevention methods compared with 63.2 per cent of their counterparts aged 24 years and below. Similarly, 88.1 per cent of the men aged 25 years and above have knowledge of HIV prevention methods compared 84.0 per cent of their colleagues aged 24 years and below. As expected the proportion of respondents with knowledge of the disease increased from 63.9 per cent among women with no education to 71.0 per cent among those with more than secondary education. Similarly, the proportion increased from 82.7 per cent among men with no education to 92.1 per cent among their counterparts with more than secondary education. By wealth quintile, the proportion increased from 65.7 per cent among women in the lowest wealth quintile to 71.0 per cent among those in the highest wealth quintile. Similarly, the percentage increased from 83.0 per cent among men in the lowest wealth quintile to 90.2 per cent among those in the highest wealth quintile. The respondents with knowledge of the disease was also higher among women in the urban areas (69.4 per cent) than those in the rural areas (62.1 per cent). Similarly, the proportion was higher among the men in the urban areas (87.4 per cent) than those in the rural areas (85.2 per cent). There was no clear pattern between marital status, religious affiliation, occupation and knowledge of HIV prevention methods. A study on HIV awareness and knowledge among secondary school students in China indicated that sex and age were significantly associated with knowledge of HIV prevention University of Ghana http://ugspace.ug.edu.gh 18 methods, Zhao et. al., (2009). Another study on knowledge levels and misconception about AIDS in Turkey: what do university students really know? shows that sex and age were significantly associated with knowledge of HIV prevention methods, Frain et. al. (2012). 2.1.3 Misconception about AIDS Misconception about AIDS is one of the factors that influence attitude towards PLWHA. This section therefore examines the factors that determine misconception about AIDS. A research on sexual networking in Freetown against the background of the AIDS epidemic revealed that misconception about HIV differed among sex. Babatola and Oni (1995) revealed that more males (77.6 per cent) responded that HIV can be transmitted through sexual intercourse than females (75.0 per cent). Similarly, 10.5 per cent of males compared with 9.5 per cent of females indicated that HIV can be transmitted through blood transfusion. The study further revealed that more of females (7.4 per cent) reported that HIV can be cured through spiritual means than males (6.6 per cent). They also observed differences in education and place of residence. A higher proportion of the respondents with higher education and a greater number of them in urban areas indicated that HIV cannot be contracted by touching someone with the disease. The 2009 Kenya Demographic and Health Survey (KDHS) shows that sex, education, wealth status and place of residence are associated with rejection of misconception about AIDS. For instance, 62.5 per cent of women and 68.1 per cent of men correctly rejected misconceptions about AIDS. As expected, the respondents who correctly rejected misconception about the disease increased from 25.0 per cent among women with no education to 80.1 per cent among University of Ghana http://ugspace.ug.edu.gh 19 their counterparts with higher education. The proportion rose from 26.2 per cent among men with no education to 83.1 per cent among their counterparts with higher education. By wealth quintile, the proportion rose from 39.8 per cent among the women in the lowest wealth quintile to 75.0 per cent among their counterparts in the highest wealth quintile, whilst the proportion increased from 49.1 per cent among the men in the lowest wealth quintile to 80.7 per cent among their counterparts in the highest wealth quintile. According to type of place of residence, the percentage increased from 59.1 per cent among the women in the rural areas to 72.4 per cent amongst those in the urban areas. The proportion also increased from 64.1 per cent among the men in the rural areas to 81.5 per cent among those in the urban areas. However, there was no definite pattern between age, marital status, ethnicity, religious affiliation, occupation and misconception about AIDS. The 2010 Cambodia Demographic and Health Survey (CDHS) report also shows that sex, education, wealth quintile and place of residence are associated with misconception about AIDS. The result of the survey shows that 46.8 per cent of the women and 48.5 per cent of the men correctly rejected the misconception about AIDS. The proportion that correctly rejected misconception about the disease also increases with rising level of education. It was 26.6 per cent among women with no education to 69.3 per cent among those with higher secondary education. Similarly, 20.0 per cent of men with no education correctly rejected misconception about AIDS compared with 62.3 percent of those with secondary and higher education. The result further shows that the respondents in the lowest wealth quintile are worse off in terms of rejection of misconception of the disease. Among the women, only 31.5 per cent in the lowest wealth quintile rejected the misconception compared to 62.9 per cent of those in the highest quintile. Similarly, the proportion was 32.3 per cent among the men in the lowest wealth University of Ghana http://ugspace.ug.edu.gh 20 quintile compared to 69.2 per cent among those in the highest wealth quintile. The proportion of the respondents who rejected the common misconception about AIDS was higher in the urban areas than in the rural areas. Among the women, the proportion was 60.1 per cent among those in the urban areas and 43.2 per cent among those in the rural areas. Similarly, the proportion was 72.2 per cent among the men in the urban areas and 42.2 per cent among those in the rural areas. The report however shows that there is no clear pattern between age, marital status, religious affiliation, ethnicity, occupation of the respondents and their misconception about AIDS. 2.1.4 Knowledge of HIV Transmiss ion Knowledge of HIV transmission is an important factor that affects attitude towards PLWHA. A study by Ntozi et. al., (2000) in Uganda showed that knowledge of mechanisms of AIDS transmission was significantly associated with respondent’s level of education and type of occupation. Knowledge that the disease can be transmitted through unprotected sex, unsterilized instrument and blood transfusion increased with education. Policy makers had the highest knowledge of the three ways through which AIDS has spread, perhaps because of their higher education. The study also shows that knowledge of AIDS transmission did not differ much with age, residence or religion. According to the result of the 2006 Uganda Demographic and Health Survey (UDHS) sex, age, education wealth status and place of residence are positively associated with knowledge of HIV transmission. For instance, 52.2 per cent of the women and 43.7 per cent of the men have knowledge of HIV transmission. Generally, older respondents have more knowledge of HIV transmission than their younger counterparts. For example, the proportion increased from University of Ghana http://ugspace.ug.edu.gh 21 51.6 per cent among younger women to 52.3 per cent among the older women, while it rose 40.7 per cent among younger men to 43.1 per cent among the older men. In terms of education, the proportion increased from 39.3 per cent among women with no education to 65.9 per cent among their counterparts with secondary and higher education, while it rose from 29.0 per cent among men with no education to 50.1 per cent among their partners with secondary and higher education. By wealth quintile, knowledge of HIV transmission increased from 38.2 per cent among women in the lowest wealth quintile to 68.8 among those in the highest wealth quintile, while the proportion increased from 36.4 per cent among men in lowest quintile to 49.7 per cent among those in the highest wealth quintile. The report also shows that 66.7 per cent of the women in the urban areas have knowledge of HIV transmission compared to 49.3 per cent of those in the rural areas. Similarly, the proportion was 45.5 per cent among the men in the urban areas and 42.4 among their counterparts in the rural areas. The 2006 IFHS also examined the relationship between the background characteristics of the respondents and their knowledge of HIV transmission. The result of the survey shows that sex, education, wealth quintile and place of residence were significantly associated with knowledge of HIV transmission. The report shows that 18.6 per cent of the women and 20.3 per cent of men have knowledge of HIV transmission methods. The proportion increased from 6.1 per cent among the women with no education to 43.0 per cent among those with higher education. Similarly, the proportion increased from 6.5 per cent among men with no education to 35.3 per cent among those with higher education. In terms of ethnicity, the percentage was higher among women from the other tribe (22.4 per cent) and lower among those from the scheduled tribe (10.5 per cent). Similarly, the percentage was higher among men from the other tribe (21.3 per cent) and lower among those University of Ghana http://ugspace.ug.edu.gh 22 from the scheduled tribe (12.7 per cent). By wealth quintile, the proportion was 4.3 per cent among women in the lowest wealth quintile compared to 35.0 per cent among those in the highest wealth quintile. Similarly, the proportion was 6.5 per cent among the men in the lowest wealth quintile and 29.0 per cent among those in the highest wealth quintile. The percentage was higher among the women in the professional occupation (45.9 per cent) and lower among those who are not employed (21.3 per cent). Similarly, the percentage was higher among men in the professional occupations (37.5 per cent) and lower among those who are not employed (26.0 per cent). The proportion of the women with knowledge of HIV transmission rose from 13.8 per cent among women in the rural areas to 28.4 per cent among those in the urban areas. Similarly, the proportion rose from 17.9 per cent among men in the rural areas to 24.6 per cent among those in the urban areas. However, there was no clear pattern between age, marital status, and knowledge of HIV transmission. 2.1.5 Attitude Towards PLWHA Socio-demographic characteristics of an individual may affect his/her attitude towards PLWHA. Al ± Owaish et. al., (1999) assessed the attitudes of the population in Kuwait towards PLWHA. This is one of the few studies conducted in the Gulf region regarding HIV- related stigma. A cross-sectional survey of 2,219 participants included a set of questions specific to the attitudes about HIV infected people. The findings of the study suggested that about 80.0 per cent of the participants believed that PLWHA should not be left freely in the community and 34.0 per cent of them also said that those infected with HIV should be ostracized in order to prevent the HIV chain of transmission. Interestingly, the multiple regression model used in the study showed that females, younger ages, single participants and those of low socio-economic status were more University of Ghana http://ugspace.ug.edu.gh 23 likely to express negative attitude towards PLWHA. This reality reflected a huge need for educational programs targeting the population susceptible to expressing more discrimination attitude. Evidence from Botswana, showed that sex, age and education are positively correlated to attitude towards PLWHA, (Letamo, 2004). The study shows that respondents aged 10-14 years were 2 times more likely to state that they were unwilling to care for a family member living with HIV/AIDS than those who were aged 15-19 years. The study further shows that respondents with primary education were 2 times more likely than those with secondary or above education to state that they would not buy vegetables from a shopkeeper living with HIV/AIDS. Another study conducted in rural Jamaica by Maldi et. al., (2004) revealed that individuals less than 30 years of age were likely to stigmatize people living with the disease when compared with people aged 30 years and above. The study also showed that women were tolerant towards PLWHA than men. Botswana has the highest prevalence of HIV in the world and discriminating attitudes are expected to be very common in this Southern African Country. For that reason, the Botswana AIDS impact survey in 2001 had several questions that were asked to assess the stigmatizing attitude among the survey respondents (Letamo, 2003). The findings of this study showed that women were found to be more tolerant than men, perhaps because women are principal caregivers in household in developing countries. The study also showed that most of the people who expressed discriminating attitudes were young people which indicated a need for targeted educational programme. The results of 2006 IFHS, also shows that sex, education, religious affiliation, ethnicity, wealth index, occupation and place of residence are associated with attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 24 The proportion of women who expressed accepting attitude towards PLWHA on all the four indicators was 33.7 per cent among the women compared to 36.8 per cent among the men. The proportion increased from 21.1 per cent among women with no education to 46.7 per cent among those with 12 or more years completed education. Similarly, the proportion increased from 19.0 per cent among men with no education to 51.8 per cent among those with 12 or more years completed education. In terms of religion, the proportion increased from 24.1 per cent among women who are Christians to 44.0 per cent among those who belong to the Jain religion. Similarly, the proportion increased from 29.2 per cent among the men who are Christians to 55.2 per cent among those who belong to the Jain religion. With ethnicity, the percentage was higher among women who belong to the other cast (37.7 per cent) and lower among those who belong to the scheduled tribe (29.4 per cent). Similarly, the percentage was higher among the men who belonged to the other cast (41.0 per cent) and lower among those who belonged to the scheduled tribe (32.2 per cent). By wealth quintile, proportion was highest among women in the highest wealth quintile (41.2 per cent) and lowest among those in the lowest wealth quintile (23.7 per cent). Similarly, the proportion was highest among women in the highest wealth quintile (47.8 percent) and lowest among those in the lowest wealth quintile (24.4 per cent). Occupationally, the proportion increased from 36.1 per cent among the women who are not employed to 49.3 per cent among those who are professionals. Similarly, the proportion rose from 45.0 per cent among men who are unemployed to 51.5 per cent among those who are professionals. The proportion was higher among women in the urban areas (36.6 per cent) and lower among those in the rural areas (31.2 per cent). Similarly, the proportion was higher among University of Ghana http://ugspace.ug.edu.gh 25 men in the urban areas (41.6 per cent) and lower among their counterparts in the rural areas (33.4 per cent). The level of stigma and discrimination towards PLWHA was also found to be very high in a study conducted in India by Sudha et. al., (2005). According to the survey involving 800 individuals in the city of Hyderabad, only 18.0 per cent of participants were willing to care for HIV-positive family members. Furthermore, 41.0 per cent of the survey respondents stated that HIV infected students should not be allowed to attend schools, and about the same percentage reported that they would not buy things from a retailer suspected of being infected with HIV. More than 80.0 per cent of the participants stated that they believed it to be inappropriate for people to tell others about their HIV status. The extent of the negative attitude towards PLWHA in this large city was further demonstrated by the fact that 51.0 per cent of the respondents wanted a public list of the people infected with HIV in order to avoid them. The overall result of the study showed that illiterates, and poor participants were more likely to exhibit discriminatory attitudes. A survey of the general population consisting in 20 items that assessed HIV-related attitudes (Lau and Tsui, 2005) examined the attitudes of 800 participants in a cross-sectional telephone survey in Hong Kong. Forty-two per cent of the survey respondents affirmed that they would avoid contact with an HIV positive individual among the 20 items assessing the HIV- related attitudes. Approximately 40.0 per cent of the female respondents and 34.0 per cent of the male respondents believed that a person infected with HIV could not appear healthy. In general, younger people and respondents with a higher level of education, wealth quintile as well as respondents who are married and those in the urban areas expressed more positive attitude towards HIV positive people. University of Ghana http://ugspace.ug.edu.gh 26 In Canada, the AIDS Attitudinal Tracking Survey conducted by EKOS Research Associates (2006) showed some patterns of stigmatization towards PLWHA in the general population. Although 81.0 per cent of the survey respondents did not believe that HIV positive people should be quarantined, approximately 25.0 per cent believe that people with HIV infection should not be allowed to provide some public services (hairstylists, dentists and food vendors). Canadian women were more likely to have positive attitude, whiles senior citizens and the employed were less likely to support the right of those infected by the virus. An epidemiological study about HIV Knowledge, attitude and misconception was conducted in Turkey. The result of the study demonstrated that women, people living in the city, married participants, well educated and rich participants expressed more positive attitude towards PLWHA (Ayaranci, 2005). Furthermore, the study revealed that misconception about HIV/AIDS are related to stigmatizing attitudes and recommends that accurate knowledge about the disease should be addressed by educational programmes. The increased rates of HIV infection in Russia fueled mixed reactions and feelings in the population. In May 2005, 2,400 people were surveyed in order to assess, among other issues the attitudes and stereotypes related to HIV infected individuals (Popova, 2007). The study participants included students in high schools, workers, parents and non workers. The finding from the survey showed that a vast majority of the respondents did not blame PLWHA for their condition. However, nearly half of the participants did not believe that being in close proximity with HIV infected people should be avoided. Interestingly the students and workers were found to be more tolerant towards people who are infected with HIV compared to non-workers and parents of the student. Professionals were also found to be more sympathetic towards PLWHA than their counterparts in the other occupations. University of Ghana http://ugspace.ug.edu.gh 27 2.1.6 Comprehensive Knowledge about AIDS and Attitude Towards PLWHA A study on knowledge of AIDS and attitudes towards people living among the general staff of a public university in Malaysia revealed that the age, level of education and income of the respondents are significantly associated with their attitude towards PLWHA. However there was no variation by gender.(Tee and Huang, 2009). Messiah et.al, (2004) assessed the attitude of 273 physicians towards their patients in Barbados. Because physicians are more knowledgeable about HIV, one might expect that they would have more favorable attitude towards PLWHA. However, the result of the survey confirmed that some physicians (20.0 per cent) were uncomfortable having AIDS clients and would test a patient without consent. The analysis of the result also demonstrated that the attitude of the physicians were associated with their level of knowledge about the disease, physicians with higher level of knowledge about HIV infection tended to have more positive attitudes towards patient living with HIV, while physicians with lower knowledge expressed more negative attitude and were more likely to provide inappropriate care and services to their patients. Genberg et. al., (2009) extensively discussed in their article the impact of HIV - related stigma and discrimination towards people living with the virus. The authors compared the perceived acts of discrimination towards PLWHA in 4 countries (Tanzania, Zimbabwe, South Africa and Thailand). The result of the comprehensive survey demonstrated more negative attitudes and higher perceived discrimination towards patients living with HIV by respondents who lacked knowledge about HIV than their counterparts who have knowledge about the disease. University of Ghana http://ugspace.ug.edu.gh 28 2.1.7 Knowledge HIV Prevention Method s and Attitude Towards PLWHA Knowledge of HIV influences attitude towards PLWHA. A study by Letamo, (2004) on HIV±related stigma and discrimination among adolescents in Botswana showed that knowledge of HIV prevention was positively correlated to attitude towards PLWHA. Respondents who did not know that one can reduce contracting HIV infection by consistent use of condoms were 1.7 times more likely to state that they were unwilling to care for a family member living with HIV than those who knew. 2.1.8 Misconception about AIDS and Attitude Towards PLWHA The study by Letamo. (2004) also shows that misconception about AIDS was significantly associated with attitude towards PLWHA. Respondents who believed that a person can get HIV infection by sharing a meal with AIDS patients were 2.3 times more likely than their counterparts to stigmatize and discriminate against a teacher who has AIDS. Also, respondents who believed that a person can get HIV infection by sharing a meal with a person living with HIV were almost three times more likely to say that they were unwilling to care for a family member with HIV than those who did not have this misconception. Generally, respondents who had misconception about HIV transmission were more likely than their counterparts who did not have this misconception to state that they were unwilling to care for a family member living with the disease. University of Ghana http://ugspace.ug.edu.gh 29 2.1.9 Knowledge of HIV Transmiss ion and Attitude Towards PLWHA In Nepal, key attitudes and beliefs related to stigma and discrimination attitudes towards PLWHA were explored by Family Health International (FHI), 2003. Even though majority of the survey respondents who have knowledge of HIV transmission approved of social interactions with HIV infected people, one third of the respondents expressed their desire to separate individuals living with HIV from the general population. Respondents expressed concerns and fear that HIV infection could be transmitted through casual contact with infected people. In addition, nearly three fourth of the respondents thought that contracting HIV was a punishment for immoral behaviour. The same proportion of the respondents said they would discourage someone from marrying the child of an infected person. These findings suggest urgent needs for aggressive awareness campaigns to educate the population of Nepal about the means of transmission of HIV. According to FHI,(2003) the negative attitudes and beliefs could be reduced and even eradicated by a greater depth of knowledge of the nature of the disease. 2.2 Conceptual Framework Based on the literature review, a conceptual framework was developed for the study, in the framework, independent, intermediate and dependent variables were used to explain people's attitude towards PLWHA. The independent variables are sex, age, level of education, marital status, religious affiliation, ethnicity, wealth status, occupation and place of residence. The intermediate variable is comprehensive knowledge about AIDS. Although knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission are components of comprehensive knowledge about AIDS, these three variables were again included in the conceptual framework under comprehensive knowledge about AIDS as intermediate University of Ghana http://ugspace.ug.edu.gh 30 variables to see how each of them will affect attitude towards PLWHA in order to get a better understanding of the relationship between each of them and attitude towards PLWHA. The dependent variable is attitude towards PLWHA. Consequently, sex, age, level of education, marital status, religious affiliation, ethnic group, wealth status, occupation, place of residence, comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission were used as predictors of attitude towards PLWHA. It is conceptualized that the sex of a person influences his/her attitude towards PLWHA. This is because males are more likely to have better sexual experience and discussion on AIDS than their female counterparts. Consequently, they are more likely to express positive attitude towards PLWHA than their female partners. With respect to age, older persons have more exposure and understanding of the disease than younger persons, hence, they are more likely to show positive attitude towards PLWHA than their younger counterparts. In the case of education, an individual with higher education is more likely to have positive attitude towards PLWHA than his/ her counterpart with no education. This is because with education one is able to read and write and acquire more information and knowledge about the disease which influences his/her attitude towards PLWHA. Marital status shows that persons who are married are more likely to express positive attitude towards PLWHA than their colleagues who are not married. This stems from the fact that the married are likely to have more experience and discussion about sex than the never married. Therefore, they have better understanding of the disease. In the case of religion, Christians are more likely to indicate less positive attitude towards PLWHA than their University of Ghana http://ugspace.ug.edu.gh 31 counterparts who are not Christians. This is due to the fact that some Christians regard AIDS as a punishment for sexual sin. The ethnic groups of the areas where the disease is more prevalent are likely to have more knowledge and experience about the disease than ethnic groups of areas where the disease is less prevalent. Consequently, ethnic groups of high prevalence areas are more likely to express positive attitude towards PLWHA than ethnic groups with low prevalence rates. Regarding wealth quintile, it is more likely for the richest to express positive attitude towards PLWHA than the poorest. This is because with their relatively greater wealth, they are able to access more information on the disease. Concerning occupation, respondents with professional, technical and managerial occupations are more likely to express positive attitude towards PLWHA than their counterparts who are unemployed. This is largely due to the fact that professionals have relatively high income and therefore better access to information on HIV. As a result they are likely to have more understanding and experience about the disease. With place of residence, respondents in the urban areas are more likely to express positive attitude towards PLWHA than their counterparts in the rural areas, this is because of the massive educational programmes in the urban areas. Respondents with comprehensive knowledge about HIV are likely to express positive attitude towards PLWHA than their counterparts with no comprehensive knowledge about the disease. Respondents with knowledge of HIV prevention methods are likely to express positive attitude towards PLWHA than their counterparts with no knowledge of HIV prevention methods. Respondents with no misconception about AIDS are likely to express positive attitude towards PLWHA than their counterparts with misconception about AIDS. Respondents with knowledge of HIV University of Ghana http://ugspace.ug.edu.gh 32 transmission are more likely to express positive attitude towards PLWHA than their counterparts with no knowledge of HIV transmission. Figure 2.1: Conceptual Framew ork showi ng the Interrelat ionsh i ps betw een some background variab les of the responde nts and their Att it ude towards PL WHA. 2.3 Hypotheses The following hypotheses have been examined in the study. i Level of Education is positively related to positive attitude towards PLWHA. ii. Wealth status is positively related to positive attitude towards PLWHA. iii Comprehensive knowledge about AIDS is positively related to positive attitude towards PLWHA. INDEPENDENT VARIABLES INTERMEDIATE VARIABLES DEPENDENT VARIABLES Socio -d emographic c haracteristics 1. Sex 2. Age 3. Level of Education 4. Marital Status 5. Religion 6. Ethnicity 7. Wealth Status 8. Occupation 9. Place of Residence Comprehensive knowledge about AIDS - Knowledge of HIV Prevention Methods - Misconception about AIDS - Knowledge of HIV Transmission Attitude towards PLWHA 1. Very bad 2. Bad 3. Fair 4. Good 5. Very good 6ource Author’s Construct . University of Ghana http://ugspace.ug.edu.gh 33 2.4 The Method ology of the Study 2.4.1 Sources of Data Both primary and secondary data were used in the study. The secondary data which is the 2008 Ghana Demographic and Health Survey (GDHS), is the main source of data for the study. The 2008 GDHS is the fifth in a series of demographic and health surveys conducted in Ghana. The first, second, third and fourth surveys were conducted in 1988, 1993, 1998 and 2003 respectively. The 2008 GDHS was carried out by the Ghana Statistical Service and the Ghana Health Service (GHS). ICF Macro, an International Company, provided technical support for the survey through the MEASURE DHS programme. The survey was conducted from 8 September to 25 November 2008 on a nationally representative sample of 12,323 households. Each of these households was visited to obtain information about the household using the household Questionnaire. The 2008 GDHS was a household- based survey, implemented in a representative probability sample in the selected households nationwide. This sample was selected in such a manner as to allow for separate estimates of key indicators for urban and rural areas separately. The 2008 GDHS utilized a two-stage sample design. The first stage involved selecting sample points or clusters from an updated master sampling frame constructed from the 2000 Ghana Population and Housing Census. A total of 412 clusters were selected from the master sampling frame. The clusters were selected using systematic sampling with probability proportional to size. A complete household listing operation was conducted from June to July 2008 in all the selected clusters to provide a sampling frame for the second stage selection of households. University of Ghana http://ugspace.ug.edu.gh 34 The second stage of selection involved systematic sampling of 30 of the households listed in each cluster. The primary objective of this exercise was to ensure adequate numbers of completed individual interviews to provide estimates for key indicators with acceptable precision and to provide a sample large enough to identify adequate numbers of under- five deaths to provide data on causes of death. Data were not collected in one of the selected clusters due to security reasons, resulting in a final sample of 12,323 selected households. Weights were calculated taking into consideration cluster, household, and individual non-responses, so the representation was not distorted. Each household selected for the GDHS was eligible for interview with the Household Questionnaire. In half of the households selected for the survey, all women age 15-49 and all men age 15-59 were eligible to be interviewed if they were either usual residents of the household or visitors present in the household on the night before the survey. A Questionnaire design workshop organized by GSS was held in Accra to obtain input from the ministry of health and other stakeholders on the design of the 2008 GDHS, Questionnaires. Based on the questionnaires used for the 2003 GDHS, the workshop and several other informal meetings with various local and international organizations, the DHS model questions were modified to reflect relevant issues in population, family planning, domestic violence, HIV/AIDS, malaria and other health issues in Ghana. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including the age, sex, education and relationship to the head of household. The main purpose of the Household Questionnaire was to identify women and men for individual University of Ghana http://ugspace.ug.edu.gh 35 interview. The Household Questionnaire collected information on characteristics of the household’s dwelling unit such as the source of drinking water, type of toilet facilities, flooring materials, ownership of various consumer goods, and ownership and use of mosquito nets. 7he Women’s 4uestionnaire was used to collect information from all women age -49 in half of selected households. These women were asked questions about themselves and their children born in the five years since 2003 on the following topics: respondents background characteristics, such as education, residential history, media exposure, knowledge and the use of family planning methods, fertility preferences, antenatal and delivery care, breastfeeding and infant and child feeding practices, vaccinations and childhood illness, childhood mortality, marriage and se[ual activity woman’s work and husband’s background characteristics and awareness and behaviour about AIDS and other Sexually Transmitted Infections (STIs), awareness of Tuberculosis (TB) and other health issues and domestic violence. 7he 0en’s 4uestionnaire was administered to all men age 15-59 in half of the selected households. 7he men’s 4uestionnaire collected much of the same information found in the women’s 4uestionnaire but was shorter because it did not contain reproductive history or questions on maternal and child health and nutrition. A total of 4916 women age 15-49 and 4568 men age 15-59 were interviewed. However, 2656 males age 15-59 years and females 2816 age 15-49 years were used for the analysis because these respondents responded to questions on HIV/AIDS. The qualitative method was used to collect the primary data for the study. In-depth interview was used to collect data from PLWHA in Tema and at Agomanya. The study targeted 150 PLWHA, 80 at Agomanya (45 women and 35 men) and 70 in Tema (40 women and 30 men), but the number was limited to 60, 25 from Tema (14 women and 11 men) and 35 from University of Ghana http://ugspace.ug.edu.gh 36 Agomanya (21 women and 14 men) because these were the PLWHA who were willing to co- operate. The women were aged 20-54 years whiles the men were aged 21-57 years. Purposive sampling was used to collect data for the study, that is, interviewing people who have been diagnosed as having the disease. Tema and Agomanya were selected because of their high prevalence rates of 2.0 per cent and 8.0 per cent respectively compared with the national prevalence rate of 2.2 per cent in 2008. (NACP and GHS, 2009). These two places (Tema and Agomanya) were also chosen because Tema has the Tema General Hospital and Agomanya, St Martin de Porres Catholic Hospital which offer comprehensive prevention, care and support packages for PLWHA including voluntary counseling and testing (VCT), and clinical care services. Therefore, people living with HIV were interviewed from 4 settings: HIV patients admitted to the Tema and Agomanya hospital wards for treatment; patients receiving treatment at home; patients coming to hospitals for routine checks and patients attending support meetings at hospitals. In each situation, nurses and social counselors were approached and asked to explain the purpose of the study to HIV positive persons with the view to eliciting their participation in the study. Table 2.1 shows the distribution of PLWHA interviewed in Tema and Agomanya. University of Ghana http://ugspace.ug.edu.gh 37 Table 2.1 : Distribution of PLWHA interview ed in Tema and at Agomanya. Cat egory Agomanya Tema Total Admission at the hospital/Clinic 9 6 15 Receiving treatment at home 4 2 6 Going to hospital for routine checks 10 5 15 Attending support meetings 12 12 24 Total 35 25 60 Source: Fieldwork, 2008 The In-depth interview used interview guide structured on the main themes based on the literature. The themes are: the experience of PLWHA in their family, in receiving care and treatment at home and in the hospital. In addition, information was obtained on what they experience in their use of public means of transport, in school, marriage, at work or the performance of their economic activity and in their use of public facilities such as toilet, bathhouse. Information from PLWHA was collected on their background characteristics. The qualitative data from the in-depth interviews were used to complement or reject the results of the quantitative data from the 2008 GDHS respondents. 2.4.2 Measurement of variables. Three categories of variables were used in this study, these are the independent variables (sex, age, level of education, marital status, religious affiliation, ethnicity, wealth index, occupation and place of residence), the intermediate variable (comprehensive knowledge about AIDS consisting of knowledge of HIV prevention methods, misconception about HIV and Knowledge of HIV transmission) and the dependent variable (attitude towards PLWHA). Under University of Ghana http://ugspace.ug.edu.gh 38 the independent variable, the sex of the respondents was indicated as male or female as the case may be. The age of the respondents was recorded in completed years, that is, age at last birthday. Thus, a person aged 29 years 11 months was recorded as 29 years. The age was grouped into 5 year age groupings; these are 15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, 45-49 years, 50-54 years, 55-59 years. Education was measured in terms of the highest level of education completed. The categories are no education, primary, Middle/ JSS, secondary/SSS and higher. Six mutually exclusive categories under marital status are: married, never married, living together, divorced, separated and widowed. Religion relates to the religious group to which the respondent himself/herself claimed to belong. As a result, the categories include: Catholic, Anglican, Methodist, Presbyterian, Pentecostal/Charismatic, other Christian which include: Seventh day Adventist(SDA), Mosama Disco Kristo, Church of Christ, Kristo Asafo, Odifo Nkansah/ Awoyo, Church of Jesus Christ of Latter day saint -ehovah’s witness church universal and triumphant and others, Moslem, Traditionalist/ spiritualist, no religion and other, that is followers of Eckankar, Bahai, Hinduism, Buddhism, Hare Krisna, Yoga and Transcendental Meditation. Ethnicity pertains to Ghanaians by birth only and thus excludes Ghanaian by naturalization/registration and other nationals. The categories are: Akan, Ga/Dangme, Ewe, Guan, Mole- Dagbani, Grussi, Gruma, Mende and other. Occupation relates to the kind of work the respondent actually did during the survey. The categories are: not working, professional/technical/managerial, clerical, sales, Agriculture, services, skilled manual and unskilled manual. Household wealth status was computed based on household assets and this was divided into five quintiles which were classified as: poorest, poorer, middle, richer and University of Ghana http://ugspace.ug.edu.gh 39 richest. Place of residence was classified as urban or rural, based on the size of the population. All localities with a population of 5000 or more are classified as urban whiles those with a population of less than 5000 are classified as rural. The intermediate variable which is the comprehensive knowledge about HIV was measured by asking the respondents 11 questions. These questions were made up of 3 questions on knowledge of HIV prevention methods, 4 questions on misconception about AIDS and 4 questions on knowledge of HIV transmission. The 3 questions on knowledge of HIV prevention methods are: whether a person can reduce the risk of getting the AIDS virus by not having sex at all, whether a person can reduce the risk of getting the AIDS virus by using condoms always during sex and whether a person can reduce the risk of getting the AIDS virus by having one sex partner only. The 4 questions on misconception about AIDS are: whether a healthy person can have the AIDS virus; whether HIV can be transmitted by mosquito bites; whether AIDS can be transmitted by supernatural means and whether a person can get the AIDS virus by sharing food with a person who has AIDS. The 4 questions on knowledge of HIV transmission are: whether there are drugs to avoid HIV transmission to baby during pregnancy; whether HIV can be transmitted during pregnancy; whether HIV can be transmitted during delivery and whether HIV can be transmitted during breastfeeding. If a respondent answers correctly he/she is scored 1, but if he/she answers wrongly he/she is scored 0. For example, if a respondent is asked whether a healthy person can have the AIDS virus and he/she responds yes he/she is scored 1, but if he/she answers no he/ she is scored 0. On the other hand, if a respondent is asked whether AIDS can be transmitted by mosquito bites and he/she answers yes he/she is scored 0, but if he/she responds no he/she is scored 1. The overall score was obtained by combining all the answers to the 11 questions and the scored obtained University of Ghana http://ugspace.ug.edu.gh 40 ranged from 0-11. The score was divided into five categories, taking into account the frequencies of the scores, consequently, a score from 0-7 was classified as very bad comprehensive knowledge about AIDS, 8 was classified as bad comprehensive knowledge about AIDS, 9 was classified as fair comprehensive knowledge about AIDS, 10 was classified as good comprehensive knowledge about HIV and 11 was classified as very good comprehensive knowledge about AIDS. Knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission were measured as follows: knowledge of HIV prevention methods of the respondents was measured by asking the respondent 3 questions. These are: whether a person can reduce the risk of getting the AIDS virus by not having sex at all, whether a person can reduce the risk of getting the AIDS virus by using condoms always during sex and whether a person can reduce the risk of getting the AIDS virus by having one sex partner only. If the respondent answers a question correctly he/she is scored 1 but if he/she answers wrongly he/she is scored 0. The answer to the three questions were combined to obtain a score varying from 0-3, when a respondent scores 0, it was classified as bad knowledge of HIV prevention methods, 1 was classified as fair knowledge of HIV prevention methods, 2 classified as good knowledge of HIV prevention methods and 3 classified as having very good knowledge of HIV prevention methods. Misconception about AIDS was measured by asking the respondent 4 questions, these are: whether a healthy person can have the AIDS virus; whether AIDS can be transmitted by mosquito bites; whether AIDS can be transmitted by supernatural means and whether a person can get the AIDS virus by sharing food with a person who has AIDS. If the respondent answers correctly he/she is scored 1 but if he/she answers wrongly he/she is scored 0. As with knowledge University of Ghana http://ugspace.ug.edu.gh 41 of HIV prevention methods, the answers to all the questions were combined to obtain a score which ranged from 0-4. A score of 0 was classified as very strong misconception about AIDS, 1 was classified as strong misconception about AIDS, 2 was classified as fair misconception about AIDS, 3 was classified as weak misconception about AIDS and 4 was classified as no misconception about AIDS. Knowledge of HIV transmission was measured by asking the respondents 4 questions. These are: whether there are drugs to avoid HIV transmission to baby during pregnancy, whether HIV can be transmitted during pregnancy, whether HIV can be transmitted during delivery and whether HIV can be transmitted during breastfeeding. If a respondent answers correctly he/she is scored 1 but if he/she answers wrongly he/she is scored 0. For example, if a respondent is asked whether there are drugs to avoid HIV transmission to baby during pregnancy and if he/she answers yes he/she is scored 1, but if he/she answers no he/she is scored 0. The answers to the 4 questions were combined to obtain a score varying from 1-4. Therefore, a score of 1 was classified as bad knowledge of HIV transmission, 2 was classified as fair knowledge of HIV transmission, 3 was classified as good knowledge of HIV transmission and 4 classified as very good knowledge of HIV transmission. The dependent variable, attitude towards PLWHA was measured by asking the respondents 4 questions. These are: whether the respondents would like to buy from a vendor who has the AIDS virus; whether respondents are willing to care for a family member with the AIDS virus in his home; whether a female teacher with the AIDS virus who is not sick should continue to be allowed to teach; whether respondents would want to keep it a secret if a family member has the AIDS virus. If the respondent answers a question correctly, he/she is scored 1 but if he/she answers wrongly he/she is scored 0. For example, if a respondent is asked whether University of Ghana http://ugspace.ug.edu.gh 42 he/she would like to buy from a vendor who has the AIDS virus and he/she answers yes, he/she is scored 1, but if he/she answers no he/she is scored 0. On the other hand if a respondent is asked whether he/she would want to keep it a secret if a family member has the AIDS virus and responds yes, he/she is scored 0, but if he/she responds no he/she is scored 1. Hence, a score of 0 was classified as very bad attitude towards PLWHA, 1 was classified as bad attitude towards PLWHA, 2 was classified as fair attitude towards PLWHA, 3 was classified as good attitude towards PLWHA and 4 was classified as very good attitude towards PLWHA. Under comprehensive knowledge about AIDS, knowledge of AIDS prevention methods, misconception about AIDS, knowledge of HIV transmission and attitude towards PLWHA all the respondents who responded ³don’t know´ or did not respond to a question were excluded because the study is only interested in those who responded yes or no. 2.4.3 Method of Analysis Univariate, biavariate and multivariate analyses techniques were used in analyzing and presenting the result. The univariate methods such as frequency distributions were used to describe the distribution of respondents by selected socio-demographic characteristics, and comprehensive knowledge about AIDS (knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission) and attitude towards PLWHA. The bivariate analysis seeks to investigate the association between the independent variables, (socio-demographic characteristics) and the intermediate variables (comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS and Knowledge of HIV transmission). Independent and dependent variables (attitude towards PLWHA). Bivariate analysis was also conducted between the intermediate variable University of Ghana http://ugspace.ug.edu.gh 43 (comprehensive knowledge about AIDS, its components which are knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission) and the dependent variable (attitude towards PLWHA). The chi-square test was used to test the differences between proportions at alpha level of 0.05. Ordered logistic regression model was used to determine the socio- demographic factors that predict respondents attitude towards PLWHA controlling for the level of comprehensive knowledge of respondents about AIDS. The outcome variable for the regression model is attitude towards PLWHA. The independent variables (socio-economic and demographic factors) are sex, age, level of education, marital status, religious affiliation, ethnicity, wealth index, occupation and type of place of residence. Comprehensive knowledge about AIDS is a scale measurement made up of knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission was treated as the intermediate variable. The result is presented based on the weighted sample. The ordered logistic regression technique was used because the dependent variable (attitude towards PLWHA was ordered scale). This ranged from a score of 0-4 where 0 is the least or the worst form of attitude in that ranking order to 4 which is the best form of attitude towards PLWHA. Ordered logit model has the form: P1 Logit (P1) = log _____ = a +  1x 1 ± P1 P1 + P 2 Logit (P1 + P 2 ) = log ______ = a 2 +  1x 1 ± P1 ± P2 University of Ghana http://ugspace.ug.edu.gh 44 P1 + P 2  ….PR = a K+ x Logit P1 + P 2  ….  Px = Log ____________ _________ 1 ± P1 ± P2 - …. - PK And P1 + P 2  ….  PR + 1 = 1 This model is known as the proportional ± odds model because the odds ratio of the event is independent of the category j. The odds ratio is assumed to be constant for all categories. 2.5 Definition of Concepts Acquired Immune Deficiency Syndrome (AIDS ): Acquired Immune Deficiency Syndrome or Acquired Immunodeficiency Syndrome (AIDS) is a disease of the human immune system caused by the Human Immunodeficiency Virus (HIV). The illness interferes with the immune system making people with AIDS much more likely to get infections, including opportunistic infections and tumors that do not affect people with working immune systems. This susceptibility gets worse as the disease continues. Human Immunodeficiency Virus (HIV): The virus responsible for AIDS transmission. Seropositive: People with HIV infection in their blood. Seroprevalence: The proportion of a defined population infected with HIV at any one given point in time. Homosexual: Sexual relations among persons of the same sex. Heterosexual: Sexual relation among persons of the opposite sex. Stigma: A negatively defined characteristic, either tangible or intangible. Discrimination: Any form of distinction, exclusion or restriction affecting a person by virtue of personal characteristics. University of Ghana http://ugspace.ug.edu.gh 45 2.6 Limitation of the Study The use of secondary data limited the investigator to the variables collected by the survey. Dependent variables such as whether respondents would share a common swimming pool, toilet seat, and cookery or cutlery with a PLWHA were not covered in the 2008 GDHS. The addition of these variables would have given more understanding of the relationship between the independent, intermediate and dependent variables used in the study. University of Ghana http://ugspace.ug.edu.gh 46 CHAPTER THREE CHARACTERISTICS OF THE RESPONDENTS 3.1 Introduction The attitude of respondents towards PLWHA may depend on their background characteristics. This chapter is therefore devoted to examining the characteristics of the respondents who were interviewed in the survey to give a better understanding of their attitude towards those living with the disease. 7he respondent’s comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS, knowledge of HIV transmission and attitude towards PLWHA are also described as part of their characteristics. 3.2 Sex The percentage distribution of the respondents by sex is presented in Table 3.1. From Table 3.1, it can be seen that more than half (51.5 per cent) of the respondents are females of the total number which is 5,472, while less than half (48.5 per cent) of the respondents are males. This is because the sex ratio in Ghana over the past 30 years has fallen slightly from 98.5 males per 100 females in 1970 to 97.9 in 2000 (Ghana Statistical Service (GSS) and Macro International Inc., 2004). Since more than half (51.5 per cent) of the respondents are females, a high proportion of the respondents may express positive attitude towards PLWHA. This is because generally, women in Ghana are found to be more tolerant, sympathetic and caring than men. Also, perhaps because women are the principal caregivers in the households in developing countries. A study by Letamo, (2003) also shows that women were more tolerant to PLWHA than men. University of Ghana http://ugspace.ug.edu.gh 47 Table 3.1: Distribution of the Respondents by Sex Sex Percent Number Female 51.5 2816 Male 48.5 2656 Total 100.0 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. 3.3 Age Table 3.2 shows the distribution of the respondents by age. From Table 3.2, it can be observed that less than one quarter of the respondents are in all the age groups. The proportion ranges from 2.0 per cent amongst those aged 55-59 years to 20.2 per cent amongst those aged and 15-19 years respectively. Less than 2 of 10 of the respondents are aged 20-24 years, while less than 10.0 per cent of the respondents are aged 40-44 years. It can also be observed from Table 3.2 that more than 80.0 per cent of all the respondents are in the age group 15-44 years. Within this age bracket, majority (66.8 per cent) of them are in the 15-34 years age bracket. The age group 15-19 years has the highest percentage (20.2 per cent) because of the young population structure of Ghana, only 12.8 per cent of the respondents are aged 45-59 years. It can also be seen from Table 3.2 that the percentage distribution of the respondents decreases with increase in their ages. For example, the highest proportion of the respondents aged 15-19 years was 20.2 per cent, the proportion decreased till it reached the lowest percentage of 2.0 per cent among respondents aged 55-59 years. Because more than half of the respondents are young, a high proportion of the respondents may express negative attitude towards PLWHA. Perhaps this is because young people lack experience with PLWHA. The findings of a study by University of Ghana http://ugspace.ug.edu.gh 48 Al-Owaish et. al., (1999) in Kuwait also indicated that the younger ages were more likely to express negative attitude towards PLWHA. Table 3.2 : Distribution of the Respondents by Age Age Group Respondents Percent Number 15-19 20.2 1108 20-24 18.2 996 25-29 15.9 870 30-34 12.5 685 35-39 12.1 663 40-44 8.3 453 45-49 7.6 415 50-54 3.2 171 55-59 2.0 111 Total 100.0 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. 3.4 Level of Education The percentage distribution of the respondents by level of education is presented in Figure 3.1. More than 8 out of 10 of the respondents have some level of education. The proportion of the respondents with some level of education ranges from 7.6 per cent to 43.4 per cent amongst those with higher and Middle/JSS levels of education respectively. A high proportion of the respondents has Middle/JSS level of education (43.4 per cent) perhaps, because the level of educational attainment in Ghana is quite low. However, 14.5 per cent of the respondents have no education. Since most of the respondents have some level of education, a high proportion of the respondents may have positive attitude towards PLWHA. This is in line with the generally observed relationship between the level of education and attitude towards PLWHA (GSS, 2004). University of Ghana http://ugspace.ug.edu.gh 49 Figure 3. 1: Distribution of Respondents by Level of Education 3.5 Marital Status The analysis also enquired into the marital status of the respondents to find out their attitude towards PLWHA. Table 3.3 shows that less than a tenth of the respondents are in the various marital groups except those who are never married (38.3 per cent) and those who are married (45.9 per cent). The proportion of the respondents among the rest of the marital groups rose from 1.3 per cent among the widowed to 9.7 per cent among those living together. It can be seen from Table 3.3 that a high proportion of the respondents who are the never married (38.3 per cent) may be attributable to the fact that they are still in school. Since a large percentage of the respondents are married, and formerly married a high percentage of the respondents may have more experience and discussion on sexual matters and therefore may have better knowledge of how the disease can be transmitted and prevented. University of Ghana http://ugspace.ug.edu.gh 50 Consequently, a large number of the respondents may have positive attitude towards PLWHA. This result confirms a study by Al-Owaish et. al., (1999) in Kuwait which states that the single participants were more likely to express negative attitude towards PLWHA than the married ones. Table 3 .3 : Distribution of Respondents by Marital Status Marital Status Respondents Percent Number Never Married 38.3 2095 Married 45.9 2510 Living Together 9.7 529 Widowed 1.3 72 Divorced 2.2 121 Separated 2.6 145 Total 100.0 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. 3.6 Religious Affiliation The survey asked about the religious affiliations of the respondents in order to assess the possible impact of their religious beliefs on their attitude towards PLWHA. From Figure 3.2, it can be noted that fewer than two-fifths of the respondents are in all the religious groups. The proportion of the respondents in all the religious groups ranges from 0.2 per cent to 33.4 per cent among the religious group labeled as ³other´ and PentecostalCharismatic respectively. It can also be seen from Figure 3.2 that, more than three-quarters of the respondents are Christians. A large proportion of the respondents are Pentecostal/Charismatic (33.4 per cent), while a small proportion of them are Anglicans (0.9 per cent). Most of the respondents are Christians because Ghana is predominantly a Christian country. University of Ghana http://ugspace.ug.edu.gh 51 However, less than one quarter of the respondents are non-Christians, of these, the highest proportion of them are Moslem, they constitute 15.2 per cent. The lowest percentages of them are labeled as ³other´ they recorded . per cent. %ecause a large majority of the respondents are Christians a high proportion of the respondents may express a less positive attitude towards PLWHA because some Christians in Ghana generally regard the disease as punishment for sexual sin. This result confirms the IFHS, (2006) report which states that the Christians were more likely to express negative attitude towards PLWHA than the non-Christian. Figure 3. 2: Distribution of Respondents by Religious Affiliation 3.7 Ethnicity The ethnic backgrounds of the respondents were asked during the survey to ascertain how their ethnicity affects their comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS, knowledge of HIV transmission and attitude University of Ghana http://ugspace.ug.edu.gh 52 towards PLWHA. From Table 3.4, it can be seen that less than 2 out of 10 of the respondents are in the different ethnic groups, except Akan (48.0 per cent). The proportion in the rest of the ethnic groups is between 0.5 per cent among the Mende and 18.7 per cent among Mole-Dagbani. Generally, there are vast differences in the proportion among the rest of the ethnic groups. A high proportions of the respondents are Akan, this is because they constitute the major ethnic group in Ghana. They are made up of Asante, Fante, Kwahu, Akyem, Akuapim and Brong (GSS and Macro International Inc., 2004). However, a small proportion of the respondents are Mende, they constitute 0.5 per cent. There are little variations in the ethnicity of the respondents therefore there may not be any significant association between ethnicity of the respondents and their attitude towards PLWHA because of the little differences in cultural beliefs among the ethnic groups. The IFHS, (2006) report however shows that the association between the ethnicity of respondents and their attitude towards PLWHA is significant. Table 3 .4: Distribution of Respondents by Ethnicity Ethnicity Respondents Percent Number Akan 48.0 2623 Ga/Dangme 6.7 366 Ewe 13.9 761 Guan 2.4 130 Mole-Dagbani 18.7 1024 Grussi 2.9 160 Gruma 3.2 174 Mende 0.5 26 Other 3.7 205 Total 100.0 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. University of Ghana http://ugspace.ug.edu.gh 53 3 .8 Wealth Status Figure 3.3 shows the percentage distribution of the respondents by their wealth status. From figure 3.3, it can be observed that more than three-fifths of the respondents are in the middle or better (richer and richest) wealth status (65.8 per cent) whereas, less than two fifths of them are in the poorer or poorest wealth status (34.2 per cent). Consequently, a high proportion of the respondents may have positive attitude towards PLWHA. This is because with their relatively higher wealth they can assess better and more information about the disease. The result of a study by Sudha et. al., (2005) in India also shows that respondents in the low socio-economic status were likely to express negative attitude towards PLWHA than their counterparts in the high socio-economic status. Figure 3. 3: Distribution of Respondents by Wealth Sttus University of Ghana http://ugspace.ug.edu.gh 54 3.9 Occupation Table 3.5 shows the distribution of the respondents by their occupation. From Table 3.5, it can be seen that less than a fifth of the respondents are in the different occupational groups except among those who are not working (20.8 per cent) and those who are in agriculture (27.7 per cent). A high percentage of the respondents are in agriculture because it is the most common economic activity in Ghana (GSS and Macro International Inc., 2004). The proportion of the respondents in the rest of the occupational groups ranges from 0.5 per cent to 18.9 per cent among those who are manually unskilled and those who are in sales respectively. On the whole, there are vast differences in the proportion among the respondents in the various occupational groups. Since more than 70.0 per cent of the respondents are working, majority of the respondents may access a lot of information about the disease. As a result, they may express more positive attitude towards people living with the disease. This finding confirms the result of a study by Popova, (2007) in Russia which shows that respondents who are working were more tolerant to PLWHA than their counterparts who are not working. Table 3 .5 : Distribution of Respondents by Occupation Occupation Respondents Percent Number Not Working 20.8 1136 Professional/Technical/Managerial 8.1 437 Clerical 4.0 214 Sales 18.9 1012 Agriculture 27.7 1487 Services 7.0 378 Skilled Manual 12.6 677 Unskilled Manual 0.5 24 Total 100.0 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. University of Ghana http://ugspace.ug.edu.gh 55 3 .10 Place of Resid ence The survey inquired of the place of residence of the respondents to see how it affects their comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS, knowledge of HIV transmission and attitude towards PLWHA. It can be seen from the Figure 3.4 that majority (51.7 per cent) of the respondents are in the rural areas, while the minority (48.3 per cent) of them are in the urban areas. A high proportion of the respondents may express less positive attitude towards PLWHA, because more than half (51.7 per cent) of the respondents are in the rural areas where there are less public education and information on the disease compared to the urban areas. The result of the 2006 IFHS report also shows that the respondents in the urban areas expressed more positive attitude towards PLWHA than their counterparts in the rural areas. Figure 3. 4: Distribution of Respondents by Place of Resid ence University of Ghana http://ugspace.ug.edu.gh 56 3.11 Comprehensive Knowledge about AIDS Considering the distribution of respondents by comprehensive knowledge about AIDS, Table 3.6 shows that, more than three fifths (63.1 per cent) of the respondents have fair or better (good and very good) comprehensive knowledge about AIDS whereas, less than 4 in 10 of the respondents have bad or very bad comprehensive knowledge about AIDS. Since more than 6 out of 10 of the respondents have fair or better comprehensive knowledge about the disease, a high proportion of the respondents may express positive attitude towards PLWHA. A survey by Messiah et al., (2004) in Barbados reports that physicians with high level of knowledge about HIV infection tended to have more positive attitude towards patients living with AIDS, while physicians with lower knowledge expressed negative attitude towards PLWHA. Table 3.6 : Distribution of Respondents by Comprehensive Knowledge about AIDS Comprehensive Knowledge About AIDS Respondents Per cent Number Very Bad 17.3 950 Bad 19.6 1072 Fair 23.4 1278 Good 23.5 1286 Very Good 16.2 886 Total 100.0 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. 3.12 Knowledge of HIV Prevention Method s Figure 3.5 shows the percentage distribution of respondents by knowledge of HIV prevention methods. From Figure 3.5, it can be seen that almost all the respondents have fair or University of Ghana http://ugspace.ug.edu.gh 57 better (good and very good) knowledge of HIV prevention methods while, fewer than 3.0 per cent of them have bad or very bad knowledge of HIV prevention methods. Since more than 9 out of 10 of the respondents have fair or better knowledge of HIV prevention methods, a high proportion of them may have positive attitude towards people living with the disease. A study by Letamo, (2004) in Botswana also shows that knowledge of HIV prevention is positively associated with attitude towards PLWHA. Figure 3.5: Distribution of Respondents by Knowledge of HIV Prevention Method s University of Ghana http://ugspace.ug.edu.gh 58 3.13 Misconception about AIDS The percentage distribution of respondents by misconception about AIDS, is shown in Figure 3.6, it can be observed from figure 3.6 that a little more than three-fifths (60.3 per cent) of the respondents have some misconception about AIDS whereas, fewer than 4 in 10 of them have no misconception about the disease Since the majority (60.3 per cent) of the respondents have some level of misconception about AIDS, it implies that a high proportion of the respondents may express negative attitude towards PLWHA. The result of a study by Letamo, (2004) in Botswana also shows that misconception about HIV/AIDS is significantly associated with attitude towards PLWHA. Figure 3. 6: Distribution of Respondents by Misconception About AIDS University of Ghana http://ugspace.ug.edu.gh 59 3.14 Knowledge of HIV Transmiss ion The result from Figure 3.7 shows that all the respondents have some level of knowledge of how HIV is transmitted. Nearly all (97.1 per cent) of the respondents have fair or better (good and very good) knowledge of HIV transmission while, less than 3.0 per cent of them have bad knowledge of HIV transmission. Because more than 9 out of 10 of the respondents have fair or better knowledge of HIV transmission, a high proportion of the respondents may have positive attitude towards PLWHA. A study by FHI, (2003) in Nepal also shows that majority of the survey respondents who have knowledge of HIV transmission approved of social interaction with HIV infected people compared with their counterparts who have no knowledge of how the disease is transmitted. Figure 3.7 : Distribution of Respondents by Knowledge of HIV Transmiss ion University of Ghana http://ugspace.ug.edu.gh 60 3 .15 Attitude Towards PLWHA Figure 3.8 indicates the percentage distribution of respondents by attitude towards PLWHA. From Figure 3.8, it is clear that more than three quarters, who constitute the majority of the respondents have fair or better (good and very good) attitude towards PLWHA whereas, 2 in 10 of the respondents have bad or very attitude toward PLWHA. It can be expected that most of the respondents may show positive attitude towards PLWHA. . Figure 3. 8: Distribution of Respondents by Attitude Towards PLWHA 3.16 Summary Chapter three examined the characteristics of the respondents. The findings show that majority (51.5 per cent) of the respondents were females while minority (48.5 per cent) were males. More than half (54.3 per cent) of the respondents are young. A high proportion of University of Ghana http://ugspace.ug.edu.gh 61 the respondents had Middle/JSS education (43.4 per cent) whilst a small proportion of them had higher education (7.6 per cent). A high percentage of the respondents are married (45.9 per cent) whiles a small proportion of them are widowed (1.3 per cent). A high proportion of the respondents are Christians (64.8 per cent) whereas a small proportion of them labeled as ³other´ constitute 0.2 per cent. A high percentage of the respondents are Akan (48.0 per cent) whiles a small percentage of them are Mende (0.5 per cent). With wealth quintilie, more than three-fifths (65.7 per cent) of respondents are in the middle or better wealth status whiles less than two-fifths (34.2 per cent) of them are in the poor or poorer wealth status. A high percentage of the respondents are into agriculture (27.7 per cent) whereas a small percentage are unskilled manual workers (0.5 per cent). Majority (51.7 per cent) of the respondents are in the rural areas whiles minority (48.3 per cent) of them are in the urban areas. More than half (63.1 per cent) of the respondents have fair or better comprehensive knowledge about AIDS whereas the rest have bad or very bad comprehensive knowledge about AIDS. In terms of knowledge of HIV prevention methods, almost all (97.4 per cent) of the respondents have fair or better knowledge of HIV prevention methods whereas a few (2.6 per cent) of them have bad knowledge of HIV prevention methods. More than 60.0 per cent of the respondents have some misconception about AIDS whereas the rest have no misconception about AIDS. Nearly all (97.1 per cent) have fair or better knowledge of HIV transmission while 2.9 per cent of them have bad knowledge of HIV transmission. More than three quarters (79.7 per cent) of the respondents have fair or better attitude towards PLWHA whiles the rest have bad or very bad attirude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 62 CHAPTER FOUR SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS AND COMPREHENSIVE KNOWLEDGE ABOUT AIDS 4.1 Introduction Generally, there is a correlation between one’s knowledge of an issue and his/her conception about it. All other things being equal, the higher the level of a person’s knowledge of an issue, the better his/her conception about it. It follows therefore, that if a person or groups of persons have good knowledge of HIV, then, all other things being equal, they should have positive conception and attitude towards it. On the other hand, if their knowledge of the epidemic were relatively low or insufficient, then, ordinarily, they would be expected to have wrong or negative conception and attitude towards it. Sight should, however, not be lost of the fact that one’s knowledge and conception of an issue or phenomenon could be influenced by certain socio-demographic factors such as, sex, age, education, marital status, religious affiliation, ethnicity, wealth index, occupation and type of place of residence. This chapter therefore examines the respondents’ comprehensive knowledge about AIDS. As indicated earlier in the methodology, knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission constitute the components of comprehensive knowledge about AIDS, therefore, this section also examines these three variables, (knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV Transmission) in addition to the major variable that is, comprehensive knowledge about AIDS to find out how the characteristics of the respondents affect each one of them. This is to University of Ghana http://ugspace.ug.edu.gh 63 ensure better understanding of the relationship among socio-demographic background and comprehensive knowledge about AIDS. 4.2 Comprehensive Knowledge about AIDS Comprehensive knowledge about AIDS is one of the important factors that affect people’s attitude towards PLWHA. This section examines the characteristics of the respondents and their influence on their comprehensive knowledge of the disease. . 4.2.1 Sex and Comprehensiv e Knowledge about AIDS Table 4.1 indicates the distribution of the respondents by sex and their comprehensive knowledge about AIDS. More than three fifths of the respondents of both sexes have fair or better comprehensive knowledge about AIDS. The proportion is higher amongst the males (63.8 per cent) than the females (62.3 per cent). Overall, more than 3 of 10 of the respondents have bad or very bad comprehensive knowledge about AIDS. The proportion is lower among the males (36.2 per cent) than the females (37.7 per cent). The p-value (0.312) also shows that the association between the sex of the respondents and their comprehensive knowledge about AIDS is not significant. This result is however inconsistent with 2010 MDHS report which indicates that sex is significantly associated with comprehensive knowledge about AIDS. University of Ghana http://ugspace.ug.edu.gh 64 Table 4.1: Percentage Distribution of Respondents by Sex and Comprehensive Knowledge about AIDS Sex Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Female 17.5 20.2 23.3 23.0 16.0 100.0 Male 17.2 19.0 23.4 24.0 16.4 100.0 Total % 17.3 19.6 23.4 23.5 16.2 100.0 No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.312 2 = 9.3695 4.2.2 Age and Comprehensive Knowledge about AIDS Another dimension investigated in this study is the relationship between age and comprehensive knowledge about AIDS. The result from Table 4.2 reveals that at least half of the respondents in the different age groups have fair or better comprehensive knowledge about AIDS, the proportion with fair or better comprehensive knowledge about AIDS is highest among the respondents aged 20-24 years (66.8 per cent) and lowest among those aged 15-19 years (58.8 per cent). Overall, there are little differences in the proportion among the age groups with fair or better comprehensive knowledge about AIDS. Less than half of the respondents in the different age groups have bad or very bad comprehensive knowledge about AIDS. The percentage is highest among those aged 15-19 years (41.4 per cent) and lowest amongst those aged 20-24 years (33.2 per cent). The p-value (0.065) also shows that there is no significant association between the age of the respondents and their comprehensive knowledge about AIDS. The result contradicts a study in Kumasi, Ghana,on attitude towards PLWHA by Ulasi et. al., (2009) which indicates that there is a significant association between age and comprehensive knowledge about AIDS. University of Ghana http://ugspace.ug.edu.gh 65 Table 4 .2: Percentage Distribution of Respondents by Age Group Comprehensive Knowledge about AIDS Age Group Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total 15-19 21.7 19.7 23.8 21.9 12.9 100.0 20-24 15.1 18.1 24.9 24.9 17.0 100.0 25-29 16.9 17.1 21.5 25.5 19.0 100.0 30-34 14.1 21.3 24.1 23.9 16.6 100.0 35-39 17.1 21.1 22.6 21.4 17.8 100.0 40-44 16.4 21.9 24.1 23.0 14.6 100.0 45-49 20.3 20.0 23.6 21.2 14.9 100.0 50-54 17.5 19.3 19.9 26.3 17.0 100.0 55-59 12.7 21.6 20.7 27.0 18.0 100.0 Total % 17.3 19.6 23.4 23.5 16.2 100.0 No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.065 2 = 81.956 4.2.3 Level of Education and Comprehensive Knowledge about AIDS The analysis is also done to find out whether or not education of the respondents affects their comprehensive knowledge about AIDS. The result presented in Table 4.3 indicates that there is a significant association between the level of education of the respondents and their comprehensive knowledge about AIDS. Over two-fifths of the respondents in the different educational groups have fair or better comprehensive knowledge about AIDS. The proportion increased from 49.1 per cent among the respondents with no education to 87.2 per cent among those with higher education. In all, there are wide variations among the respondents with fair or better comprehensive knowledge about AIDS. At least 1 in 10 of the respondents have bad or very bad comprehensive knowledge about AIDS. The proportion ranges from 12.8 per cent among those with higher education to 50.9 percent among those with no education. There are vast differences among the respondents with University of Ghana http://ugspace.ug.edu.gh 66 bad or very bad comprehensive knowledge about AIDS even as the p-value (0.000) also indicates that there is a significant association between the education of the respondents and their comprehensive knowledge about AIDS. This finding supports the 2010 TDHS report which shows that the education of respondents is significantly associated with their comprehensive knowledge about AIDS. Table 4 .3 : Percentage Distribution of Respondents by Level of Education and Comprehensi ve Knowledge about AIDS Level of Education Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total No Education 27.1 23.8 22.9 16.4 9.8 100.0 Primary 22.2 25.1 24.6 17.5 10.6 100.0 Middle/JSS 17.5 20.0 24.7 24.0 13.8 100.0 Secondary/SSS 10.0 15.1 23.1 30.0 21.8 100.0 Higher 4.8 8.0 14.7 31.9 40.6 100.0 Total % 17.3 19.6 23.4 23.5 16.2 100.0 No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 498.5583 4.2.4 Marital Status and Comprehensive Knowledge about AIDS Another important area of interest in the study is the role of the marital status of the respondents in their comprehensive knowledge about AIDS. Table 4.4 shows that over half of the respondents in all the marital categories have fair or better comprehensive knowledge about AIDS. The proportion is between 54.4 per cent among those who are separated and 66.6 per cent among those who are widowed. There are wide differences in the proportion among the respondents with fair or better comprehensive knowledge about AIDS. University of Ghana http://ugspace.ug.edu.gh 67 More than a third of the respondents in the different marital categories have bad or very bad comprehensive knowledge about AIDS. The proportion is highest among those who are separated (45.6 per cent) and lowest amongst those who are widowed (33.4 per cent). There are slight disparities in proportion among the respondents with bad or very bad comprehensive knowledge about AIDS. The p-value (0.001) indicates that the association between marital status of the respondents and their comprehensive about AIDS is significant. The result confirms a study by Ulasi et. al., (2009) in Ghana, which found out that the marital status of the respondents is significantly associated with their comprehensive knowledge about AIDS. Table 4 .4: Percentage Distribution of Respondents by Marital Status and Comprehensive Knowledge about AIDS Marital Status Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Never Married 17.8 17.9 23.2 25.5 15.6 100.0 Married 17.5 19.6 22.5 22.2 18.2 100.0 Living Together 17.3 22.1 25.3 23.4 11.9 100.0 Widowed 12.6 20.8 33.3 20.8 12.5 100.0 Divorced 13.3 23.1 26.4 24.0 13.2 100.0 Separated 14.6 31.0 26.2 17.9 10.3 100.0 Total % 17.3 19.6 23.4 23.5 16.2 100.0 No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.001 2 = 73.1796 4.2.5 Religious Affiliation and Comprehensive Knowledge about AIDS The study also examined the association between the religious affiliation of the respondents and their comprehensive knowledge about AIDS. From Table 4.5, it can be observed that at least half the respondents in the different religious groups have fair or better University of Ghana http://ugspace.ug.edu.gh 68 comprehensive knowledge about AIDS. The percentage of the respondents with fair or better comprehensive knowledge about AIDS is highest among the Catholics (65.2 per cent) and lowest among the Traditionalist/Spiritualist (49.4 per cent). As a whole, there are not much differences in the proportion amongst the respondents with fair or better comprehensive knowledge about AIDS. At least a third of the respondents have bad or very bad comprehensive knowledge about AIDS, the proportion of respondents with bad or very bad comprehensive knowledge of AIDS increases from 33.3 per cent to 50.6 per cent among Anglicans and Traditionalist/Spiritualist respectively. But on the whole, there are not much disparities among the respondents with bad or very comprehensive knowledge about AIDS. The p-value (0.001) indicates that there is a significant association between the religious affiliation of the respondents and their comprehensive knowledge about AIDS. This results supports a study in Kumasi, Ghana, by Ulasi et.al., (2009) which states that the association between the religious affiliation of the respondents and their comprehensive knowledge about AIDS is significant. University of Ghana http://ugspace.ug.edu.gh 69 Table 4. 5 : Percentage Distribution of Respondents by Religious Affiliation and Comprehensive Knowledge about AIDS Religious Affiliat ion Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Catholic 16.7 18.1 21.4 23.8 20.0 100.0 Anglican 21.5 11.8 33.3 21.6 11.8 100.0 Methodist 14.3 21.5 26.3 21.2 16.7 100.0 Presbyterian 15.4 21.6 22.9 24.2 15.9 100.0 Pentecostal/Charismatic 16.4 19.3 23.7 23.9 16.7 100.0 Other Christian 18.2 17.5 23.8 25.6 14.9 100.0 Moslem 17.7 18.9 22.2 25.5 15.7 100.0 Traditionalist/Spiritualist 24.6 26.0 23.8 13.7 11.9 100.0 No Religion 26.2 23.8 23.3 18.3 8.4 100.0 Other 20.0 30.0 40.0 10.0 0.0 100.0 Total % 17.4 19.6 23.3 23.5 16.2 100.0 No 950 1072 1277 1285 885 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.001 Missing cases = 3 2 = 119.7998 4.2.6 Ethnicity and Comprehensive Knowledge about AIDS The study also investigated the association between the ethnic background of the respondents and their comprehensive knowledge about AIDS. At least 6 out of 10 of the respondents of each ethnic group have fair or better comprehensive knowledge about AIDS. The proportion of the respondents with fair or better comprehensive knowledge about the disease is highest among the Grussi (70.0 per cent) and lowest among the Gruma (60.3 per cent). Generally, there are little variations in the proportion among the respondents with fair or better comprehensive knowledge about AIDS. More than a quarter of the respondents in the different ethnic groups have bad or very bad comprehensive knowledge about AIDS. The proportion ranges from 30.0 per cent among the University of Ghana http://ugspace.ug.edu.gh 70 Grussi to 60.3 per cent among the Gruma. There are much disparities in proporion among the respondents with bad or very bad comprehensive knowledge about AIDS. The p-value (0.000) shows that there is a significant association between the ethnicity of the respondents and their comprehensive knowledge about AIDS. This result however contradicts the 2010 TDHS report which indicates that there is no significant association between the ethnicity of the respondents and their comprehensive knowledge about AIDS. Table 4.6: Percentage Distribution of Respondents by Ethnicity and Comprehensive Knowledge about AIDS Ethnicity Comprehensive Knowledge Ab out AIDS Very Bad Bad Fair Good Very Good Total Akan 16.6 20.2 24.9 24.2 14.1 100.0 Ga/Adamgne 18.2 18.9 21.9 23.5 17.5 100.0 Ewe 17.6 19.8 21.8 24.6 16.2 100.0 Guan 17.7 16.2 25.4 21.5 19.2 100.0 Mole-Dagbani 18.1 17.6 22.4 22.9 19.0 100.0 Grussi 11.9 18.1 23.1 18.8 28.1 100.0 Gruma 34.4 25.9 19.0 11.5 9.2 100.0 Mande 7.7 26.9 15.4 34.6 15.4 100.0 Other 11.7 19.0 21.0 26.3 22.0 100.0 Total % 17.4 19.6 23.3 23.5 16.2 100.0 No 950 1071 1277 1285 886 100.0 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. Missing cases = 3 P - value = 0.000 2 = 122.8156 University of Ghana http://ugspace.ug.edu.gh 71 4.2.7 Wealth Status and Comprehensive Knowledge about AIDS Wealth status has been observed to influence a person’s comprehensive knowledge about AIDS (TDHS, 2010). The result presented in Table 4.7 shows that generally, comprehensive knowledge about AI'6 increases with increase in respondent’s wealth status. Over two-fifths of the respondents in all the wealth statuses have fair or better comprehensive knowledge about AIDS. The percentage is highest among the richest (75.0 per cent) and lowest among the poorest (49.6 per cent). There are vast differences in the proportion among the respondents with fair or better comprehensive knowledge about AIDS. A high proportion of the richest have fair or better comprehensive knowledge about AIDS, may be because they can afford mass-media items like televisions and radio that give them access to different HIV/AIDS information. Moreover, the richest may also have higher levels of education At least 2 out of 10 of the respondents have bad or very bad comprehensive knowledge about AIDS. The percentage of the respondents with bad or very bad comprehensive knowledge about AIDS is from 25.0 per cent among the richest to 50.4 per cent among the poorest. The p- value (0.000) also shows that the association between the wealth status of the respondents and their comprehensive knowledge about AIDS is significant. This finding confirms a study in Eastern Ethopia by Olijira et.al,. (2012) which states that wealth status is significantly associated with comprehensive knowledge about AIDS. University of Ghana http://ugspace.ug.edu.gh 72 Table 4. 7 : Percentage Distribution of Respondents by Wealth Status and Comprehensive Knowledge about AIDS Wealth Status Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Poorest 27.2 23.2 23.1 16.3 10.2 100.0 Poorer 22.7 22.7 23.9 18.9 11.8 100.0 Middle 16.4 22.8 24.1 24.8 11.9 100.0 Richer 14.8 17.0 24.8 26.4 17.0 100.0 Richest 10.0 15.0 21.1 27.9 26.0 100.0 Total % 17.3 19.6 23.4 23.5 16.2 100.0 No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.000 2 = 347.2369 4.2.8 Occupation and Comprehensive Knowledge about AIDS The study also investigated how the occupation of the respondents influences their comprehensive knowledge about AIDS. The result indicated in Table 4.8 shows that, more than 4 out of 10 of the respondents have fair or better comprehensive knowledge about AIDS. The proportion of the respondents with fair or better comprehensive knowledge about AIDS rose from 45.8 per cent among those who are unskilled manually to 82.4 per cent among those in the Professional/Technical/Managerial occupations. Unskilled manual workers are usually lowly educated. Those with Professional/Technical/Managerial occupations are highly educated who may be more exposed to adequate information on HIV/AIDS. More than 3 out of 10 of the respondents in the various occupational groups have bad or very comprehensive knowledge about AIDS. The proportion is highest among those who are manually unskilled (54.2 per cent) and lowest among those who are in the Professional/Technical/Managerial occupations (17.6 per cent). There are vast differences in the proportions amongst the respondents with bad or very bad comprehensive knowledge about University of Ghana http://ugspace.ug.edu.gh 73 AIDS. The p-value (0.000) however indicates that the association between the occupation of the respondents and their comprehensive knowledge about the disease is significant. This finding supports a study in Kumasi, Ghana, by Ulasi et. al., (2009) which indicates that occupation is significantly associated with comprehensive knowledge about AIDS. Table 4 . 8 : Percentage Distribution of Respondents by Occupation and Comprehensive Knowledge about AIDS Occupation Compreh ensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Not-working 18.3 18.6 23.7 23.7 15.7 100.0 Professional/Technical/ Managerial 5.7 11.9 17.2 30.0 35.2 100.0 Clerical 14.9 17.8 21.5 23.4 22.4 100.0 Sales 12.2 22.4 25.4 26.0 14.0 100.0 Agriculture 23.7 22.9 24.2 18.8 10.4 100.0 Services 16.5 15.3 24.3 23.0 20.9 100.0 Skilled Manual 28.2 18.5 21.9 25.3 16.1 100.0 Unskilled Manual 33.4 20.8 20.8 33.3 12.5 100.0 Total % 17.3 19.7 23.3 23.5 16.2 100.0 No 930 1056 1252 1259 868 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P - value = 0.000 Missing cases 107 2 = 345.6990 4.2.9 Place of Resid ence and Comprehensive Knowledg e about AIDS From Table 4.9, it is clear that over half of the respondents in both the urban and rural areas have fair or better comprehensive knowledge about AIDS. The proportion is higher among those in the urban areas (69.3 per cent) and lower among those in rural areas (56.6 per cent). However, less than half of the respondents in both places of residence have bad or very bad comprehensive knowledge about AIDS. The proportion ranges from 30.7 per cent among University of Ghana http://ugspace.ug.edu.gh 74 those in the urban areas to 43.4 per cent amongst those in the rural areas. There are considerable differences in the proportion amongst the respondents with bad or very bad comprehensive knowledge about AIDS. The p-value (0.000) also shows that the association between the place of residence of the respondents and their comprehensive knowledge about AIDS is significant. Rural residents probably have less access to information on HIV/AIDS compared to those in the urban areas who also have better levels of education. Table 4 . 9 : Percentage Distribution of Respondents by Place of Resid ence and Comprehensive Knowledge about AIDS Place of Resid ence Comprehensive Knowledge about AIDS Very Bad Bad Fair Good Very Good Total Urban 13.2 17.5 23.0 26.7 19.6 100.0 Rural 21.8 21.6 23.7 20.5 13.0 100.0 % 17.3 19.6 23.4 23.5 16.2 100.0 Total No 950 1072 1278 1286 886 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 125.7784 4.3 Knowledge of HIV prevention method s . Knowledge of HIV prevention methods of the respondents may depend on their and socio- demographic characteristics. This section therefore examines the characteristics of the respondents who were interviewed to facilitate a better understanding of their attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 75 4.3.1 Sex and Knowledge of HIV Prevention Method s Table 4.10 examines the sex of the respondents by their knowledge of HIV prevention methods. From Table 4.10, it can be seen that more that almost all the males and females have fair or better knowledge of HIV prevention methods. The proportion was higher among the males (97.5 per cent) than the females (97.3 per cent). Generally, there is a slight difference among the females and the males with fair or better knowledge of HIV prevention methods. Fewer than 3.0 per cent of both the males and females have bad knowledge of HIV prevention methods, the proportion is 2.7 per cent and 2.5 per cent among the men and women respectively. The p-value (0.000) also indicates that the association between the sex of the respondents and their knowledge of HIV prevention methods is significant. This result appears to confirm a study by Anarfi, (1995) in Accra, Ghana which states that there is a significant association between the sex of the respondents and their knowledge of HIV prevention methods. Table 4. 10: Percentage Distribution of Respondents by Sex and Knowledge of HIV Prevention Method s Sex Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Female 2.5 9.1 24.4 64.1 100.0 Male 2.7 6.6 19.2 71.5 100.0 Total % 2.6 7.9 21.9 67.7 100.0 No 140 431 1198 3707 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.000 2 = 38.8998 University of Ghana http://ugspace.ug.edu.gh 76 4.3.2 Age and Knowledge of HIV Prevention Method s The results from Table 4.11 shows that, nearly all the respondents in the different age groups have fair or better knowledge of HIV prevention methods. The percentage varies from 95.5 per cent among the respondents aged 55-59 years to 99.3 per cent among those aged 50-54 years. The result from Table 4.11 shows little disparity among respondents with fair or better knowledge of HIV prevention methods. Only a small proportion of the respondents have bad knowledge of HIV prevention methods. The proportion ranges from 0.7 per cent among respondents aged 50-54 years to 4.5 per cent among those aged 55-59 years. However, the p-value (0.000) shows that the association between the age of the respondents and their knowledge of HIV prevention methods is significant. The results of this study confirm a study by Zhao et. al., (2009) which shows that there is a significant association between the age of the respondents and their knowledge of HIV prevention methods. University of Ghana http://ugspace.ug.edu.gh 77 Table 4.11 : Percentage Distribution of Respondents by Age Group and Knowledge o f HIV Prevention Method s Age Group Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total 15-19 2.9 7.8 25.4 63.9 100.0 20-24 3.0 8.6 20.1 68.3 100.0 25-29 2.5 7.8 21.3 68.4 100.0 30-34 2.0 7.1 22.9 68.0 100.0 35-39 1.7 8.0 20.5 69.8 100.0 40-44 1.8 7.7 21.2 69.3 100.0 45-49 4.1 10.1 22.7 63.1 100.0 50-54 0.7 6.4 17.5 75.4 100.0 55-59 4.5 0.9 17.1 77.5 100.0 Total % 2.6 7.9 21.9 67.7 100.0 No 140 431 1198 3703 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.008 X 2 = 43.6076 4.3.3 Level of Education and Knowledge of HIV Prevention Method s The results presented in Table 4.12 shows that over four-fifths of the respondents with different levels of education have fair or better knowledge of HIV prevention methods. The percentage with fair or better knowledge of HIV prevention is highest among respondents with primary level of education (98.2 per cent) and lowest amongst those with no level of education (96.1 per cent). Minority of the respondents have bad knowledge of HIV prevention methods. The proportion of the respondents with bad knowledge of HIV prevention methods is from 2.1 per cent amongst respondents with higher education to 3.9 per cent amongst those with no education. The p-value (0.000) shows that there is a significant association between the education of the respondents and their knowledge of HIV prevention methods. This result appears to confirm the University of Ghana http://ugspace.ug.edu.gh 78 (2006 IFHS) report which shows that the level of education of the respondents is significantly associated with their knowledge of HIV prevention methods. Table 4.12 : Percentage Distribution of Respondents by Level of Education and Knowled ge of HIV Prevention Method s Level of Education Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total No Education 3.9 9.2 22.9 64.0 100.0 Primary 1.8 8.1 21.2 68.9 100.0 Middle/JSS 2.4 8.6 22.8 66.2 100.0 Secondary/SSS 2.7 6.8 21.8 68.7 100.0 Higher 2.1 3.2 16.7 78.0 100.0 Total % 2.6 7.9 21.9 67.7 100.0 No 140 431 1198 3703 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.000 2 = 41.9044 4.3.4 Marital Status and Knowledge of HIV Prevention Method s The study also looked at the association between the various marital categories of the respondents and their knowledge of HIV prevention methods. It can be seen from Table 4.13 that more than 9 out of 10 of the respondents have fair or better knowledge of HIV prevention methods. The proportion of those with fair or better knowledge of HIV prevention methods is highest among those who are separated (98.6 per cent) and lowest among those who are never married (97.1 per cent). The result from Table 4.13 shows that there are little differences in the percentage among the respondents with fair or better knowledge of HIV prevention methods. Less than 5.0 per cent of the respondents in the different marital groups have bad knowledge of HIV prevention methods. The p-value (0.635) shows that there is no significant University of Ghana http://ugspace.ug.edu.gh 79 association between the marital categories of the respondents and their knowledge of HIV prevention methods which is in line with the 2006 IFHS report which indicates that there is no significant association between the marital categories of the respondents and their knowledge of HIV prevention methods. Table 4.13 : Percentage Distribution of Respondents by Marital Status and Knowledge of HIV Prevention Method s Marital Status Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Never Married 2.9 7.9 22.5 66.7 100.0 Married 2.3 7.7 20.8 69.2 100.0 Living Together 2.8 8.5 23.3 65.4 100.0 Widowed 4.2 8.3 19.4 68.1 100.0 Divorced 2.4 8.3 20.7 68.6 100.0 Separated 1.4 6.2 29.6 62.8 100.0 2.6 7.9 21.9 67.7 100.0 % Total No 140 431 1198 3703 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.635 2 = 12.5796 4.3.5 Religious Affiliation and Knowledge of HIV Prevention Method s This study was also interested in comparing the religious affiliation of the respondents and their knowledge of HIV prevention methods. It can be seen from Table 4.14 that more than 9 of 10 of the respondents have fair or better knowledge of HIV prevention methods. The proportion is highest among the respondents with no religion and those who are Pentecostals/Charismatic (98.0 per cent) each and lowest among the respondents in the religious group labeled as ³other ´(90.0 per cent). The result from Table 4.14 shows that generally there is University of Ghana http://ugspace.ug.edu.gh 80 little variation in proportion amongst the respondents with fair or better knowledge of HIV prevention methods. At least a tenth of the respondents have bad knowledge of HIV prevention methods. The proportion ranges from 2.0 per cent amongst those with no religion and those who are PentecostalCharismatic to . per cent among the religious group labeled as ³other´. 7he p- value (0.180) shows that there is no significant association between the religious affiliation of the respondents and their knowledge of HIV prevention methods. The result contradicts the 2006 IFHS which states that there is a significant association between religious affiliation of the respondents and their knowledge of HIV prevention methods. Table 4.14 : Percentage Distribution of Respondents by Religious Affiliation Knowledge o f HIV Prevention Method s Religious Affiliation Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Catholic 2.7 8.4 20.2 68.7 100.0 Anglican 3.9 5.9 31.4 58.8 100.0 Methodist 3.1 8.3 17.9 70.7 100.0 Presbyterian 2.2 5.7 25.6 66.5 100.0 Pentecostal/Charismatic 2.0 7.6 22.4 68.0 100.0 Moslem 2.3 8.9 24.0 64.8 100.0 Traditionalist/Spiritualist 4.0 7.5 15.9 72.6 100.0 No Religion 2.0 8.9 20.8 68.3 100.0 Other Christian 3.7 8.1 21.4 66.8 100.0 Other 10.0 0.0 30.0 60.0 100.0 Total % 2.6 7.9 21.9 67.7 100.0 No 140 431 1198 3700 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.180 Missing cases = 3 2 = 32.1484 University of Ghana http://ugspace.ug.edu.gh 81 4.3.6 Ethnicity and Knowledge of HIV Prevention Method s The study also sought to find out whether or not the ethnic background of respondents affects their knowledge of HIV prevention methods. The results from Table 4.15 shows that generally almost all the respondents in the different ethnic groups have fair or better knowledge of HIV prevention methods. The proportion ranges from 93.7 per cent amongst the Gruma to 99.2 per cent among the Guan. There are little variations among ethnic groups with fair or better knowledge of HIV prevention methods. Less than 7.0 per cent of the respondents have bad knowledge of HIV prevention methods. The proportion of the respondents with bad knowledge of HIV prevention of methods ranges from . per cent amongst the ethnic groups labeled ³other´ to 6.3 per cent among the Gruma. The p-value (0.000) shows that the ethnicity of the respondents is significantly associated with their knowledge of HIV prevention methods. The result of this study supports the 2006 IFHS report which shows that there is a significant association between the ethnicity of the respondents and their knowledge of HIV prevention methods. University of Ghana http://ugspace.ug.edu.gh 82 Table 4.15 : Percentage Distribution of Respondents by Ethnicity and Knowledge o f HIV Prevention Method s Ethnicity Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Akan 2.2 7.7 22.9 67.2 100.0 Ga/Dangme 5.5 9.0 22.4 63.1 100.0 Ewe 2.1 6.0 22.7 69.2 100.0 Guan 0.8 6.2 17.6 75.4 100.0 Mole-Dagbani 2.6 9.0 20.7 67.7 100.0 Grussi 1.9 4.4 16.9 76.8 100.0 Gruma 6.3 14.4 20.7 58.6 100.0 Mende 3.8 3.8 19.3 73.1 100.0 Other 1.0 8.3 18.5 72.2 100.0 Total % 2.6 7.9 21.8 67.7 100.0 No 140 431 1197 3701 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.000 Missing cases = 3 2 = 55.1715 4.3.7 Wealth Status and Knowledge of HIV Prevention Method s Wealth status is significantly associated with a person’s knowledge of HI9 prevention methods. The result in Table 4.16 also suggests that there is generally a significant association between the wealth status of the respondents and their knowledge of HIV prevention methods. Over four-fifth of the respondents have fair or better knowledge of HIV prevention methods. The proportion was highest amongst the richest and those in the middle quintile (98.3 per cent) and lowest among those in poorest quintile (95.4 per cent). The proportion is highest amongst the richest may be because they can afford mass media items like television and radio giving them access to different HIV/AIDS information sources. The findings from Table 4.16 indicate that there are little variations among respondents with fair or better knowledge of HIV prevention methods. University of Ghana http://ugspace.ug.edu.gh 83 Fewer than 5.0 per cent of the respondents have bad knowledge of HIV prevention methods. The proportion is highest amongst the poorest (4.6 per cent) and lowest among the respondents in the middle and richest wealth quintile (1.7 per cent). The p-value (0.000) also shows that the wealth quintile of respondents is significantly associated with their knowledge of HIV prevention methods. This result confirms 2006 IFHS report which states that wealth quintile is significantly associated with knowledge of HIV prevention methods. Table 4.16 : Percentage Distribution of Respondents by Wealth Status and Knowledge o f HIV Prevention Method s Wealth Status Knowledge of HIV Pre vention Method s Bad Fair Good Very Good Total Poorest 4.6 8.8 20.6 66.0 100.0 Poorer 1.8 9.8 23.7 64.7 100.0 Middle 1.7 6.5 25.6 66.2 100.0 Richer 3.2 7.6 19.7 69.5 100.0 Richest 1.7 7.3 20.7 70.3 100.0 Total % 2.6 7.9 21.8 67.7 100.0 No. 140 431 1198 3703 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.000 2 = 48.5639 4.3.8 Occupation and Knowled ge of HIV Prevention Method s Another important area of interest in the study is the role of occupation in the knowledge of HIV prevention methods of the respondents. From Table 4.17 it can be observed that at least 8 in 10 of the respondents have fair or better knowledge of HIV prevention methods. The proportion is highest among those in sales (98.3 per cent) and lowest among those who are manually unskilled (87.5 per cent). There are little differences in the proportion among the respondents with fair or better knowledge of HIV prevention methods. University of Ghana http://ugspace.ug.edu.gh 84 Fewer than 5.0 per cent of the respondents have bad knowledge of HIV prevention methods except those who are unskilled manually (12.5 per cent). The respondents in the rest of occupational groups range from 1.7 per cent amongst those who are in sales to 2.8 per cent amongst those who are not working. The p-value (0.002) however reveals that there is a significant association between the occupation of the respondents and their knowledge of HIV prevention methods. This result confirms a study by Ntozi et.al., (2000) which states that there is a significant relationship between the occupation of the respondents and their knowledge of HIV prevention methods. Table 4.17 : Percentage Distribution of Respondents by Occupation and Knowledge o f HIV Prevention Method s Occupation Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Not Working 2.8 9.2 24.9 63.1 100.0 Professional/Technical/Managerial 2.3 5.2 17.2 75.3 100.0 Clerical 3.7 6.5 19.6 70.2 100.0 Sales 1.7 7.8 22.5 68.0 100.0 Agriculture 2.7 9.0 20.7 67.6 100.0 Services 2.4 7.4 23.0 67.2 100.0 Skilled Manual 2.4 6.4 22.3 68.9 100.0 Unskilled Manual 12.5 0.0 25.0 62.5 100.0 Total % 2.5 7.9 22.0 67.6 100.0 No 135 425 1180 3625 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.002 Missing cases = 107 2 = 48.1386 University of Ghana http://ugspace.ug.edu.gh 85 4.3.9 Place of Resid ence and Knowledge of HIV Prevention Method s The study also considered the influence of place of residence of the respondents on their knowledge of HIV prevention methods. The results presented in Table 4.18 indicate that more than 9 in 10 of all the respondents in the two different areas of residence have fair or better knowledge of HIV prevention methods. The proportion of the respondents with fair or better knowledge of HIV prevention methods is higher amongst those in the urban areas (97.6 per cent) and lower among those who are in the rural areas (97.3 per cent). There are slight differences in the proportion among the respondents in both areas of residence who have fair or better knowledge of HIV prevention methods. Perhaps, this is because of the HIV public educational campaign in both areas. However, less than 4.0 per cent of the respondents in the two places of residence have bad knowledge of HIV preventive methods. The proportion is higher among the rural areas (2.7 per cent) and lower among those in the urban areas (2.4 per cent). The p-value (0.676) also shows that there is no significant association between the place of residence of the respondents and their knowledge of HIV prevention methods. The findings contradict the 2007 LDHS report which indicates that place of residence is significantly associated with knowledge of HIV prevention methods. University of Ghana http://ugspace.ug.edu.gh 86 Table 4.18 : Percentage Distribution of Respondents by Place of Resid ence and Knowledge o f HIV Prevention Method s Place of Resid enc e Knowledge of HIV Prevention Method s Bad Fair Good Very Good Total Urban 2.4 7.7 21.5 68.4 100.0 Rural 2.7 8.1 22.3 66.9 100.0 Total % 2.6 7.9 21.9 67.7 100.0 No. 140 431 1198 3703 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-Value = 0.676 2 = 52.82 4.4 Misconception about AIDS Misconception about AIDS transmission is one of the factors that influence discrimination and stigmatization towards PLWHA. This section looks at the characteristics of the respondents to ascertain how they affect their misconception about the disease. 4.4.1 Sex and Misconception About AIDS Table 4.19 examines the sex of the respondents by their misconception about AIDS. It can be seen from the Table 4.19 that, more than a half of the respondents have some level of misconception about AIDS. The proportion is higher among the females (62.9 per cent) and lower among the males (57.5 per cent). The result from Table 4.19 also shows that there is little difference in proportion of the respondents with some level of misconception about AIDS. However, more than a third of the respondents have no misconception about AIDS. The percentage is higher among the males (42.5 per cent) and lower among the females (37.1 per cent). The p-value (0.000) also shows that there is a significant association between the sex of University of Ghana http://ugspace.ug.edu.gh 87 the respondents and their misconception above AIDS. The finding confirms a study by Babatola and Oni (1995) in Freetown which states that the sex of the respondents is significantly associated with their misconception about AIDS. Table 4 .19 : Percentage Distribution of Respondents by Sex and Misconception About AIDS Sex Misconcept ion about AIDS Very Strong Strong Fair Weak No Total Female 0.9 9.4 19.5 33.1 37.1 100.0 Male 0.5 7.6 17.4 32.0 42.5 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 2 = 23.2669 4.4.2 Age and Misconception About AIDS Another important aspect of interest in the study is the role of age in the respondent’s misconception about AIDS. The result from Table 4.20 indicates that at least 5 in 10 of the respondents in the various age groups have some misconception about AIDS. The proportion ranges from 55.5 per cent among those aged 20-24 years to 66.0 per cent among those aged 40- 44 years. There are little variations in the proportion among the respondents with some level of misconception about AIDS However, Table 4.20 also indicates that at least 3 in 10 of the respondents have no misconception about AIDS. The proportion is highest among those aged 20-24 years (44.5 per cent) and lowest among those aged 40-44 years (34.0 per cent). The p-value (0.000) reveals that age and misconception about AIDS are significantly associated. The result seems to refute the University of Ghana http://ugspace.ug.edu.gh 88 findings of the 2009 KDHS report which shows that age is not significantly associated with misconception about AIDS. Table 4 .20: Percentage Distribution of Respondents by Age Group and Misconception about AIDS Age Group Misconception about AIDS Very Strong Strong Fair Weak No Total 15-19 1.0 7.1 19.0 34.2 38.7 100.0 20-24 0.2 6.0 16.4 32.9 44.5 100.0 25-29 1.1 8.5 15.9 34.0 40.5 100.0 30-34 0.6 7.7 19.9 30.5 41.3 100.0 35-39 0.9 11.9 20.7 31.2 35.3 100.0 40-44 0.9 10.4 20.1 34.7 34.0 100.0 45-49 0.2 13.3 20.2 28.4 37.8 100.0 50-54 0.0 6.4 18.7 30.4 44.4 100.0 55-59 0.0 6.3 18.0 33.3 42.3 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 2 = 75.4612 4.4.3 Level of Education and Misconception About AIDS The result presented in Table 4.21 shows that more than three-fifths of the respondents in all educational groups have some level of misconception about AIDS with the exception of those with Secondary/SSS education (42.2 per cent) and those with higher education (25.1 per cent). The proportion among the rests of the respondents with some level of misconception ranges from 64.8 per cent among those with Middle/JSS education to 73.4 per cent among those with primary education. University of Ghana http://ugspace.ug.edu.gh 89 Less than two-fifths of the respondents in the different educational groups have no misconception about AIDS except those with Secondary/SSS education (57.8 per cent) and those with higher education (74.9 per cent). The p-value (0.000) also shows that the level of education of the respondents is significantly associated with their misconception about AIDS. This result also seems to confirm the 2010 CDHS report which indicates that education is significantly associated with misconception about AIDS. Table 4 .21: Percentage Distribution of Respondents by Level of Education and Misconception about AIDS Level of Education Misconception about AIDS Very Strong Strong Fair Weak No Total No Education 1.8 20.2 22.9 27.7 27.5 100.0 Primary 1.1 12.5 27.8 32.0 26.6 100.0 Middle/JSS 0.4 7.1 19.4 37.9 35.2 100.0 Secondary/SSS 0.4 2.1 10.4 29.2 57.8 100.0 Higher 0.0 1.0 3.4 20.8 74.9 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 X 2 = 733.2249 4.4.4 Marital Status and Misconception About AIDS Table 4.21 shows the distribution of the respondents by marital status and their misconception about AIDS. From Table 4.21, it can be seen that more than three-fifths of the respondents in the different marital groups have some level of misconception about AIDS with the exception of those who are never married (55.9 per cent). The proportion in the rest of the group ranges from 60.7 per cent amongst those who are married to 75.2 per cent among those University of Ghana http://ugspace.ug.edu.gh 90 who are separated. The result from Table 4.21 shows that there is little variation among respondents with some level of misconception about AIDS. However, more than 2 in 10 of the respondents in the various marital groups have no misconception about AIDS. The proportion is highest among those who are never married (44.1 per cent) and lowest among those who are separated (24.8 per cent). The p-value (0.000) analysis shows that the marital group of the respondents is significantly associated with their misconception about AIDS. This contradicts the 2009 KDHS reports which indicate that marital group is not significantly associated with comprehensive knowledge about AIDS. Table 4.22: Percentage Distribution of Respondents by Marital Status and Misconception about AIDS Marital Status Misconception about AIDS Very Strong Strong Fair Weak No Total Never Married 0.6 5.9 15.7 33.8 44.1 100.0 Married 0.8 10.0 19.6 30.3 39.3 100.0 Living Together 0.6 11.2 19.8 36.7 31.8 100.0 Widowed 0.0 9.7 25.0 29.2 36.1 100.0 Divorced 2.5 8.3 24.8 34.7 29.8 100.0 Separated 0.0 9.0 26.2 40.0 24.8 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 2 = 96.6739 4.4.5 Religious Affiliation and Misconception About AIDS The result in Table 4.23 shows the distribution of the respondents by religious affiliation and misconception about AIDS. It can be observed from Table 4.23 that more than half of the respondents in all the religious groups have different levels of misconception about AIDS. The University of Ghana http://ugspace.ug.edu.gh 91 proportion ranges from 56.4 per cent among the Catholic to 80.0 per cent among the religious group labeled ³other´. 7he finding from Table 4.23 shows that there are vast variations in the proportion of the respondents with some level of misconception about AIDS. It can also be seen from Table 4.23 that at least 2 in 10 of the respondents have no misconception about AIDS. The proportion is highest among the Moslem (47.2 per cent) and lowest among the religious group labeled as ³other ´ (20.0 per cent). The p-value (0.000) however suggests that the religious affiliation of the respondents is significantly associated with their misconception about AIDS. The result however rejects 2009 MDHS report which shows that there is no significant association between the religious affiliation of the respondents and their misconception about AIDS. Table 4.23 : Percentage Distribution of Respondents by Religiou s Affiliation and Misconception about AIDS Religious Affiliation Misconception about AIDS Very Strong Strong Fair Weak No Total Catholic 0.2 9.0 15.6 31.6 43.6 100.0 Anglican 0.0 9.8 13.7 33.3 43.1 100.0 Methodist 1.5 7.3 20.7 33.1 37.4 100.0 Presbyterian 0.7 5.9 16.1 33.3 44.1 100.0 Pentecostal/Charismatic 0.3 8.4 18.8 35.0 37.6 100.0 Other Christian 0.5 6.5 20.8 33.4 38.8 100.0 Moslem 1.4 7.7 15.2 28.4 47.2 100.0 Traditionalist/Spiritualist 1.8 17.6 25.1 28.6 26.9 100.0 No Religion 1.0 14.9 27.2 32.2 24.8 100.0 Other 0.0 10.0 40.0 30.0 20.0 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1010 1783 2173 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 Missing cases = 3 2 = 138.7035 University of Ghana http://ugspace.ug.edu.gh 92 4.4.6 Ethnicity and Misconception About AIDS The study also considered the association between the ethnic background of the respondents and their misconception about AIDS. From Table 4.24, it can be seen that more than 5 out of 10 of the respondents in the different ethnic groups have some level of misconception about AIDS with the e[ception of the ethnic group labeled as ³other´ . per cent). The proportion among the respondents in the remaining ethnic group ranges from 53.1 per cent among the Guan to 70.7 per cent among the Gruma. The result from Table 4.24 also indicates that there are vast variations in proportion of the respondents with some level of misconception about AIDS. However, less than half of the respondents in all the ethnic groups have no misconception about AIDS except among the ethnic group labeled as ³other´ 1.2 per cent). There are also vast differences among the respondents with no misconception about AIDS. The p-value (0.000) shows that the ethnicity of the respondents is significantly associated with their misconception about AIDS. This contradicts the 2010 CDHS reports which show that the association between ethnicity and misconception about AIDS is not significant. University of Ghana http://ugspace.ug.edu.gh 93 Table 4 .24: Percentage Distribution of Respondents by Ethnicity and Misconception about AIDS Ethnicity Misconception about AIDS Very Strong Strong Fair Weak No Total Akan 0.4 7.5 20.2 36.6 35.3 100.0 Ga/Dangme 0.8 6.6 17.8 32.5 42.3 100.0 Ewe 0.8 9.2 17.1 29.7 43.2 100.0 Guan 0.8 10.8 13.8 27.7 46.9 100.0 Mole-Dagbani 1.3 9.1 16.6 27.9 45.1 100.0 Grussi 1.9 11.9 14.4 25.6 46.2 100.0 Gruma 0.6 21.3 21.3 27.6 29.3 100.0 Mende 0.0 0.0 15.4 46.2 38.5 100.0 Other 0.5 5.9 15.6 26.8 51.2 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1010 1782 2174 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 Missing cases = 3 2 = 125.4856 4.4.7 Wealth Status and Misconception About AIDS The study examined the influence of the respondent’s wealth quintile on their misconception about AIDS. The result presented in Table 4.25 shows that over half of the respondents in all the wealth quintiles have different levels of misconception about AIDS with the exception of the richest (44.8 per cent). The percentage of the respondents in the rest of the wealth quintile is between 57.8 per cent among the richer and 72.9 per cent among the poorest. The result from Table 4.25 also indicates that there are wide variations in the proportion of the respondents with some level of misconception about AIDS. From Table 4.25, it can also be seen that less than 5 in 10 of the respondents have no misconception about AIDS with the exception of the richest (55.2 per cent). The proportion of the respondents in the rest of the wealth quintile is between 27.1 per cent among the poorest and University of Ghana http://ugspace.ug.edu.gh 94 42.2 per cent among the richer. The p-value (0.000) also implies that the wealth quintile of the respondents is significantly associated with their misconception about AIDS. This result appears to confirm with the 2009 KDHS which reports that the wealth of the respondents is significantly associated with their misconception about AIDS. Table 4 .25 : Percentage Distribution of Respondents by Wealth Status and Misconception about AIDS Wealth Status Misconception about AIDS Very Strong Strong Fair Weak No Total Poorest 2.0 16.6 22.2 32.1 27.1 100.0 Poorer 0.5 13.3 22.5 32.6 31.1 100.0 Middle 0.5 8.6 21.0 33.9 36.0 100.0 Richer 0.6 5.0 18.3 33.8 42.2 100.0 Richest 0.2 2.8 11.1 30.7 55.2 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 2 = 390.4450 4.4.8 Occupation and Misconception About AIDS The study again sought to find out whether or not the occupation of the respondents affects their misconception about AIDS. It is clear from Table 4.26 that more than two-fifths of the respondents in the various occupational groups have some misconception about AIDS with the exception of those who are in the Professional/Technical/Managerial occupations (30.9 per cent) and those who are manually unskilled (29.2 per cent). The proportion in the rest of the occupational groups ranges from 49.5 per cent among those in the clerical occupations to 71.7 per cent among those who are in agriculture. The result from Table 4.26 also shows that there University of Ghana http://ugspace.ug.edu.gh 95 are vast differences in the proportion of the respondents with some level of misconception about AIDS. The result from Table 4.26 also show that less than half of the respondents in the different occupational groups have no misconception about AIDS with the exception of those who are in the Professional/Managerial/Technical occupations (69.1 per cent), Clerical (50.5 per cent) and those who are manually unskilled (70.2 per cent). The p-value (0.000) also shows that there is a significant association between the occupation of the respondents and their misconception about AIDS. This result rejects the 2010 CDHS which states that there is no significant association between occupation of the respondents and their misconception about AIDS. Table 4. 26 : Percentage Distribution of Respondents by Occupation and Misconception about AIDS Occupation Misconception about AIDS Very Strong Strong Fair Weak No Total Not Working 0.7 5.7 16.5 32.7 44.4 100.0 Professional/Technical/Managerial 0.2 1.6 6.2 22.9 69.1 100.0 Clerical 0.9 5.6 15.4 27.6 50.5 100.0 Sales 0.8 7.1 20.8 34.9 36.4 100.0 Agriculture 1.1 15.1 22.5 33.0 28.3 100.0 Services 0.0 6.6 18.0 33.9 41.5 100.0 Skilled Manual 0.3 7.5 18.9 37.5 35.7 100.0 Unskilled Manual 0.0 4.2 4.2 20.8 70.8 100.0 Total % 0.7 8.5 18.5 32.8 39.5 100.0 No 38 457 991 1761 2118 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 Missing cases = 107 2 = 403.1650 University of Ghana http://ugspace.ug.edu.gh 96 4.4.9 Place of Resid ence and Misconception About AIDS The study also considered the association between place of residence of the respondents and their misconception about AIDS. The result from Table 4.26 reveals that less than half of the respondents have no misconception about AIDS. The proportion of the respondents with no misconception is higher in urban areas (47.7 per cent) and lower in the rural areas (32.3 per cent). Over half of all the respondents in both the urban and rural areas have some level of misconception about AIDS. The proportion is higher among the rural residents (67.7 per cent) than the urban residents (52.3 per cent). However, there are little variations in the proportion of respondents with misconception about the disease. The p-value (0.000) also shows that the place of residence of the respondents is significantly associated with their misconception about AIDS. This result seems to confirms the 2009 KDHS reports which states that the place of residence of the respondents is significantly associated with their misconception about AIDS Table 4 .27 : Percentage Distribution of Respondents by Place of Resid ence and Misconception about AIDS Place of Resid ence Misconception about AIDS Very Strong Strong Fair Weak No Total Urban 0.4 4.6 15.4 31.9 47.7 100.0 Rural 1.0 12.2 21.4 33.2 32.3 100.0 Total % 0.7 8.5 18.5 32.6 39.7 100.0 No 38 465 1011 1783 2175 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 208.0466 University of Ghana http://ugspace.ug.edu.gh 97 4.5 Knowledge of HIV Transmiss ion Knowledge of HIV transmission is one of the factors that determine attitude towards PLWHA. This section therefore examines how the background characteristics of the respondents affect their knowledge of HIV transmission. 4.5.1 Sex and Knowled ge of HIV Transmiss ion The results from Table 4.28 show the distribution of the respondents by sex and their knowledge of HIV transmission. Table 4.28 reveals that almost all the respondents in both sexes have fair or better knowledge of HIV transmission. The proportion is higher among the females (98.4 per cent) and lower among the males (95.8 per cent). The result from Table 4.28 also indicates that there is little variation in the proportion of the respondents with fair or better knowledge of HIV transmission. Table 4.28 also shows that less than 5.0 per cent of the respondents have bad knowledge of HIV transmission. There is little difference between the proportions of the respondents with bad knowledge of HIV transmission. The p-value (0.000) also shows that there is a significant association between the sex of the respondents and their knowledge of HIV transmission. This finding seems to supports the 2006 UDHS report which states that sex is significantly associated with knowledge of HIV transmission. University of Ghana http://ugspace.ug.edu.gh 98 Table 4.28 : Percentage Distribution of Respondents by Sex and Knowledge of HIV Transmiss ion Sex Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Female 1.6 7.7 36.7 54.0 100.0 Male 4.2 11.3 38.7 45.8 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± Value = 0.000 2 = 71.9621 4.5.2 Age and Knowledge of HIV Transmiss ion The study is also interested in the association between age of the respondents and their knowledge of HIV transmission. From Table 4.29, it can be observed that almost all the respondents have fair or better knowledge of HIV transmission. The proportion is highest among the respondents aged 45-49 years (98.8 per cent) and lowest among those aged 15-19 years (94.8 per cent). The result from Table 4.29 shows that there are little disparities in the proportion among the respondents with fair or better knowledge of HIV transmission. Fewer than 6.0 per cent of the respondents in all the age groups have bad knowledge of HIV transmission. The percentage ranges between 1.3 per cent and 5.2 per cent amongst those aged 45-49 years and 15-19 years respectively. On the whole, there are little differences in the proportion amongst the respondents with bad knowledge of the transmission. The p-value (0.000) shows that there is significant association between the age of the respondents and their knowledge of HIV transmission. This finding however confirms the 2006 UDHS report which University of Ghana http://ugspace.ug.edu.gh 99 indicates that there is a significant association between the age of the respondents and their knowledge of HIV transmission. Table 4.29 : Percentage Distribution of Respondents by Age Group and Knowled ge of HIV Transmiss ion Age Group Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total 15-19 5.2 13.4 40.0 41.3 100.0 20-24 3.0 10.5 37.2 49.2 100.0 25-29 2.9 6.7 34.9 55.5 100.0 30-34 1.5 8.0 38.1 52.4 100.0 35-39 1.8 7.7 32.9 57.6 100.0 40-44 1.8 9.1 39.3 49.9 100.0 45-49 1.2 5.8 41.4 51.6 100.0 50-54 3.5 14.0 40.4 42.1 100.0 55-59 2.7 9.0 40.5 47.7 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value = 0.000 2 = 118.6218 4.5. 3 Level of Education and Knowledge of HIV Transmiss ion The study also considered the association between the education of the respondents and their knowledge of HIV transmission. The result presented in Table 4.30 shows that almost all the respondents in the different educational groups have fair or better knowledge of HIV transmission. The proportion is between 96.2 per cent among those with no education and 99.0 per cent among those with higher education. The result from Table 4.30 also indicates that generally, there are little variations in the proportion of the respondents with fair or better knowledge of HIV transmission. University of Ghana http://ugspace.ug.edu.gh 100 Fewer than 4.0 per cent of the respondents have bad knowledge of HIV transmission. The percentage ranges from 1.0 per cent among those with higher education to 3.8 per cent among those with primary education. The p-value (0.000) also suggests that there is a significant association between the level of education of the respondents and their knowledge of HIV transmission. This findings support the 2006 UDHS report which indicate that the education of the respondents is significantly associated with their knowledge of HIV transmission. Table 4.30 : Percentage Distribution of Respondents by Level of Education and Knowled ge of HIV Transmiss ion Level of Education Knowledge of HI V Transmiss ion Bad Fair Good Very Good Total No Education 2.9 9.3 39.3 48.5 100.0 Primary 3.8 10.8 39.4 46.0 100.0 Middle/JSS 2.8 9.3 39.0 48.9 100.0 Secondary/SSS 3.0 9.3 36.2 51.5 100.0 Higher 1.0 8.2 26.3 64.5 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value= 0.000 2 = 74.3845 4.5.4 Marital Status and Knowledge of HIV Transmiss ion The study also examined the association between the marital status of the respondents and their knowledge of HIV transmission. From Table 4.31 it can be observed that almost all the respondents in the different marital groups have fair or better knowledge of HIV transmission. The proportion is highest among those who are those who are separated (100.0 per cent) and lowest among those who are never married (95.5 per cent). University of Ghana http://ugspace.ug.edu.gh 101 Less than 5.0 per cent of the respondents have bad knowledge of HIV transmission. The p-value (0.000) however reveals that the marital status of the respondents is significantly associated with their knowledge of HIV transmission. The result contradicts the 2006 IFHS report which shows that there is no significant association between the marital status of the respondents and their knowledge of HIV transmission. Table 4.31 : Percentage Distribution of Respondents by Marital Status and Knowledge of HIV Transmiss ion Marital Status Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Never Married 4.5 11.4 39.6 44.5 100.0 Married 1.9 8.6 36.2 53.3 100.0 Living Together 2.3 8.1 35.5 54.1 100.0 Widowed 1.4 8.3 36.1 54.2 100.0 Divorced 0.8 2.5 39.7 57.0 100.0 Separated 0.0 7.6 41.4 51.0 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data P-value= 0.000 2 = 79.3845 4.5. 5 Religious Affiliation and Knowledge of HIV Transmiss ion Considering the religious affiliation of the respondents and how it affects their knowledge of HIV transmission, the result presented in Table 4.32 shows that almost all the respondents in the different religious groups have fair or better knowledge of HIV transmission. The proportion of the respondents with fair or better knowledge of HIV transmission is lowest among the Moslem (98.6 per cent) and highest among the religious group labeled as ³other ´ (100.0 per University of Ghana http://ugspace.ug.edu.gh 102 cent). The finding from Table 4.32 shows that there are little differences in the proportion of the respondents with fair or better knowledge of HIV transmission Less than 5.0 per cent of the proportions of the respondents have bad knowledge of HIV transmission. There are little differences in the proportion of the respondents with bad knowledge of HIV transmission. The p-value (0.006) however shows that the religious affiliation of the respondents is significantly associated with their knowledge of HIV transmission. The findings contradicts a study by Ntozi et. al., (2000) which states that there is no significant association between the religious affiliation of the respondents and their knowledge of HIV transmissions. Table 4.32 : Percentage Distribution of Respondents by Religious Affiliation and Knowled ge of HIV Transmiss ion Religious Affiliation Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Catholic 3.2 8.6 33.0 55.2 100.0 Anglican 2.0 11.8 47.1 39.2 100.0 Methodist 1.5 9.6 38.1 50.8 100.0 Presbyterian 1.8 11.7 43.8 42.7 100.0 Pentecostal/Charismatic 2.7 8.8 36.1 52.5 100.0 Other Christian 3.8 9.7 40.2 46.3 100.0 Moslem 4.4 11.5 41.9 42.3 100.0 Traditionalist/Spiritualist 3.5 10.4 41.6 44.6 100.0 No Religion 2.8 9.5 36.5 51.2 100.0 Other 0.0 0.0 60.0 40.0 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2060 2735 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-value= 0.006 Missing Cases = 3 2 = 49.6790 University of Ghana http://ugspace.ug.edu.gh 103 4.5. 6 Ethnicity and Knowledge of HIV Transmis sion The survey also enquired about the association between the ethnic background of the respondents and their knowledge of HIV transmission. The results presented in Table 4.33 shows that more than 9 out of 10 of the respondents in each ethnic group have fair or better knowledge of HIV transmission, while less than 5.0 per cent of them have bad knowledge of HIV transmission. The p-value (0.000) however reveals that there is a significant association between the ethnicity of the respondents and their knowledge of HIV transmission. The result confirms the 2006 IFHS report which states that the ethnicity of the respondent is significantly associated with their knowledge of HIV transmission Table 4.33 : Percentage Distribution of Respondents by Ethnicity and Knowledge of HIV Transmiss ion Ethnicity Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Akan 2.7 9.1 37.2 50.9 100.0 Ga/Adamgne 0.8 9.8 38.5 50.8 100.0 Ewe 3.3 9.7 42.3 44.7 100.0 Guan 0.8 13.8 46.9 38.5 100.0 Mole-Dagbani 4.4 9.3 33.4 52.9 100.0 Grussi 1.2 5.6 28.1 65.0 100.0 Grumma 2.3 14.4 46.0 37.4 100.0 Mande 0.0 7.7 50.0 42.3 100.0 Other 2.4 9.3 38.0 50.2 100.0 Total % 0.0 0.0 66.7 33.3 100.0 No 157 517 2059 2736 100.0 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data P-values = 0.000 Missing Cases = 3 2 = 72.3223 University of Ghana http://ugspace.ug.edu.gh 104 4.5. 7 Wealth Status and Knowledge of HIV Transmiss ion The result presented in Table 4.34 shows that more than 9 in 10 of the respondents in the various wealth quintile have fair or better knowledge of HIV transmission. The proportion of the respondents with fair or better knowledge of HIV transmission is highest among the richest (98.0 per cent) and lowest among the poorest (95.5 per cent), while fewer than 5.0 per cent of the respondents have bad knowledge of HIV transmission. The proportion of the respondents in the different wealth quintile with bad knowledge of transmission is between 2.0 per cent among the richest and 4.5 per cent among the poorest. There are little variations amongst the respondents and knowledge of HIV transmission. The p-value (0.000) also shows that there is a significant association between wealth quintile of the respondents and their knowledge of HIV transmission. This result seems to confirm the 2006 UDHS report which indicates that wealth quintile is significantly associated with knowledge of HIV transmission. Table 4.34 : Percentage Distribution of Respondents by Wealth Status and Knowledge of HIV Transmiss ion Wealth Status Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Poorest 4.5 10.8 39.1 45.6 100.0 Poorer 2.9 10.4 39.6 47.1 100.0 Middle 3.4 8.5 41.0 47.1 100.0 Richer 2.1 9.3 37.3 51.3 100.0 Richest 2.0 8.7 33.1 56.2 100.0 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-values = 0.000 2 = 48.6905 University of Ghana http://ugspace.ug.edu.gh 105 4.5. 8 Occupation and Knowled ge of HIV Transmiss ion The study also examined the association between the occupation of the respondents and their knowledge of HIV transmission. The result presented in Table 4.35 shows that more than 9 out of 10 of the respondents in all the occupational groups have knowledge of the HIV transmission. The percentage is highest among those who are in sales (96.8 per cent) and lowest among those who are manually unskilled (91.7 per cent). There are little differences in proportion amongst the respondents with fair or better knowledge of HIV transmission. However, less than a tenth of the respondents in the various occupational groups have bad knowledge of HIV transmission. The proportion is between 1.2 per cent among those who are in sales to 8.3 per cent among those who are manually unskilled. There are little disparities in proportion amongst the respondents with bad knowledge of HIV transmission. The p-value (0.000) also shows that there is a significant association between the occupation of the respondents and their knowledge of HIV transmission. This finding however supports a study by Ntozi et. al., (2000) which indicates that there is a significant association between the occupation of the respondents and their knowledge of HIV transmission. University of Ghana http://ugspace.ug.edu.gh 106 Table 4.35 : Percentage Distribution of Respondents by Occupation and Knowledge of HIV Transmiss ion Occupation Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Not-working 4.1 11.7 38.9 45.2 100.0 Professional/Technical/ Managerial 1.4 8.0 29.7 60.9 100.0 Clerical 3.7 9.3 37.4 49.5 100.0 Sales 1.2 7.1 38.4 53.3 100.0 Agriculture 4.4 10.2 42.7 42.4 100.0 Services 2.9 7.7 33.6 55.8 100.0 Skilled Manual 3.0 10.6 34.9 51.6 100.0 Unskilled Manual 8.3 12.5 41.7 37.5 100.0 Total % 2.9 9.4 51.4 34.6 100.0 No 155 504 2006 2700 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P-values = 0.000 2 = 76.8829 4.5. 9 Place of Resid ence and Knowledge of HIV Transmiss ion The result presented in Table 4.36 shows the distribution of the respondents by place of residence and their knowledge of HIV transmission. Table 4.36 indicates that more than 9 out of 10 of the respondents in both places of residence have fair or better knowledge of HIV transmission. The proportion is highest among the urban dwellers (97.5 per cent) and lowest among the rural dwellers (96.8 per cent). Minority (5.0 per cent) of the respondents have bad knowledge of HIV transmission. The proportion is higher in rural areas (3.2 per cent) and lower in the urban areas (2.5 per cent). The p-value (0.096) analysis also shows that there is no significant association between the type of place of residence of the respondents and their knowledge of HIV transmission. This finding University of Ghana http://ugspace.ug.edu.gh 107 however refutes the 2006 IFHS report which indicates that there is a significant association between the place of residence and knowledge of HIV transmission Table 4.3 6 : Percentage Distribution of Respondents by Place of Resid ence and Knowledge of HIV Transmiss ion Place of Resid ence Knowledge of HIV Transmiss ion Bad Fair Good Very Good Total Urban 2.5 9.1 36.9 51.5 97.5 Rural 3.2 9.8 38.4 48.6 96.8 Total % 2.9 9.4 37.7 50.0 100.0 No 157 517 2061 2737 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P±Value = 0.096 2 = 6.3537 4.6 Summary Chapter four examined the effects of the socio - demographic characteristics of the respondents on their comprehensive knowledge about AIDS (knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission). The findings show that marital status, level of education, religious affiliation, ethnicity, wealth status, occupation, and place of residence of the respondents were significantly associated with their comprehensive knowledge about AIDS whiles age and sex of the respondents were found not to be significantly associated with their comprehensive knowledge about AIDS. Furthermore, sex, age, level of education, wealth status and the occupation of the respondents were significantly associated with knowledge of HIV prevention methods, whereas marital status, religious affiliation and place of residence were not. The result further revealed that all the socio- demographic characteristics of the respondents were significantly associated University of Ghana http://ugspace.ug.edu.gh 108 with their misconception about AIDS. The study further showed that all the socio- demographic characteristics of the respondents except place of residence were significantly associated with their knowledge of HIV transmission. University of Ghana http://ugspace.ug.edu.gh 109 CHAPTER FIVE SOCIO- DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS AND ATTITUDE TOWARDS PLWHA 5.1 Introduction Though knowledge about AIDS in the country can be said to be universal, there is no corresponding positive attitude towards PLWHA in the general population. Stigma and discriminatory attitudes towards PLWHA affect the effectiveness of HIV prevention and care programs (Wong and Syuhada, 2011). Socio-demographic factors are known to influence behavior and attitude (Maldi, et al., 2004). The current chapter (Chapter Five) examines the influence of selected socio-demographic characteristics of study participants on the level of attitude they exhibit towards PLWHA. The Chapter also examines the socio-demographic influence from the perspective of PLWHA who shared their experiences in terms of the attitude of the general public towards them. In order to achieve the set objective, the data were triangulated between the quantitative and the qualitative datasets factoring in the selected socio-demographic characteristics of respondents in the case of the quantitative data and the person exhibiting the attitude towards the PLWHA in the case of qualitative interviews. The selected socio-demographic characteristics considered are sex of respondent, age of respondent, level of education, marital status, religious affiliation, ethnicity, household wealth quintile, occupation and place of residence. These were related with attitude towards PLWHA and association between the socio-demographic factors and attitude was tested using chi-square at alpha level of 0.05. University of Ghana http://ugspace.ug.edu.gh 110 5.2 Sex and Attitude Towards PLWHA The distribution of the respondents by sex and attitude towards PLWHA is presented in Table 5.1. The result shows that more than three-quarters of both the male and female respondents have fair or better attitude towards PLWHA. The proportion is higher among the males (83.7 per cent) and lower among the females (75.9 per cent). There is also little difference in proportion between the sexes with fair or better attitude towards PLWHA. Less than a quarter of both the male and female respondents have bad or very bad attitude towards PLWHA. The proportion ranges from 16.3 per cent among the males to 24.1 per cent among the females. The p-value (0.000) also shows that the sex of the respondents is significantly associated with their attitude towards PLWHA. The result above confirms a study in Kuwait by Al- Owaish et. al., (1999) which reports that the association between the sex of the respondents and their attitude towards PLWHA is significant. The result from the qualitative analyses further shows that generally more of the males expressed positive attitude towards PLWHA than the females. Some of the views expressed by the PLWHA which support the result from the qualitative analyses is captured in the following quotes: “Only my wife, my 3 daughters and 2 sons know that I have the disease. My sons treat me well but my wife and my daughters don’t treat me well, they don’t want to sit in the same car with me and they don’t want to use the same toilet and bathroom with me. ´ HI9 positive man who has been living with the disease for 2 years, aged 54). “Only my relatives know that I have the disease, the men do ever ythi ng wit h me but the women do not treat me well. They do not use my plate and they do not go to my room.” (HIV/AIDS positive woman who has been living with the disease for 1½ years, aged 35). ³Ever ybody know that I have the dis ease, the men he lp me but the wome n do not tal k to me. ” (HIV positive man aged 36 who has been living the disease for 2 years). University of Ghana http://ugspace.ug.edu.gh 111 ³My girl fri end gav e me the disease, I am taking t he drug and I am fine, th e men are ni ce to me the y tal k to me an d give me ad vice bu t the women don’t talk to me” (HIV positive man aged 38 who has been living with the disease for 2 years) “I do not know how I got the disease because I do not have a boy friend. I am fine. T he m en sti ll like me and they tal k to me and give money but the women tal k about me and are not nice to me. ” ( HIV positive woman aged 26 who has been living with the disease for 1 year.) However, a small proportion of the PLWHA expressed different views. These views are captured in the following quotes. “Only my relatives know that I have the disease the men don’t treat me well, they do not talk to me and they don’t come near me.” (HIV positive man who has been living with the disease for 1 year, aged 40). I have the disease and all my fri ends know that I ha ve the disease but the men do not treat me ni ce, th ey tal k bad thi ngs about me and spoi l me to people . ( HIV positive man who has been living with the disease for 2 years, aged 38.) Table 5. 1.: Percentage Distribution of Respondents by Sex and Attitude Towards PLWHA Sex Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Female 4.0 20.1 32.2 29.8 13.9 100.0 Male 2.4 13.9 28.0 33.8 22.0 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) P±value = 0.000 2 = 15.8448 5.3 Age and Attitude Towards PLWHA Table 5.2 shows the distribution of the respondents according to their ages and attitude towards PLWHA. From Table 5.2, it can be seen that at least 7 in 10 of the respondents have fair or better attitude towards PLWHA. The proportion is highest among the respondents aged University of Ghana http://ugspace.ug.edu.gh 112 50-54 years (90.6 per cent), and followed by among those aged 55-59 years (90.1 per cent) and lowest amongst respondents aged 15-19 years (76.1 per cent). There are considerable variations in the proportion of the respondents with fair or better attitude towards PLWHA. At least a tenth of the respondents have bad or very bad attitude towards PLWHA. The proportion ranges from 9.4 per cent amongst respondents aged 50-54 years to 23.9 per cent amongst those aged 15-19 years. The result from Table 5.2 shows that there are much differences in the proportion of the respondents with bad or very bad attitude towards PLWHA. The p-value (0.000) analysis however, shows that there is a significant association between the age of respondents and their attitude towards PLWHA. This result confirms a study in rural Jamaica by Maldi, et al., (2004) which reveals that the age of the respondents is significantly associated with their attitude towards PLWHA. The result from the qualitative analysis also indicates that majority of the older people expressed positive attitude towards PLWHA than their counterparts who are younger. Some of the views expressed by the PLWHA which confirmed the above result are indicated in the following quotes: “A few of my friends and relatives know that I hav e the di sease, but be caus e I am looking nice the y treat me well . They all ow me to use th e ir cups, plat es and beds. Most of them are the old people.” (HIV-positive woman, who has been living with the disease for 5 years aged 51). ³Many people know that I have th e disease, but I am taking the drugs so I am looking well . But the younger people tease me and do not like to co me to me. But the olde r people talk to me, they encourage and they give me advice”. (HIV-positive man aged 36 who has been living with the disease for 1 ½ years). I do not know how I got the disease, those who know I hav e the disease do not come to me. A lot of the people who come to me are old people” (HIV positive man, who has been living with the disease for 2 years aged 48). “A lot of people heard that I have the disease so the young people do not come to me, they do not tal k to me and they tal k about me. But the old people gre et me, the y tal k to University of Ghana http://ugspace.ug.edu.gh 113 me and tell me that I will be well”. (HIV-positive man who has been living with the disease for 2 years aged 28). “Some people in my area know that I have the disease but because I am looking nice they treat me well , th ey all ow me to use th e sam e publ ic toi let and bathr oom w it h them, a lot of them are the old people.” (HIV positive man who has been living with the disease for 4 years aged 51). However a small proportion of PLWHA expressed different opinions. Their views are indicated in the following quotes: “Some people in my area know that I have the disease, but because I am taking t he drugs, I am looking fine and str ong, so they do everythi ng wit h me, they allow me to use their plat es and we someti mes eat together, man y of them are the young people” (HIV positive woman who has been living with the disease for 5 years aged 48). “A lot of people in my village know that I have the disease, because I am taking the drugs I am looking well , so they treat me nicely, w e use the same publi c toi let and bathr oom together. Many of the people are young people” (HIV positive man who has been living with the disease for 4 years aged 39). Table 5.2 : Percentage Distribution of Respondents by Age Group and Attitude Towards PLWHA Age Group Attitude Towards PLWHA Very Bad Bad Fair Good Very Good To tal 15-19 4.9 19.0 31.5 30.2 14.4 100.0 20-24 3.2 16.1 30.1 33.8 16.8 100.0 25-29 3.1 16.0 27.9 34.9 18.0 100.0 30-34 2.0 17.8 32.0 28.8 19.4 100.0 35-39 3.3 19.6 31.2 29.9 16.0 100.0 40-44 3.1 19.0 28.3 28.3 21.4 100.0 45-49 2.2 15.7 31.3 31.8 19.0 100.0 50-54 1.8 7.6 26.9 38.6 25.1 100.0 55-59 1.8 8.1 26.1 34.2 29.7 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 56.5953 University of Ghana http://ugspace.ug.edu.gh 114 5.4 Level of Education and Attitude Towards PLWHA The analysis is also done to find out whether or not the respondents education affect their attitude towards PLWHA. Table 5.3 shows clearly that over 70.0 percent of the respondents have fair or better attitude towards PLWHA. The proportion generally increases as the level of education of the respondents increases. It was lowest amongst respondents with no education and respondents with primary education (71.0 per cent) and highest amongst respondents with higher education (95.9 per cent). There are considerable variations in the proportion of the respondents with fair or better attitude towards PLWHA. Less than a third of the respondents have bad or very bad attitude towards PLWHA. The proportion ranges from 4.1 per cent amongst respondents with higher education to 29.0 per cent amongst respondents with primary and no education. The p-value (0.000) also shows that there is a significant association between the education of the respondents and their attitude towards PLWHA. This result confirms a study in Botswana by Letamo, (2004) which shows that education is significantly associated with attitude towards PLWHA. The findings from the qualitative analysis also indicate that a large majority of the respondents with some level of education expressed positive attitude towards PLWHA than those with no education. Some of the views by PLWHA which supported the above results are reported below: An HIV-positive man aged 38 who has been living with the disease for 3 years indicated that his friends and relatives are aware that he has the disease but because he is taking the drugs he is fine and strong. As a result, the educated ones talk with him, sit in the same vehicle with him and assist him with money. However, those who are not educated do not talk with him and insult him any time they see him. A second HIV positive man who has been living with the disease for 5 years reported that though the drugs he has been taking have made him strong, yet University of Ghana http://ugspace.ug.edu.gh 115 the people who are not educated in the area still avoid him and talk about him when they see him. However, those who are educated talk with him and give him money and advice. Another woman who has been living with the disease for 4 years aged 35 stated that though the drugs has made her strong, yet most of the people in the area who are not educated still avoid her and talk a lot about her. The fourth HIV-positive person, a woman who has being living with the disease for 4 years aged 39 indicated that because of the drugs she has been taking she is strong. Generally, the people who are educated like her and talk with her but those who are not educated avoid her. The last HIV-positive person, also woman aged 38 who has been living with the disease for 2 years reported that the people who are educated are nice to her, sit in the same vehicle with her but those who are not educated talk about her. However, a small proportion of the respondents with the disease expressed different views. For instance, an HIV positive woman aged 43 who has being living with the disease for two years stated that she is looking fine because she has been taking the drug, but most of her family members and friends who are educated avoid her and talk a lot about her. However, those who are not educated support her with provisions and money. Another HIV positive man who has been living with the disease for 3 years aged 43 indicated that although he is looking strong the people who are educated in the area complain when he uses the public bathroom and toilet but those who are not educated like him and talk with him. University of Ghana http://ugspace.ug.edu.gh 116 Table 5 .3 : Percentage Distribution of Respondents by Level of Education and Attitude Towards PLWHA Level of Education Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total No Education 2.9 26.1 38.2 22.8 10.1 100.0 Primary 5.1 23.9 33.2 26.3 11.5 100.0 Middle/JSS 4.0 17.2 30.4 33.0 15.5 100.0 Secondary/SSS 1.1 9.2 25.1 36.9 27.7 100.0 Higher 0.7 3.4 19.1 40.8 36.0 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 465.6991 5.5 Marital Status and Attitude Towards PLWHA The study further considered the association between the marital status of the respondents and their attitude towards PLWHA. From Table 5.4, it is clear that a vast majority of all the respondents in the various marital groups have fair or better attitude towards PLWHA. The proportion is highest among the never married (81.2 per cent), followed by the married (80.7 per cent) and lowest among those who are not living together (71.0 per cent). The result from Table 5.4 shows there are little variations amongst the respondents with fair or better attitude towards PLWHA. Less than a third of the respondents have bad or very bad attitude towards PLWHA. The proportion is highest amongst those who are not living together (29.0 per cent) and lowest among those who are never married (18.8 per cent). There are slight variations amongst the respondents with bad or very bad attitude towards PLWHA. The p-value (0.000) also shows that the marital status of the respondents is significantly associated with their attitude towards PLWHA. The University of Ghana http://ugspace.ug.edu.gh 117 result confirms a study in Hong Kong by Lau and Tsui, (2005) which indicates that the association between the marital groups of the respondents and their attitude towards PLWHA is significant. The results from the qualitative analysis show that a high proportion of the respondents who are married and formerly married expressed positive towards PLWHA. Some of the views expressed by the PLWHA in support of the above results are indicated in the following quotes: “ Many of my fri ends kn ow that I have the disea se but because of the dr ugs I am fine. Many of my fri ends who are marri ed stil l like me, they tal k to me and con ve rse with me ” (HIV positive man aged 34 who have been living with the disease for 2 years). “Some of my relatives heard that I have the disease but because I always take my drug I am str ong, but those who are not married do not t alk to me and do not respect me but th e ones who are married talk to me, c onverse with and respect me” (HIV-positive man aged 27 who has been living with the disease for 2½ years) “Only my husband and some of my friends are aware that I have the disease, but many of my fri ends who are married treat me well . We all go out together and we someti mes eat together” (HIV positive woman aged 34 who have been living with the disease for 5 years). However, a small proportion of the PLWHA expressed different view. These views are shown in the following quotes: “I have the dise ase but because I am taking my drugs I am very str ong and many of my fri ends who are singl e are nic e to me, they someti mes accompany me to th e hos pit ail for my drugs but those who are married do not talk to me” (HIV positive man aged 35 and living with the disease for almost 2 years). “I got the disease from my husband from Nigeria, because I am taking my drugs I am looking fi ne but my fri ends who know that I hav e the disea se do not treat me well , they refus e to eat wit h me and they complain when I use the same car with them, a lot of them are married”(HIV positive woman aged 45 who has being living with the disease for two years). University of Ghana http://ugspace.ug.edu.gh 118 Table 5 .4: Percentage Distribution of Respondents by Marital Status and Attitude Towards PLWHA Marital Stat us Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Never Married 3.6 15.2 28.4 35.6 17.2 100.0 Married 2.8 16.5 31.7 29.7 19.2 100.0 Living Together 4.3 23.8 29.9 26.5 15.5 100.0 Widowed 1.4 22.2 41.7 19.4 15.3 100.0 Divorced 3.3 17.4 30.6 32.2 16.5 100.0 Not Living Together 2.1 26.9 23.4 34.5 13.1 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 100.8051 5.6 Religious Affiliation and Attitude Towards PLWHA Turning attention to the religious background of the respondents, and how it affects their attitude towards PLWHA, the result presented in Table 5.5 shows that more than 60.0 per cent of the respondents in the different religious groups have fair or better attitude towards PLWHA. The proportion ranges from 69.8 per cent among the respondents with no religion to 100.0 per cent among the respondents in the religious group labeled as ³other´. 7he result in 7able . also shows that generally there are considerable differences in the proportion of respondents with fair or better attitude towards PLWHA. However, less than one quarter of the respondents in the different religious groups have bad or very bad attitude towards PLWHA with the exception of the respondents with no religion (30.2 per cent). The proportion in the rest of the religious group with bad or very bad attitude towards PLWHA is highest among the Pentecostals/ Charismatic (22.5 per cent) and lowest among the Catholic (17.1 per cent). The p-value (0.000) also shows that the association between University of Ghana http://ugspace.ug.edu.gh 119 the religious affiliation of the respondents and their attitude towards PLWHA is significant. This finding confirms the 2006 IFHS report which shows that the religious affiliation of the respondent is significantly associated with their attitude towards PLWHA. The result from the qualitative analysis shows that a high proportion of the non-Christians expressed positive attitude towards PLWHA. Some of the views expressed by PLWHA in support of the above result are reported below. A female respondent who has being living with the disease for 1 ½ years aged 40 stated that the Christians talk a lot about her, however, the Moslems are nice to her. They give her financial assistance and a lot of advice and encouragement. Another HIV-positive female aged 33 who has been living with the disease for 2 years indicated that Christians do not like her company and they talk about her. However, she reported that the Moslems are kind to her, they give her money when she is going to the hospital. A third HIV-positive male aged 29 who has been living with the disease for 2 years indicated that generally, the Christians avoid him and talk about him but the non-Christians associate with him, they give him a lot of encouragement and advice. However a small number of the respondents expressed different view. For instance one of the HIV-positive male respondents aged 29, who has been living with the disease for 4 years stated that many people give her money and gifts such as food stuffs and provisions. Most of these people are Christians. Another HIV-positive female aged 45, who has been living with the disease for 1½ years reported that the Christians are kind to her, they talk with her and they give her gifts such as provisions and food stuff than members of the other religions University of Ghana http://ugspace.ug.edu.gh 120 Table 5 .5 : Percentage Distribution of Respondents by Religious Affiliation and Attitude Towards PLWHA Religious Affiliation Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Catholic 3.5 13.6 29.3 33.8 19.8 100.0 Anglican 2.0 17.6 29.4 27.5 23.5 100.0 Methodist 4.5 15.7 29.8 30.3 19.7 100.0 Presbyterian 2.2 16.7 23.3 34.4 23.3 100.0 Pentecostal/Charismatic 4.0 18.5 28.5 31.9 17.1 100.0 Other Christian 2.5 16.9 32.6 31.7 16.3 100.0 Moslem 2.3 15.5 33.7 32.6 15.9 100.0 Traditionalist/Spiritualist 1.8 20.3 38.3 25.1 14.5 100.0 No Religion 3.5 26.7 33.7 22.8 13.4 100.0 Other 0.0 0.0 30.0 30.0 40.0 100.0 Total % 3.2 17.9 30.2 31.7 17.8 100.0 No 177 935 1650 1733 974 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 Missing cases = 3 2 = 91.2205 5 .7 Ethnicity and Attitude Towards PLWHA The survey also investigated the association between the ethnic background of the respondents and their attitude towards PLWHA. From Table 5.6 it can be seen that a large majority of the respondents in the different ethnic group have fair or better attitude toward PLWHA, the proportion is highest among the Grussi (92.5 per cent) and lowest among the Ga/Dangme (72.7 per cent). Table 5.6 also shows that there are slight variations in the proportion of the respondents with fair or better attitude towards PLWHA. However, more than a tenth of the respondents have bad or very bad attitude towards PLWHA with the exception of the Grussi (7.5 per cent). The proportion among the rest of the University of Ghana http://ugspace.ug.edu.gh 121 respondents ranges from 14.6 per cent among the Guan to 27.3 per cent among the Ga/Dangme. The p-value (0.000) also shows that the ethnicity of the respondents is significantly associated with their attitude towards PLWHA. The result however confirms the findings of the 2006 IFHS report which states that the association between the ethnicity of the respondents and their attitude towards PLWHA is significant. However, the findings from the qualitative analysis show that there is no clear pattern between ethnicity and attitude towards PLWHA. Some of the views expressed by the people living with the disease are indicated in the following quotes: “My fri ends and relat ive s know that I have the dis ease and be cause I am ta king my drugs I am looking nic e and they treat me well they tal k to me and give me good advice and lot of them are Akan, Ewe and Ga/Dangbe”(HIV-positive woman aged 24 who has been living with the disease for 3 years). “Some people in my area know that I have the disease but because I a m t aking my drugs they are sti ll nice to me, they use the same publi c toi let and bathr oom wit h me. They visi t me and we go out together. Most of th is people are Ewe, Ga/Dangbe and Mende” (HIV positive woman who has been living with the disease for 4 years aged 35). “I got the disease from my husband and a few of my relatives and friends know that I have the disease. Even though I am taking the drugs and looking fine they complain when I use the same toi let and bathr oom wit h them a lot of them are Akan s Ewes and Mole - Dagbani.” (HIV positive woman aged 45 who have been living with the disease for 2 years). “I have the disease and most of my friends who heard about it don’t come to me again, they are Akan, Ewe and Ga/Dangme”. (HIV positive man aged 24 who has been living with the disease for 1 year). “I am a taxi driver and I have the disease so most of my fri ends do not com e to me again, they are Grussi and Gru ama .” ( HIV positive man aged 32 with the disease for 3 years). University of Ghana http://ugspace.ug.edu.gh 122 Table 5 .6 : Percentage Distribution of Respondents by Ethnicity and Attitude Towards PLWHA Ethnicity Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Akan 4.2 18.1 29.4 32.6 15.6 100.0 Ga/Dangme 4.1 23.2 32.0 27.3 13.4 100.0 Ewe 1.6 14.5 23.3 33.2 27.5 100.0 Guan 3.1 11.5 34.6 28.5 22.3 100.0 Mole-Dagbani 1.8 15.2 34.0 31.3 17.7 100.0 Grussi 0.6 6.9 31.2 36.9 24.4 100.0 Gruma 4.0 23.0 39.7 21.3 12.1 100.0 Mande 7.7 11.5 34.6 30.8 15.4 100.0 Other 3.4 18.5 30.7 30.7 16.6 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 934 1650 1734 974 5469 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 Missing cases = 3 2 = 93.1988 5.8 Wealth Status and Attitude Towards PLWHA The study considered the effect of the wealth status of the respondents and their attitude towards PLWHA. The result presented in Table 5.7 shows that over 70.0 per cent of the respondents in all the wealth quintiles have fair or better attitude towards PLWHA. The proportion ranges from 73.2 per cent among the poorer and poorest to 86.2 per cent among the richest. The findings presented in Table 5.7 also show that there are slight differences among the respondents with fair or better attitude towards PLWHA. Fewer than 3 in 10 of the respondents have bad or very bad attitude towards PLWHA. The proportion is highest among the poorer and the poorest (26.8 per cent) and lowest among the richest (13.8 per cent). There are slight variations in the proportion of the respondents with bad or very bad attitude towards PLWHA. The p-value (0.000) also shows that there is a significant association between the wealth quintile of the respondents and their attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 123 This result confirms a study India by Sudha et al., (2005) which reports that the wealth quintile of the respondents is significantly associated with their attitude towards PLWHA. The result from the qualitative analysis also indicate that a vast majority of the respondents in the middle or better wealth quintile expressed fair and better attitude towards PLWHA than their counterparts in the poorer or poorest wealth quintile. Some of the views expressed by PLWHA in support of the above are reported below. An HIV positive man aged 40 who has been living with the disease for 2 years stated that most of his relatives and friends know that he has the disease. Whereas the poor ones are afraid to come to him, the rich ones easily talk with him and assist him financially and materially. The second HIV-positive person, a man aged 30 who has been living with the disease for 2 years reported that many of his family members know that he has the disease. Whereas the wealthy ones talk to him, associate with him and help him financially and materially the poor ones talk about him and do not come close to him. Another HIV positive woman aged 28 who has been living with the disease for 2½ years indicated that because of the disease her family members who are poor do not want to do anything with her and talk about everything she does. However she said the wealthy ones talk with her and assist her with money and provisions. The fourth HIV-positive person, a woman aged 35 who has been living with the disease for 3 years stated that because of the disease her family members especially the poor ones do not talk to her and they want her to leave the house, but the wealthy ones are still lovely and kind to her and they give her money. The fifth HIV-positive person, a woman aged 45 who has been living with the disease for 4 years reported that she got the disease from her husband in Togo but University of Ghana http://ugspace.ug.edu.gh 124 because she is taking her drugs she is feeling fine and that some of her relatives especially the rich ones have been helping her. However a small number of the PLWHA expressed different views. For instance, an HIV positive woman aged 36 who has been living with the disease for 2 years stated that although she is taking the drugs and she is looking very well her family members especially the rich ones always talk about her and complain any time she sits in the same vehicle with them. Another HIV positive man who has been living with the disease for 2 years and aged 36 reported that all his family members do not visit him again but the poor ones still come to him to give him advice and encouragement. Table 5 .7 : Percentage Distribution of Respondents by Wealth Status and Attitude Towards PLWHA Wealth Status Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Poorest 2.8 24.0 34.9 25.2 13.0 100.0 Poorer 5.4 21.4 35.4 25.7 12.0 100.0 Middle 3.4 18.4 29.0 31.2 18.0 100.0 Richer 3.1 13.2 27.1 36.0 20.6 100.0 Richest 1.8 12.0 26.9 36.7 22.5 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 296.4156 University of Ghana http://ugspace.ug.edu.gh 125 5.9 Occupation and Attitude Towards PLWHA The study sought to find out whether or not the respondents occupation affects their attitude towards PLWHA. The result presented in Table 5. 8 show that a substantial majority of the respondents have fair or better attitude towards PLWHA. The proportion is highest among those in the Professional/Technical/Managerial occupations (93.3 per cent) and lowest among those who are manually unskilled (70.8 per cent). The result presented in Table 5.8 also shows that there are little variations in the proportion of the respondents in the different occupational groups with fair or better attitude towards PLWHA. More than 1 in 10 of the respondents in all the occupational groups have bad or very bad attitude towards PLWHA with the exception of those in the Professional/Technical/Managerial occupations (6.7 per cent). The proportion of the rest of the respondents ranges from 12.2 per cent among the clerical to 29.2 per cent amongst those who are manually unskilled. Generally, there are slight variations in the proportion among the rest of the respondents with bad or very bad attitude towards PLWHA. The p-value (0.000) also suggests that the occupation of the respondents is significantly associated with their attitude towards PLWHA. The above result confirms a study in Russia by Popova, (2007) which indicated that there is a significant association between the occupation by the respondents and their attitude towards PLWHA. The result from the qualitative analysis also shows that majority of the people who are working expressed positive attitude towards PLWHA than their counterparts who are not working. Some of the views expressed by the PLWHA which confirms the above result are indicated in the following quotes: University of Ghana http://ugspace.ug.edu.gh 126 “I got the disease from my dead husband, becau se of that many people know that I have the disease. The people who are alw ays in the ho use wit h me and are not doing any work tal k about me but those who are working talk with me, give me advice and money.” (HIV-positive woman aged 45 who has been living with the disease for 5 years.) “ Because I have the dis ease I am not working again because of that those who are not doing any work do not t alk to me and do not co me to me but those who are working tal k wit h me, come to me and give me things.” (HIV positive man aged 36 who has been living with the disease for 1½ years ). “Many people in the area know I have the disease and those who are working talk to me and give me gifts but those who are not working talk bad things about me” (HIV positive man who has been living with the disease for 2 years aged 51). “ Because of the disease I am not working and because I am poor a lot of the people who are working help me wit h provisions and money but those who are not working do not mind me. (HIV positive man aged 36 who has been living with the disease for 2 years). However, a small of number of PLWHA expressed different views. One of them is indicated in the quote below: “I have the diseas e so I am not working, those who are working do not ta lk wit h me but those who are not worki ng convers e wit h me and give advi ce ” (HIV positive man who has been living with the disease for 2 years aged 28). Table 5 .8 : Percentage Distribution of Respondents by Occupation and Attitude Towards PLWHA Occupation Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Not-working 4.3 17.3 28.9 33.3 16.2 100.0 Professional/Technical/ Managerial 0.5 6.2 18.8 39.6 35.0 100.0 Clerical 3.3 8.9 29.9 36.4 21.5 100.0 Sales 3.4 20.8 29.9 29.6 16.3 100.0 Agriculture 3.4 20.6 35.6 26.8 13.6 100.0 Service 2.9 15.3 31.2 33.6 16.9 100.0 Skilled Manual 2.8 14.8 28.5 35.9 18.0 100.0 Unskilled Manual 12.5 16.7 16.7 29.2 25.0 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 175 922 1621 1704 943 5365 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 Missing cases = 107 2 = 255.9016 University of Ghana http://ugspace.ug.edu.gh 127 5 .10 Place of Resid ence and Attitude Towards PLWHA The study also looked at place of residence of the respondents and their attitude towards PLWHA. The result presented in Table 5.9 shows that more than three quarters of the respondents in the different places of residence have fair or better attitude towards PLWHA. The proportion was higher among those in the urban areas (83.0 per cent) and lower among those in the rural areas (76.5 per cent). There is little disparity in proportion among the respondents with fair or better attitude towards PLWHA. At least a tenth of the respondents have bad or very bad attitude towards PLWHA. The percentage is higher among those in rural areas (23.0 per cent) and lower among those in the urban areas (17.0 per cent). There is a slight difference in proportion among the respondents with bad or very attitude towards PLWHA. The p-value (0.000) also indicates that the association between the place of residence of the respondents and their attitude towards PLWHA is significant. The result confirms a study by Ayranci, (2005) in Turkey which shows that urban residents are more likely to have good attitude towards PLWHA. The result from the qualitative analysis also shows that majority people in the urban areas express positive attitude towards PLWHA than their counterparts in the rural areas. Some of the views expressed by PLWHA in support of the above is reported below. An HIV positive man aged 43 who has been living with the disease for 3 years indicated that most of his relatives and friends in the big towns and his village are aware that he has the disease. His friend in the big town assist him with money and converse freely with him but those in village avoid him and say bad things about him. The second HIV positive man aged 48 who has been living with the disease for 3 years reported that he prefers to stay in the big towns University of Ghana http://ugspace.ug.edu.gh 128 because he enjoys the hospitality and cordiality of his friends and family members compared to his village where the people are unfriendly and talk about him. Another HIV-positive woman aged 45 who has living with the disease for 2 years also indicated that she left her village where she was stigmatized and discriminated to the city where the people accept her and treat her well. A photographer aged 30 who has been living with the disease for 3 years stated that he got the disease from one of his customers and though he is strong and fine only those in the city are nice to him. However those in his village avoid him. However, a small proportion of the PLWHA expressed different view. One of the HIV- positive women aged 43 who has been living with the disease for 2 years said she has decided to live in her village because her village people care for her and assist her in many things compared to her family members in the big towns. Table 5.9 : Percentage Distribution of Respondents by Place of Resid ence and Attitude Towards PLWHA Place of Resid ence Attitudes Towards PLWHA Very Bad Bad Fair Good Very Good Total Urban 2.9 14.1 28.0 34.8 20.2 100.0 Rural 3.6 19.9 32.2 28.8 15.6 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 149.4246 University of Ghana http://ugspace.ug.edu.gh 129 5.11 Summary Chapter five examined the socio -demographic characteristics of the respondents and their effect on attitude towards PLWHA. The result showed that all the socio ±demographic characteristics of the respondents was significantly associated with their attitude towards PLWHA. The results of the qualitative data support those from the quantitative data with the exception of ethnicity. University of Ghana http://ugspace.ug.edu.gh 130 CHAPTER SIX COMPREHENSIVE KNOWLEDGE ABOUT AIDS AND ATTITUDE TOWARDS PLWHA 6.1 Introduction Chapter six e[amines the e[tent to which an individual’s comprehensive knowledge about AIDS influences his/her attitude towards PLWHA. As in chapter 3 and 4, this chapter also looks at how the respondent’s knowledge of HIV prevention, misconception about AIDS and knowledge of HIV transmission affects his/her attitude towards PLWHA. This is because knowledge of HIV prevention, misconception about AIDS and knowledge of HIV transmission are components of comprehensive knowledge about AIDS. The purpose of examining the association between each of the variables and attitude towards PLWHA is to get a better understanding of their effect on attitude towards PLWHA. 6.2 Comprehensive Knowledge about AIDS and Attitude Towards PLWHA The study also examined the association between the respondent’s comprehensive knowledge about AIDS and their attitude towards PLWHA. The result presented in Table 6.1 shows that a vast majority of the respondents with various levels of comprehensive knowledge about AIDS have fair or better attitude towards PLWHA. The proportion is highest amongst those with very good comprehensive knowledge about AIDS (92.2 per cent) and lowest amongst those very bad comprehensive about AIDS (69.7 per cent). The result from Table 6.1 shows that there are vast disparities in the proportion among the respondents with fair or better attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 131 Over a tenth of the respondents with different levels of comprehensive knowledge about AIDS have bad or very bad attitude towards PLWHA with the exception of those with very good comprehensive knowledge about AIDS (7.8 per cent). The proportion among the rest of the respondents ranges from 15.1 per cent among respondents with good comprehensive knowledge about AIDS to 30.3 per cent those with very bad comprehensive knowledge about AIDS. The p- value (0.000) reveals that the comprehensive knowledge of the respondents is significantly associated with their attitude towards PLWHA. This finding confirms a study in 4 countries (Tanzania, Zimbabwe, South Africa and Thailand) by Genberg et al., (2009) which indicates that comprehensive knowledge about AIDS is significantly associated with attitude towards PLWHA. Table 6.1 : Percentage Distribution of Respondents by Comprehensiv e Knowledge About AIDS and Attitude Towards PLWHA Comprehensive Knowledge about AIDS Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Very Bad 5.5 24.8 34.9 24.8 10.0 100.0 Bad 3.5 24.1 30.6 29.6 12.3 100.0 Fair 3.5 17.3 32.6 30.8 15.8 100.0 Good 2.4 12.7 28.5 36.1 20.4 100.0 Very Good 1.4 6.4 23.7 36.6 31.9 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 430.0424 University of Ghana http://ugspace.ug.edu.gh 132 6.3 Knowledge of HIV Prevention Method s and Attitude Towards PLWHA 7his section e[amines the degree to which one’s knowledge of HI9 prevention methods influences his/her attitude towards PLWHA. From Table 6.2, it can be seen that at least three- fourths of the respondents with different levels of knowledge of HIV prevention methods have fair or better attitude towards PLWHA. The percentage ranges between 75.0 per cent among the respondents with bad knowledge of HIV prevention methods and 81.2 per cent among those with very good knowledge of HIV prevention methods. The Table also shows that there are slight differences among the respondents with fair or better attitudes towards PLWHA. Less than a third of the respondents with various kinds of knowledge of HIV prevention methods have bad or very bad attitude towards PLWHA. The proportion is highest among those with bad knowledge of HIV prevention methods (25.0 per cent) and lowest among those with very good knowledge of HIV prevention methods (18.8 per cent). The result from Table 6.2 also indicates that there are little differences in the proportion among those with bad or very bad attitude towards PLWHA. The p-value (0.000) suggests that the association between knowledge of HIV prevention methods of the respondents and their attitude towards PLWHA is significant. This result confirms a study in Botswana by Letamo, (2004) which shows that the knowledge of HIV prevention method of the respondents is significantly associated with their attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 133 Table 6.2 : Percentage Distribution of Respondents by Knowledge of HIV Prevention Method s and Attitude Towards PLWHA Knowledge of HIV Prev ention Method s Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Bad 6.4 18.6 29.3 29.3 16.4 100.0 Fair 3.0 21.1 34.6 31.1 10.2 100.0 Good 3.3 19.8 30.6 29.9 16.4 100.0 Very Good 3.1 15.7 29.6 32.5 19.2 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 5453.24 6.4 Misconception about AIDS and Attitude Towards PLWHA The study also considered the association between the respondent’s misconception about AIDS and their attitude towards PLWHA. The result presented in Table 6.3 shows that at least three fifths of the respondents with different levels of misconception about AIDS have fair or better attitude towards PLWHA. The proportion is highest among the respondents with no misconception about AIDS (88.6 per cent) and lowest among those with strong misconception about AIDS (61.5 per cent). The result from Table 6.3 also shows that there are little variations in proportion among the respondents with fair or better attitude towards PLWHA. More than 2 in 10 of the respondents with different levels of misconception about AIDS have bad or very bad attitude towards PLWHA with the exception of those with no misconception about AIDS (11.4 per cent). The proportion among the respondents is between 20.8 per cent among the respondents with weak misconception about AIDS to 38.5 per cent among those with strong misconception about AIDS. The p-value (0.000) also shows that the University of Ghana http://ugspace.ug.edu.gh 134 association between the misconception of the respondents and their attitude towards PLWHA is significant. This finding supports a study in Botswana by Letamo, (2004) which reports that the misconception of the respondents is significantly associated with their attitude towards PLWHA. Table 6.3 : Percentage Distribution of Respondents by Misconception About AIDS and Attitude Towards PLWHA Misconception about AIDS Attitude Towards PLWHA Ve ry Bad Bad Fair Good Very Good Total Very Strong 7.9 23.7 47.4 21.1 0.0 100.0 Strong 6.2 32.3 34.6 20.2 6.7 100.0 Fair 4.7 25.1 34.6 26.0 9.5 100.0 Weak 3.3 17.5 32.4 31.9 14.9 100.0 No 1.7 9.7 25.0 36.9 26.7 100.0 Total 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.000 2 = 5024.8731 6.5 Knowledge of HIV Transmiss ion and Attitude Towards PLWHA Table 6.4 shows that at least 7 in 10 of the respondents with different knowledge of HIV transmission have fair or better attitude towards PLWHA. The percentage is between 77.0 per cent among respondents with good knowledge of HIV transmission to 82.0 per cent among respondents with very good knowledge of HIV transmission. There are little variations in the proportion among the respondents with fair or better attitude towards PLWHA. The result from Table 6.4 also shows that less than one quarter of the respondents with different levels of knowledge of HIV transmission have bad or very bad attitude towards PLWHA. The proportion is from 18.0 per cent among the respondents with very good University of Ghana http://ugspace.ug.edu.gh 135 knowledge of HIV transmission to 23.0 per cent among those with good knowledge of HIV transmission. The p-value (0.001) also reveals that the association between knowledge of HIV transmission of the respondents and their attitude towards PLWHA is significant. This finding confirms a study in Nepal by (FHI, 2000) which indicates that knowledge of HIV transmission of the respondents is significantly associated with their attitude toward PLWHA. Table 6.4 : Percentage Distribution of Respondents by Knowledge of HIV Transmiss ion and Attitude Towards PLWHA Knowledge of HIV Transmiss ion Attitude Towards PLWHA Very Bad Bad Fair Good Very Good Total Bad 2.5 17.2 33.8 31.8 14.6 100.0 Fair 5.0 17.6 29.8 30.0 17.6 100.0 Good 3.3 19.7 29.6 31.8 15.7 100.0 Very Good 2.9 15.1 30.5 32.0 19.6 100.0 Total % 3.2 17.1 30.2 31.7 17.8 100.0 No 177 935 1651 1735 974 5472 Source: Computed from the 2008 Ghana Demographic and Health Survey (GDHS) Data. P ± value = 0.001 2 = 39.3089 6.6 Summary Chapter six examined the respondents comprehensive knowledge about AIDS and (knowledge of HIV prevention methods, misconception about AIDS, and knowledge of HIV transmission) and their attitude towards PLWHA. The findings showed that the respondents comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission were significantly associated with their attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 136 CHAPTER SEVEN DETERMINANTS OF THE ATTITUDE OF THE RESPONDENTS TOWARDS PLWHA 7.1. Introduction A number of relevant findings have been made in the preceding chapters in the bivariate analysis. 7his chapter is on statistical investigation of the determinants of respondents’ attitude towards PLWHA. Attitude of individuals is strongly determined by both exogenous and endogenous factors (Guagnano, Stern, & Dietz, 1995). Some socio-demographic factors are known to influence the individual’s attitude towards PLWHA. Socio-demographic factors such as sex, education, marital status and wealth status have been documented to have some significant effect on individual attitude towards PLWHA, (Al-Qwaish et. al., 1999; Letamo, 2004; Lau and Tsui, 2005; Sudha et. al., 2005 ). 7.2 Socio- Demographic Determinants of Attitude Towards PLWHA Ordered logistic regression model was used to examine how the independent variables of sex, age, level of education, marital status, religious affiliation, ethnicity, wealth quintile, occupation and place of residence of the respondents determined their attitude towards PLWHA. This was done controlling for the comprehensive knowledge of respondents about AIDS. For statistical purpose, some of the independent variables were re-categorized to obtain meaningful result and interpretation. As a result, under marital status, the categories are never married, currently married (married and living together) and formerly married (separated, widowed and divorced). In the case of occupation, the categories are not working, Professional University of Ghana http://ugspace.ug.edu.gh 137 (Professional/Managerial/Technical and clerical), sales and services (sales and services), agriculture, manual (skilled and unskilled manual) and comprehensive knowledge about AIDS (knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission). The outcome variable (attitude) is ordered from 0 (zero), which is very bad attitude towards PLWHA through to the highest 4 (four) which is very good attitude towards PLWHA. 7.2.1 Sex The result presented in Table 7.1 shows that sex of the respondents is statistically significant in predicting attitude towards PLWHA at 90.0 per cent CI. This result also confirms the findings at the bivariate level that also indicate that sex of respondents is significantly associated with their attitude towards PLWHA. Being a female increases the likelihood of expressing favorable attitude towards PLWHA compared to male while all other factors held constant. This result is however at variance with the result from the qualitative analysis that shows that generally more males express positive attitude towards PLWHA than females. For example, a view expressed by one of the PLWHA in support of the result of the qualitative data is stated in the quote below. “Only my relative know that I have the disease, the m en do everythi ng wit h me but the women do not treat me well . They do not use my plat e and they do not go to my room ´ HI9AI'6 positive woman who has been living with the disease for 1½ years, aged 35). The difference in the quantitative and qualitative results in terms of male and female attitude towards PLWHA can be attributed partly to the fact that while the quantitative findings University of Ghana http://ugspace.ug.edu.gh 138 is from the general population sample the qualitative data is from PLWHA expressing their perspective of people attitude towards them. 7.2.2 Age After controlling for other socio-demographic factors, age of respondents was not a significant predictor of respondents’ attitude towards PLWHA as found at the bivariate analysis stage where age was significantly associated with attitude towards PLWHA. Though the categories of age are not statistically significant in predicting attitude towards PLWHA, the result indicates that from age  years and above as age increases respondents’ attitude towards PLWHA improves all other factors being constant (Table 7.1). Notwithstanding, the result at the multivariate analysis revealed that older persons are more likely than younger persons to have positive attitude towards PLWHA. This is consistent with findings from the qualitative analysis where it came out that generally, older persons are more likely to express positive attitude towards PLWHA as expressed in this quote: “A few of my friends and relatives know that I have the disease, but because I am looking nice they treat me well , they all ow me to use their cups, plat es and beds. Most of them are old people´ HI9 positive woman who has been living with the disease for 5 years aged 51). This finding is supported by a study in rural Jamaica by Maldi et al, (2004) which reported that individuals less than 30 years of age were more likely to stigmatize PLWHA than their counterparts aged 30 years and above. University of Ghana http://ugspace.ug.edu.gh 139 7.2.3 Level of Education 5espondent’s highest level of educational attainment is statistically significant in predicting attitude towards PLWHA. The results further indicate that there is a direct relationship between educational attainment of respondent and attitude towards PLWHA (Table 7.1). As educational attainment improves from one educational level to a higher level, ones attitude towards PLWHA improves (Table 7.1). Thus, higher educational attainment is associated with higher or favorable attitude towards PLWHA as indicated in the multivariate regression analysis. While respondents with only primary level of education are 1.27 times more likely to express positive attitude towards PLWHA as their counterparts with no formal education, all other factors remaining constant, respondents with Middle/JSS level of education are about 1.60 times more likely to express positive attitude towards PLWHA. Respondents with Secondary/SSS and those with higher level of education are more than twice likely and thrice likely respectively to express positive attitude towards PLWHA compared to their counterparts with no formal education when other factors remain constant. This finding is consistent with the result of a study in Botswana by Letamo, (2004) which reported that respondents with primary education were more likely than those with secondary or above education to express negative attitude towards PLWHA. The role of education in influencing attitude towards PLWHA as shown both at the biavariate and multivariate result provide the evidence to reject the null hypothesis and accept the hypothesis that there is a positive relationship between educational attainment and attitude towards PLWHA. This is also collaborated by the finding from the qualitative analysis which also indicates that among PLWHA, there is a general consensus that educated persons are the people who express positive attitude towards PLWHA. One of such view is reported below. University of Ghana http://ugspace.ug.edu.gh 140 An HIV-positive man aged 38 who has been living with the disease for 3 years indicated that his friends and relatives are aware that he has the disease but because he is taking the drugs he is fine and strong. As a result the educated ones talk with him, sit in the same vehicle with him and assist him with money. However, those who are not educated do not talk with him, they insult him any time they see him. 7.2.4 Marital Status 7he result 7able . shows that the respondent’s marital sttus is a significant predictor of attitude towards PLWHA. Currently married and formerly married respondents are less likely than their never married counterparts to express positive attitude towards PLWHA with other factors held constant, there is no significant difference between the attitude expressed by currently married respondents and formerly married respondents (Table 7.1). The result from the bivariate analysis shows that marital status is significantly associated with attitude towards PLWHA. However, while in the quantitative survey result at the multivariate analysis stage indicate the respondents who are never married have a higher likelihood of expressing positive attitude towards PLWA, which contradict the findings of the qualitative analysis. The result from the qualitative revealed that persons who are in marital union expressed positive attitude towards PLWHA than their counterparts who are never married as expressed in the quote below. “Only my husband and some of my friends are aware tha t I have the dise ase, but many of my fri ends who are married treat me well . We all go out together and we sometimes eat together”. (HIV positive woman aged 34 who has been living with the disease for 5 years) This view confirms a study in Hong Kong by Lau and Tsui, (2005) which indicated that married people express more positive attitude towards PLWHA than their counterparts in the other marital groups. The result of the multivariate analysis is inconsistent with the findings of University of Ghana http://ugspace.ug.edu.gh 141 the qualitative data because in the multivariate analysis, the views were expressed by respondents who were not PLWHA, whiles in the qualitative data the views were expressed by PLWHA. 7.2.5 Religious Affiliation After other socio-demographic factors are controlled, religious affiliation shows a significant association with attitude towards PLWHA at the biavariate stage but was not significant at the multivariate level. While there is no significant difference among the various religious grouping in the country in terms of attitude towards PLWHA, one group (Traditionalists/Spiritualist) shows positive attitude towards PLWHA (Table 7.1). This finding however, conflicts with the results at the biavariate level which shows that the religious affiliation of the respondents is significantly associated with their attitude towards PLWHA. The result of the multivariate analysis however, reject the findings of the qualitative analysis which shows that there is a clear association between the religious affiliation of the respondents and attitude towards PLWHA as expressed by one of those living with the disease and reported below: A female respondent who has been living with the disease for 1½ years aged 40 indicated that Christians talk a lot about her, however, the Moslems are nice to her. They give her financial assistance and a lot of advice and encouragement. The qualitative analysis confirms the result of the 2006 IFHS which shows that generally more Christians express less positive attitude towards PLWHA than their non-Christian counterparts. University of Ghana http://ugspace.ug.edu.gh 142 7.2.6 Ethnicity Among the ethnic groups, all the ethnic groups are more likely to express positive attitude towards PLWHA except the respondents belonging to Ga-Dangme and Gruma ethnic groups who are less likely to express positive attitude towards PLWHA (Table 7.1). The results further revealed that there is no difference in terms of attitude towards PLWHA between the reference category (Akan) and Ewe ethnic group when all other factors are held constant. Also, Grussi ethnic group are more than one and half times more likely to express positive attitude towards PLWHA compared with their Akan counterparts while other factors are held constant. Only Mole-Dagbani and Grussi ethnic groups are statistically significant in predicting attitude towards PLWHA. The result of the multivariate analysis is consistent with the findings of the qualitative analysis which also shows that there is no clear relationship between ethnicity of the respondents and their attitude towards PLWHA as expressed by those living with the disease. One of such views is indicated in the quote below: “Some people in my area know that I have the disease but because I am taking my drugs they are sti ll nice to me, they use the same publi c toi let and bathr oom wit h me. They visi t me and we go out together. Most of th is people are Ewe, Ga/Dangbe and Mende” (HIV positive woman who has been living with the disease for 4 years aged 35). The result of the multivariate analysis refutes the 2006 IFHS which reports that there is an association between the ethnicity of the respondents and their attitude towards PLWHA. 7.2.7 Wealth Status Household wealth quintile is a significant predictor of attitude towards PLWHA and this is consistent with the finding at the biavariate level. The result further revealed that there is almost direct relationship between household wealth quintile and attitude towards PLWHA University of Ghana http://ugspace.ug.edu.gh 143 (Table 7.1), between the poorest and the poorer, there is no significant difference in terms of attitude towards PLWHA when other factors are held constant. However, respondents in the middle quintile are more than one and a half times more likely to express positive attitude towards PLWHA given that other factors are held constant. Respondents in the richer and the richest wealth quintile are about twice as likely to express positive attitude towards PLWHA compared to their counterparts in the poorest quintile. The results of the multivariate analysis also support a study in Turkey by (Ayaranci, 2005) which reports that wealthier participant expressed more positive attitude towards PLWHA. This same trend of results was revealed in the qualitative analysis where it was generally expressed by PLWHA that wealthier persons are more likely than non-wealthier people to express positive attitude towards them. One of such view is reported below: An HIV positive man aged 45 who has been living with the disease for 4 years reported that she got the disease from her husband in Togo. But because she is taking her drugs she is feeling fine and that some of her relatives especially the rich ones have been helping her. These findings provide the evidence to reject the null hypothesis and accept the alternative hypothesis that states that wealth quintile is positively related to positive attitude towards PLWHA. 7.2.8 Occupation The result shows that occupation of respondents is not a significant predictor of attitude towards PLWHA. However, respondents in all other occupational categories are more likely than their counterparts who are not working to express positive attitude towards PLWHA (Table 7.1). However, persons in the sales and services are about twice as likely to express positive attitude towards PLWHA compared to their counterparts who are not working when other factors are University of Ghana http://ugspace.ug.edu.gh 144 held constant. While Popova, (2007) conducted a study in Russia and found out that workers were more tolerant to PLWHA than their counterparts who are not working, this current study found the contrary result. The result of the multivariate analysis rejects the findings of the qualitative analysis which shows that there is an association between the occupation of the respondents and their attitude towards PLWHA. One of the view expressed by PLWHA which is refuted by multivariate analysis is stated below. “Many people in th e are a know I hav e the diseas e and thos e who are working talk to me and give gifts but those who are not working talk bad things about me” (HIV positive man who has been living with the disease for 2 years aged 51). 7.2.9 Place of Resid ence Although there is no significant difference between urban and rural residence attitude towards PLWHA rural residence are less likely to express positive attitude towards PLWHA (Table 7.1). Thus, being in rural or urban residence does not significantly influence respondent’s attitude towards PLWHA. This can be attributed partly to high level of AIDS awareness and also the high level of social marketing foundation campaigns on AIDS education across the country. However, majority of PLWHA indicated that more of the respondents in the urban areas expressed positive attitude towards them than their counterparts in the rural areas. One of such view expressed by PLWHA is reported below. A photographer aged 30 who has been living with the disease for 3 years reported that he got the disease from one of his customers and though he is strong and fine only those in the city are nice to him. However, those in his village avoid him. University of Ghana http://ugspace.ug.edu.gh 145 7.2.10 Comprehensive knowled ge about AIDS 5espondent’s comprehensive knowledge about AIDS is highly significant in predicting attitude towards PLWHA. The results further revealed that for every unit increase in comprehensive knowledge about AIDS there is 1.23 unit increase in positive attitude towards PLWHA. The findings confirm the result at the biavariate analysis which shows that the comprehensive knowledge of the respondents is significantly associated with their attitude towards PLWHA. The result therefore provides the confidence to reject the null hypothesis and accept the alternative hypothesis that comprehensive knowledge about AIDS is positively related to positive attitude towards PLWHA. This finding also confirms the report of a study in four countries (Tanzania, Zimbabwe, South Africa and Thailand) by Genberg et al., (2009) which indicates that comprehensive knowledge about AIDS is significantly associated with attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 146 Table 7 .1: Result of Multiple Regressi on Analysis on Attitude Towards PLWHA By Characteristics of Responden ts Characteristi cs of the Respondents Odds Ratio Standard Error P > | Z | 95% of Confidence Interval Sex Female Male 1.000 0.898 0.037 0.090 0.792 ± 1.017 Age Group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54* 55-59* 1.000 1.147 1.055 1.188 1.102 1.173 1.265 1.447 1.455 0.121 0.128 0.163 0.159 0.178 0.192 0.301 0.333 0.193 0.778 0.207 0.503 0.292 0.120 0.075 0.101 0.933 ± 1.411 0.813 ± 1.319 0.909 ± 1.554 0.830 ± 1.462 0.872 ± 1.578 0.941 ± 1.702 0.963 ± 2.176 0.930 ± 2.278 Highest E ducational Level No Education Primary Middle/JSS Secondary/SSS Higher 1.000 1.274 1.595 2.334 3.042 0.151 0.180 0.301 0.493 0.042 0.000 0.000 0.000 1.09 - 1.606 1.279 ± 1.989 1.813 ± 3.006 2.215 ± 4.181 Marital Status Never Married Currently Married Formerly Married 1.000 0.675 0.822 0.617 0.121 0.000 0.185 0.564 ± 0.808 0.616 ± 1.098 Religi on Catholic Anglican Methodist Presbyterian Pentecostal/Charismatic Other Christian Moslem Traditionalist/Spiritualist No Religion Other 1.000 0.885 0.913 0.982 0.957 0.934 0.881 1.096 0.791 0.861 0.268 0.116 0.117 0.087 0.102 0.109 0.171 0.131 0.141 0.686 0.474 0.880 0.625 0.529 0.305 0.559 0.157 0.161 0.488 ± 1.602 0.711 ± 1.172 0.777 ± 1.241 0.800 ± 1.143 0.753 ± 1.156 0.691 ± 1.123 0.806 ± 1.488 0.571 ± 1.095 0.611 ± 1.106 University of Ghana http://ugspace.ug.edu.gh 147 Characteristi cs of the Respondents Odds Ratio Standard Error P > | Z | 95% of Confidence Interval Ethnicity Akan Ga/Dangme Ewe Guan Mole-Dagbani Grussi Gruma Mande Others 1.000 0.841 1.003 1.151 1.435 1.688 0.911 1.400 1.540 0.093 0.081 0.187 0.150 0.339 0.152 0.875 0.785 0.116 0.975 0.387 0.001 0.009 0.574 0.590 0.430 0.678 ± 1.044 0.856 ± 1.175 0.837 ± 1.583 1.170 ± 1.760 1.139 ± 2.501 0.657 ± 1.262 0.411 ± 4.765 0.532 ± 5.465 Wealth Status Poorest Poorer Middle Richer Richest 1.000 1.091 1.641 1.907 1.851 0.118 0.193 2.444 2.478 0.421 0.000 0.000 0.000 0.882 ± 1.350 1.303 ± 2.067 1.483 ± 2.452 1.424 ± 2.406 Occupation Not Working Professional/Technical/ Managerial/Clerical Sales and Services Agricultural Manual 1.000 1.205 1.951 1.060 1.134 0.143 0.095 0.115 0.127 0.117 0.616 0,589 0.260 0.954 ± 1.521 0.782 ± 1.156 0.857 ± 1.312 0.911 ± 1.412 Place of Residence Urban Rural 1.000 0.917 0.068 0.241 0.793 ± 1.060 Comprehensive Knowledge about AIDS 1.232 0.244 0.000 1.185 ± 1.381 Note: * = Only male Ordered Logistic Regression Number of Obs = 5150 Wald Chi 2(40) = 642.85 Prob > Chi 2 = 0.0000 Log Pseudolikelihood = 7.600 e + 09 Pseudo R2 = 0.0469 University of Ghana http://ugspace.ug.edu.gh 148 7.3 Summary Chapter seven is on the determinants of the respondents’ attitude towards PLWHA. 7he findings shows that on the whole, the major explanatory factors that contributed to attitude towards PLWHA were sex, education, marital status, wealth status and comprehensive knowledge about AIDS. In addition to these factors age, religious affiliation, ethnicity, occupation and place of residence have also been found to be important in understanding attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 149 CHAPTER EIGHT SUMMARY, CONCLUSION AND RECOMMENDATIONS 8.1 Introduction The study of people’s attitude towards PLWHA was borne out of the increasing concern expressed about the magnitude of the problems that PLWHA face. These have mainly resulted from misconception about how the disease is transmitted and prevented. Background characteristics of people also contributed to the problem of attitude towards PLWHA. The study therefore sought to examine the factors that contributed to respondents’ attitude towards PLWHA. The general objective of the study was to examine the determinants of people’s attitude towards PLWHA in Ghana. The specific objectives are: i. To examine the relationship between the respondents socio- demographic characteristics and their attitude towards PLWHA. ii. To examine respondents knowledge of HIV prevention methods and their attitude towards PLWHA. iii. To examine the respondents misconceptions about AIDS and their attitude towards PLWHA. iv. To examine respondents knowledge of HIV transmission and their attitude towards PLWHA. University of Ghana http://ugspace.ug.edu.gh 150 v. To examine the respondents comprehensive knowledge about AIDS and their attitude towards PLWHA. vi To make policy recommendations on addressing the problem of negative attitudes toward PLWHA in Ghana based on the findings of the study Data from the 2008 GDHS and in-depth interview conducted for PLWHA at Agomanya and in Tema were used in the study. The analysis is therefore both quantitative and qualitative. The 2008 GDHS collected information from 4916 women aged 15-49 years and 4568 men aged 15-59 years. However, 2656 men aged 15-59 years and 2816 women aged 15-49 years were used in the study because these were the respondents who responded to the questions on HIV/AIDS. In-depth interview was used to collect data from PLWHA in Tema and Agomanya. The study targeted 150 PLWHA, 80 at Agomanya (45 women and 35 men) and 70 in Tema (40 women and 30 men), but the number was limited to 60, of which 25 of them came from Tema (14 women and 11 men) and 35 from Agomanya (21 women and 14 men). These were the PLWHA who were willing participate in the research. The women with HIV were aged 20-54 years whilst the men were aged 21-57 years. Purposeful sampling was used to collect data for the study, which is, interviewing people who have been diagnosed as having HIV. Univariate techniques such as frequencies were used to describe the distribution of the respondents by their socio- demographic characteristics. The bivariate analysis was done between the independent variables and the intermediate variables, the independent variables and the dependent variables, the intermediate variable and the dependent variable. The chi-square test was used to test the differences between proportions. Ordered logistic regression model was used to determine the socio-demographic variables that predict respondents’ attitude towards PLWHA controlling for the level of comprehensive knowledge of respondents about AIDS. University of Ghana http://ugspace.ug.edu.gh 151 8 . 2 Summary Chapter three examined the characteristics of the respondents. The findings show that majority (51.5 per cent) of the respondents were females while minority (48.5 per cent) were males. More than half (54.3 per cent) of the respondents are young. A high proportion of the respondents had Middle/JSS education (43.4 per cent) whilst a small proportion of them had higher education (7.6 per cent). A high percentage of the respondents are married (45.9 per cent) whereas a small proportion of them are widowed (1.3 per cent). Majority (64.8 per cent) of the respondents are Christians while a small proportion of them labeled as ³other´ constitute . per cent . A high percentage of the respondents are Akan (48.0 per cent) whereas a small percentage of them are Mende (0.5 per cent). With wealth quintilie more than three±fifths (65.7 per cent) of respondents are in the middle or better wealth status while less than two±fifth (34.2 per cent) of them are in the poor or poorer wealth status. A high percentage of the respondents are into agriculture (27.7 per cent) whereas a small percentage are unskilled manual workers (0.5 per cent). Majority (51.7 per cent) of the respondents are in the rural areas whilst minority (48.3 per cent) of them are in the urban areas. More than half (63.1 per cent) of the respondents have fair or better comprehensive knowledge about AIDS whereas the rest have bad or very bad comprehensive knowledge about AIDS. In terms of knowledge of HIV prevention methos, almost all (97.4 per cent) of the respondents have fair or better knowledge of HIV prevention while a few (2.6 per cent) of them have bad knowledge of HIV prevention methods. More than 60.0 per cent of the respondents have some misconception about AIDS whereas the rest have no misconception about AIDS. University of Ghana http://ugspace.ug.edu.gh 152 Nearly all (97.1 per cent) the respondents have fair or better knowledge of HIV transmission while 2.9 per cent of them have bad knowledge of HIV transmission. More than three quarters (79.7 per cent) of the respondents have fair or better attitude towards PLWHA while the rest have bad or very bad attirude towards PLWHA. Chapter four examined the effects of the socio - demographic characteristics of the respondents on their comprehensive knowledge about AIDS (knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission). The findings show that marital status, level of education, religious affiliation, ethnicity, wealth status, occupation, and place of residence of the respondents are significantly associated with their comprehensive knowledge about AIDS while age and sex of the respondents were found not to be significantly associated with comprehensive knowledge about AIDS. Furthermore, sex, age, level of education, wealth status and the occupation of the respondents are significantly associated with their knowledge of HIV prevention methods while marital status, religious affiliation and type of place of residence were not. The result further revealed that all the socio-demographic characteristics of the respondents were significantly associated with their misconception about AIDS. Lastly, the study showed that all the socio- demographic characteristics of the respondents except place of residence was significantly associated with their knowledge of HIV transmission. Chapter five examined the socio -demographic characteristics of the respondents and their effect on attitude towards PLWHA. The result showed that all the socio±demographic characteristics of the respondents was significantly associated with their attitude towards PLWHA. The results of the qualitative data support those from the quantitative data with the exception of ethnicity. University of Ghana http://ugspace.ug.edu.gh 153 Chapter six examined respondents comprehensive knowledge about AIDS (knowledge of HIV prevention methods, misconception about AIDS, knowledge of HIV transmission and their attitude towards PLWHA). The findings showed that comprehensive knowledge about AIDS, knowledge of HIV prevention methods, misconception about AIDS and knowledge of HIV transmission are significantly associated with attitude towards PLWHA. The multivariate analysis also revealed that sex, education, , marital status, wealth status and comprehensive knowledge about AIDS are statistically significant in predicting attitude towards PLWHA and are also supported by responses from the qualitative data. The hypotheses that there exist a positive relationship between education, wealth status and comprehensive knowledge about AIDS of the respondents and their attitude towards PLWHA were accepted. 8.3 Conclusion The foregoing analysis shows that on the whole, the major explanatory factors that contributed to attitude towards PLWHA are sex, education, marital status, wealth status and comprehensive knowledge about AIDS. In addition, age, religious affiliation, occupation and place of residence have been found to be important factors in understanding attitude towards PLWHA among the study population. 8.4 Recommendations Based on the findings of the study the following recommendations are made: 1. Erroneous belief and misconceptions are obstacles in fighting against stigmatization and discrimination, and also tend to encourage the spread of the HIV disease. Since more than University of Ghana http://ugspace.ug.edu.gh 154 60 per cent of the respondents have misconception about AIDS, programme implementers should promote and sustain their IEC interventions. 2. To control the spread of the disease, it is crucial to address stigmatization and discrimination against those with the disease. As a result of reduced stigma those infected may be more likely to access the health system earlier without fear of being stigmatized, judged, blamed or discriminated against. Attempts at promoting positive attitude towards PLWHA should continue to be a major component of GAC’s programmes. The use of community leaders in communication and education effort is a key strategy for disseminating accurate information about AIDS to most people. 3. Since education is significantly associated with the attitude of the respondents towards PLWHA, it is essential that for the Ministry of Education in Ghana to incorporate appropriate HIV education and information about other sources of disease into school curricula. But the out-of-school population should also be targeted for education on HIV/AIDS 4. Lastly, community and church mobilization, political involvement, policy development and health education are important and necessary to challenge misconception about the disease and change the stigmatizing, discrimination and negative attitude towards PLWHA. 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