Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.

1. FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS
COUNSELLING AND TESTING ACCEPTANCE AND UPTAKE AMONG
YOUTH IN KUMASI METROPOLIS, GHANA
EVA DEDEI TAGOE-DARKO
CHARLOTTE MONICA MENSAH
RAZAK MOHAMMED GYASI
DEPARTMENT OF GEOGRAPHY AND RURAL DEVELOPMENT, COLLEGE OF ART AND
SOCIAL SCIENCES, FACULTY OF SOCIAL SCIENCES, KWAME NKRUMAH UNIVERSITY
OF SCIENCE AND TECHNOLOGY, KUMASI, GHANA
E-mail: binghi_econ@yahoo.com
Mob: 0322 (0) 208 545 052
1

2. 1. Introduction
Sub-Saharan Africa continues to bear a disproportionate share of the global HIV burden. In
mid-2010, about 68% of all people living with HIV resided in sub-Saharan Africa, a region
with only 12% of the global population (WHO/UNAIDS, 2012). HIV/AIDS pandemic
significantly and unabatedly continues to spread in many parts of Africa. Ghana is identified
as one of the countries with the lowest official HIV prevalence rate of 1.9%, where an
estimated 260,000 Ghanaians were living with HIV/AIDS by the end of 2009, whilst 23,236
new infections occurred in the same year (WHO/UNAIDS, 2012). Notwithstanding, the
prevalence rate among Ghanaian youth (15 – 24 year olds) increased from 1.9% in 2008 to
2.1% in 2009 (GHS and MoH, 2009). Moreover, AIDS has been identified as one of the
highest causes of mortality in Ghana, claiming about 21,000 lives in 2007 (UNAIDS, 2008).
The Ghana AIDS Commission (2010) estimated that about 1.2 million of the projected 25
million Ghanaians will be living with HIV/AIDS by the end of 2014.
This HIV/AIDS prevalence and mortality rates pose a great threat to Ghana‘s development
agenda. The pressure on Government of Ghana (GoG) to develop the country is exacerbated,
considering the amount of resources being channelled to HIV/AIDS prevention and
treatment. In 2008, for instance, the GoG spent $38,850,940 on HIV/AIDS and the annual
cost of treating HIV/AIDS opportunistic infections is also expected to triple by the year 2014
(MoH, 2001; Ghana AIDS Commission, 2010; 2008). Barnett and Whiteside (2006) have
also indicated that Ghana and other countries, south of Sahara are not likely to meet the
health-related Millennium Development Goals (MDGs)1 by 2015 because HIV/AIDS-
induced infant, mother-to-child-transmission and child mortality will continue to increase in
the years ahead. Consequently, the Ghana AIDS Commission (2010) has identified the need
1
The three health-related MDGs include goals 4, 5 and 6 of reducing infant mortality, improving maternal
health and combating HIV/AIDS, malaria and other diseases respectively.
2

3. for a combination of evidence informed and targeted interventions in HIV programme as key
for effective HIV prevention and treatment. In this regard, the GoG adopted Counselling and
Testing (CT) in 2003 as a conduit to complement ongoing ABC HIV prevention campaigns
(UNAIDS, 2000). HIV CT is the process by which an individual undergoes confidential
counselling, enabling him or her to cope with stress and make an informed choice about
being tested for HIV and to take appropriate action thereof (UNAIDS, 2000; UNFPA and
IPPF, 2004).
In recent years, testing for HIV, in combination with pre- and post-test counselling, has
become increasingly important in national and international prevention and care efforts. CT
has been recognized as the crux of HIV surveillance, prevention and treatment programs
(WHO/UNAIDS, 2009). The benefits of HIV CT are manifold and well documented in the
literature. Denison et al., (2008), in their study on the voluntary counselling and testing and
behavioural risk reduction in developing countries, point out that CT serves as an effective
prevention strategy for HIV-1 since the combined effect of one‘s knowledge of their HIV
status and counselling under CT helps individuals change their behaviour to skirmish further
transmission of the virus. Additionally, when an individual tests seronegative high quality
counselling helps them to maintain a lifestyle that will keep them seronegative (Denison et
al., 2008; Wolitski et al., 1997; Baggaley, 2001; de Paula et al., 2008; 2010). Baggaley
(2001) has explicated the need for HIV prevention to address injecting drug use and
homosexual transmission. Individuals who test HIV positive after an HIV CT have the
chance to access medical treatment that can prevent mortality. This is a way of ensuring that
HIV seropositive people stay longer to contribute their quota to the development agenda of
their countries and the world at large (Baggaley, 2001). Moreover, knowledge of serostatus
through CT can be a motivating force for HIV-positive and-negative people alike to adopt
3

4. safer sexual behaviour, which enables seropositive people to prevent their sexual partners
from getting infected and those who test seronegative to remain negative (Ghana Statistical
Service [GSS], 2008; UNAIDS, 2001; WHO/UNAIDS, 2007; UNFPA and IPPF, 2004).
Lack of knowledge of serostatus by people living with HIV is a major obstacle to actualizing
the goal of universal access to treatment and prevention. A significant proportion of people
living with HIV continues to present late for treatment because they are unaware that they are
seropositive (Cohen, 2008; UNFPA, 2002), thus reducing the effectiveness of antiretroviral
therapy on morbidity, survival and preventing HIV infection.
Since 2003, GoG has launched a number of HIV prevention and treatment programs
including CT services (Koku, 2010). In the face of these efforts vis-avis the benefits of CT,
desire for and uptake of HIV testing remains disproportionately low. The Ghana
Demographic and Health Survey found that 14% of men and 21% of women aged, 15-49
have ever undergone HIV CT. Moreover, only 7% and 4% of women and men respectively of
those recently tested have received results (GSS, 2008). The relatable factors that influence
the decision to accept CT are mixed and still far from comprehension. Studies have correlated
poor intention of testing in general to such psycho-social and physical factors as
psychological and emotional trauma experienced by the seropositive individual or the fear of
testing outcomes, lack of confidentiality, proximity and access to CT site and HIV-related
stigmatization and discrimination experienced by seropositive people leading to loss of
family and employment (Koku, 2010; Mansergh et al., 1998; Dannenbueg et al., 1996;
Maman et al., 2000 and Yeager et al., 2000; Nuwaha et al., 2002; Kalichman and Simbayi,
2003). Others include socio-demographic and economic determinants such as age (Shisana et
al, 2005; Hutchinson and Mahlalela, 2006; Ma et al, 2007; Wringe et al, 2008; Bwambale et
4

5. al, 2008) marital status, educational level, occupation, household wealth, and area of
residence (Hutchinson and Mahlalela, 2006; Wringe et al, 2008; Gage and Ali, 2005; Haile et
al, 2008).
Research has shown that the introduction of routine testing has particularly increased testing
experience among women through prevention of mother-to-child transmission programs
(Byamugisha et al, 2010a; Chandisarewa et al, 2007). Conversely, men are reluctant and thus
do not show up to the antenatal clinics with their wives for CT (Falnes et al, 2011;
Byamugisha et al, 2010b; Theuring et al, 2009). Improving CT utilization by men has the
potency to influence directly or indirectly women’s CT utilization (Demissie et al, 2009; Lata
et al, 2012). There is thus urgent need to understand the predictors of acceptability and
uptake of HIV CT by men since it connotes with nitty-gritty for designing policy measures
and options to stem future spread of HIV infections and foster its treatment, care and support.
The 2009 national Official HIV Sentinel Survey conducted by Ghana AIDS Commission
revealed that the Ashanti Region recorded 3.0% prevalence rate of HIV with 4.0% in the
capital city, Kumasi (Ghana AIDS Commission, 2010). What makes the situation more
looming is the fact that most of the young people in the area are express little willingness to
accept and uptake HIV CT to ascertain their HIV serostatus. Campaigns that entreat them to
know their status have been coldly and grimly embraced, and CT services that are taken to
the various communities have recorded minimal turn out rates. The possible consequence of
this is that most of these young folks ignorantly spread the disease. Nevertheless, studies on
HIV CT in Ghana have focused on the other side of the subject; see Wyss et al. (2007),
Holmes et al. (2008), Appiah et al. (2009) and Koku (2010). This informed the thesis and the
locus of this research and the selection of Kumasi Metropolis as the study prefecture.
5

6. 2. Methods
2.1 Study setting
The study will be conducted between December, 2012 and March, 2013 in the Kumasi
Metropolitan District of Ashanti Region, Ghana. This is one of the 27 political and
administrative districts in the Ashanti Region with Kumasi as capital. The Metropolis is
located in the transitional moist semi-deciduous forest zone and spans an area of 254km2
forming approximately 1.04% of the total landmass of the region. It is located in the south-
central portion of Ashanti Region. The Metropolis shares boundaries with Afigya Kwabre
and Kwabre East Districts to the North, Ejisu-Juaben to the East, Atwima Kwanwoma to the
south and Atwima Nwabiagya District to the West. Specifically, the Metropolis stretches
between latitude 6.35o – 6.40o and longitude 1.30o – 1.35o, an elevation which ranges
between 250 – 300 metres above sea level (see figure 1) (KMA/Ghana District, 2012). The
predominant economic activities in the Metropolis are trading, commerce and other services.
The unique centrality of Kumasi as a traversing point from all parts of the country makes it a
special place for many to migrate to. Kumasi is the most populous district in the region and
accounts for almost a third of the region’s population. According to the 2010 Population and
Housing Census Report, Kumasi accommodates a total of 2,035,064 people, reflecting an
inter-censal growth rate of 5.4% (GSS, 2012).
The Metropolis is made up of 10 Sub-Metros with 189 health facilities. It is worth noting that
the private sector operates a significant number by taking over 90% share of the facilities.
Komfo Anokye Teaching Hospital (KATH), 1 of the national autonomous hospitals, is
situated in Kumasi Metropolis. There are other 4 quasi-government health institutions, 172
private health institutions and 3 CHAG in the Metropolis (Kumasi Metropolitan Health
Directorate, 2012). These health institutions are evenly distributed across the district to
6

7. enhance easy access and use of health care services. The common diseases in the Metropolis
include malaria, diarrhoea, HIV/AIDS, tuberculosis, hypertension and diabetes mellitus.
Septic abortion and road traffic accidents also constitute another major challenge to the health
sector (Kumasi Metropolitan Health Directorate, 2012).
Among other services, CT provided at 10 health facilities videlicet, Kumasi South, Suntreso,
Tafo, Manhyia, Bomso Clinic, Aninwaa Medical Centre, KNUST hospital, Kwadaso,
Seventh Day Adventist Hospital and KATH whilst Anti retroviral treatment is provided at the
KATH, the Kumasi South Hospital and the Bomso Clinic only (Kumasi Metropolitan Health
Directorate, 2012).
2.2 Study design and sampling
This retrospective cross-sectional survey will employ triangulation of both quantitative and
qualitative approaches of research. Individuals, both male and female between the age
brackets of 15-29 found in the selected communities in the study prefecture will constitute the
study sample. The target population from which the sample will be drawn is 601,336. A
sample size of 360, representing .061% of the population will be used. A multi-stage
stratified cluster and simple random sampling technique will be utilised to select 6 Sub-
Metros and 12 study settlements from the Metropolis for the study. The selected Sub-Metros
will be Asokwa, Subin, Manhyia, Nhyiaeso, Kwadaso and Oforikrom.
Two communities will be selected randomly from each Sub-Metro for the study. The research
communities will include: Atonsu, Kaase, Asafo, Amakom, Krofrom, Ashanti New Town,
Ayigya, Kotei, Ahodwo, Fankyinebra, Kwadaso and Asuoyeboa (see figure 1). The sub-
sample for each community will be proportionately determined based on population size.
7

8. Unit of analysis will be households and one (1) respondent will be selected from each
household through systematic random sampling method. The sample interval of the
communities will base on the density of houses and households and that the intervals will be
pegged at 5 for communities with high density of houses and 3 for research settlements with
low house densities. The underpinning factor in the selection of these communities is to
ensure fair and adequate coverage of the Metropolis to boost accuracy and representativeness
of research findings.
2.3 Data collection
Primary data will be sourced and collected from households in the various selected study
communities for this research. In-depth interviews and questionnaire instruments will
respectively be considered in obtaining qualitative and quantitative data in the primary data
collection. The illiterate and semi-literate respondents who find it relatively difficult to read
and interpret the questionnaire guide will be interviewed. However, some literates will have
the option to be interviewed so as to play down possible challenges of call-backs. The
questionnaire and interviews will be translated into Twi, the major language spoken in the
study prefecture and verified by a second translator. Where inconsistencies are found, these
will be corrected. Pre-testing of the questionnaire will be completed with 5 qualified persons
but not be included in the study. However, English will be used to administer the interviews
where necessary. Besides, secondary information will be utilised to place the study in the
context of scholarly world.
Ethical approval will be obtained from the Committee on Human Research and Publication
Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and
Technology, Kumasi prior to the data collection exercise. Israel and Hay (2006) have
8

9. reverberated that Social Scientists do not have an inalienable right to conduct research
involving other people. The opinion leaders, household heads and respondents in each
selected community will be notified and briefed on the objectives of the research and be
made to sign consent form before the commencement of the data collection. Questionnaire
will be anonymised, with no personal identifying information recorded on them. Also,
contributions made by participants will be treated anonymous and confidential. Besides, a
respondent will reserve the right to withdraw at any point in time or deny certain information
in the course of the interview. Each interview will approximately last for 45 minutes.
Detailed notes will be taken and those in local dialect then translated and back translated into
English for analysis.
2.4 Outcome measures
Respondents will be interviewed with an anonymously structured questionnaire that requests
information on demographic variables, socioeconomic status, knowledge of HIV, HIV risk
history, impact of HIV, HIV CT history and knowledge and determinants of intension to
accept and utilise CT (Peltzer et al, 2009).
The survey will include questions concerning history of HIV antibody testing. These
measures will be used to classify participants into groups based on whether they had been
tested for HIV and know their results. Participants who will report having been tested for
HIV will be made to indicate their HIV awareness status of their most recent test, or that they
did not know the results.
To assess HIV risk history, participants will indicate the number of sex partners they had in
the previous 12 months, had symptoms of a sexually transmitted infection, and whether they
9

10. have ever used a condom, a condom with their last sexual partner and their last sexual non-
regular partner. All responses will be dichotomous indicating the occurrence or non-
occurrence of each risk factor. A 4-item HIV knowledge test will be used; e.g. is it possible to
transmit HIV through unprotected sex? Response options will be “Yes”, “No”, and “Does not
know”. “Does not know” responses will be scored as “No”; CT knowledge will be assessed
with one item: “Have you ever heard about test for people with HIV called HIV CT?”
Response options will be “Yes” or “No”. A 3-item will be used to measure HIV impact
items; thus, Has anyone in the household ever been diagnosed with HIV/AIDS, is there a
person in the household who is bed-ridden with an AIDS related illness and past year
occurrence of AIDS-related death of household member. Response options will be “Yes” or
“No”. For AIDS stigma attitudes, 4-AIDS-stigma items will be used; “Would you be willing
to care for a family member with AIDS”. Response options were, “Yes”, “No”, or “Do not
know”.
Demographic and social variables linked to HIV CT will be included in the survey. These
will include sex, age, marital status, ethnic background, religious affiliation, and place of
residence whist socioeconomic status included will be household income standing, formal
education completed and employment status.
2.5 Data Analysis
Data analysis will be performed using Predictive Analytic Software (PASW) for Windows
software application program version 17.0. Data will be ordered, edited, coded, and entered
into the software and analysed quantitatively using multiple regression. Stepwise method will
be employed to determine the relative strengths of the independent variables on HIV CT. The
multiple regression analysis will be preceded by a bivariate correlation matrix to examine the
10

11. strength of associations between the dependent variable HIV CT utilization and relevant
potential predictor variables. The probability (p) value less or equal to 0.05 will be used to
indicate statistical significance in the regression model. Frequencies, means, and standard
deviations will be computed to describe the sample. The qualitative data will be subjected to
a content analysis. The analysis will be done using the grounded-theory approach. This
method is based on techniques to systematically discover categories, themes or patterns that
emerge from the data, through coding and categorisation of information into manageable
units (Strauss and Corbin, 1998). In this respect, the categories for analysis will be drawn
from the interview guides and then, themes and patterns emerge after reviewing the data
within and across groups of respondents (Carey, 1994; Charmaz, 1990). Results will be
presented through direct quotes.
References
Appiah, L. T., Havers, F., Gibson, J., Kay, M., Sarfo, F. and Chadwick, D. (2009). Efficacy
and acceptability of rapid, point-of-care HIV testing in two clinical settings in Ghana.
AIDS Patient Care & STDs, 23(5). Pp. 365 - 9
Baggaley, R. (2001). Voluntary counselling and testing (VCT). Paper for the UNAIDS expert
panel on HIV testing in United Nations peacekeeping operations. 17-18th September
2001, New York.
Barnett, T. and Whiteside, A. (2006). AIDS in the twenty-first century: disease and
globalization. New York: Palgrave Macmillan.
Bwambale, F. M., Ssali, S. N., Byaruhanga, S., Kalyango, J. N. and Karamagi, C. A. (2008)
Voluntary HIV counselling and testing among men in rural western Uganda:
implications for HIV prevention. BMC Public Health, 30(8):263.
Byamugisha, R., Tumwine, J. K., Semiyaga, N., Tylleskar. T. (2010a). Determinants of male
11

12. involvement in the prevention of mother-to-child transmission of HIV programme in
Eastern Uganda: a cross-sectional survey. Reprod Health , 7:12.
Byamugisha, R., Tylleskar, T., Kagawa, M. N., Onyango, S., Karamagi, C. A. and Tumwine,
J. K. (2010b). Dramatic and sustained increase in HIV-testing rates among antenatal
attendees in Eastern Uganda after a policy change from voluntary counselling and
testing to routine counselling and testing for HIV: a retrospective analysis of hospital
records, 2002–2009. BMC Health Serv Res, 10:290.
Carey, M. (1994). The group effect in focus groups: planning, implementing, and interpreting
focus group research. In: Morse, J.M. (ed.) Critical Issues in Qualitative Research.
Thousand Oaks, California, Sage Publications.
Chandisarewa, W., Stranix-Chibanda, L., Chirapa, E., Miller, A., Simoyi, M., Mahomva, A.
and Charmaz, K. (1990). ‘Discovering’ chronic illness: using grounded theory. Social
Science and Medicine 30(11), pp. 1161–1172.
Cohen, T. (2008). Optimal HIV testing and earlier care: the way forward in Europe. HIV
Medicine, 2008, 9:1–5.
Dannenbueg, A., McNeil, J., Brundage, J. and Brookmeyer, R. (1996). Suicide and HIV
infection: mortality follow up of 4147 HIV-seropositive military service applicants
JAMA, 268 (15). Pp. 2066-68.
Demissie, A., Deribew, A., and Abera, M. (2009). Determinants of acceptance of voluntary
HIV testing among antenatal clinic attendees at Dil Chora Hospital, Dire Dawa, East
Ethiopia. Ethiop j Health Dev, 23(2):7.
Denison, J. A., O‘Reilly, K. R., Schmid, G. P., Kennedy, C. E., Sweat, M. D. (2008). HIV
Voluntary Counseling and Testing and Behavioral Risk Reduction in Developing
Countries: A Meta-analysis, 1990–2005. AIDS Behav;12: Pp. 363–373
de Paula, A., Shapira, G., and Todd, P. E. (2008). How Beliefs about HIV status affect risky
12

13. behaviours: Evidence from Malawi.
Falnes, E. F., Moland, K. M., Tylleskar, T., de Paoli, M. M., Msuya, S. E., and Engebretsen,
I. M. (2011). “It is her responsibility”: partner involvement in prevention of mother to
child transmission of HIV programmes, northern Tanzania. J Int AIDS Soc 2011,
14(1):21.
Gage, A. J. and Ali, D. (2005). Factors associated with self-reported HIV testing among men
in Uganda. AIDS Care, 17(2):153-65.
Ghana Health Service and Ministry of Health. (2009). National AIDS/STI Control
Programme: national HIV prevalence and AIDS estimates reports 2008 ‐ 2015, Accra.
Ghana AIDS Commission. (2010). Ghana‘s progress report (January 2008 – December 2009)
on the United Nations General Assembly Special Session (UNGASS). Declaration of
commitment on HIV and AIDS: Accra, Ghana.
Ghana AIDS Commission. (2008). The HIV and AIDS programme of work. AIDS
Commission: Accra, Ghana.
Ghana Statistical Service. (2012). 2010 Population and Housing census, Accra.
Ghana Statistical Service (2008). Ghana Demographic and Health Survey 2008. Accra,
Ghana: Ghana Statistical Service, Ghana Health Service and ICF Macro.
Haile, B. J., Chamber, J. W. and Garrison, J. L. (2008). Correlates of HIV knowledge and
testing: Results of a 2003 South African HIV Survey. J Black Studies 2007, 38:194-
208.
Holmes, C., Preko, P. O., Bolds, R., Baidoo, J. and Jolly, P. E. (2008). Acceptance of
Voluntary Counselling, Testing and Treatment for HIV among Pregnant Women in
Kumasi, Ghana. Ghana Medical Journal. March, 2008 Volume 42, Number 1.
Hutchinson, P. L. and Mahlalela, X. (2006). Utilization of voluntary counselling and testing
services in the Eastern Cape, South Africa. AIDS Care, 18(5):446-55.
13

14. Israel, M. and Hay, I. (2006). Research Ethics for Social Scientists. SAGE Publication Ltd.
Kalichman, S. C. and Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigma, and
voluntary HIV counselling and testing in a black township in Cape Town, South
Africa. Sex Transm Infect, 79(6):442-447.
Koku, E. F. (2010). Desire for and uptake of HIV tests by Ghanaian women: The relevance of
community level Stigma. Journal of Community Health, 36 (2). Pp. 289 – 299.
Kumasi Metropolitan Assembly/Ghana Districts. (2012). Ashanti: Kumasi Metropolitan.
Ministry of Local Government and Rural Development and Maks Publications and
Media Services. http://ghanadistricts.com/districts/?news&r=2&_=6 (Accessed: 18th
November, 2012).
Kumasi Metropolitan Health Directorate. (2012). Biostatistics data, Statistics Department,
(unpublished).
Leta, T. H., Syndøy, I. F and Knut, F. (2012). Factors affecting voluntary HIV counselling
and testing among men in Ethiopia: a cross-sectional survey. BMC Public Health,
12:438 doi:10.1186/1471-2458-12-438.
Ma, W., Detels, R., Feng, Y., Wu, Z., Shen, L., Li, Y., Li, Z., Chen, F., Wang, A. and Liu, T.
(2007). Acceptance of and barriers to voluntary HIV counselling and testing among
adults in Guizhou province, China. AIDS, 21(Suppl 8):S129-35.
Maldonado, Y, Shetty, A. K. (2007). Routine offer of antenatal HIV testing (“opt-out”
approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull
World Health Organ, 85(11):843–850.
Maman, S., Mbwambo, J. and Hogan, M. (2000). History of partner violence is common
among women attending a voluntary counseling and testing clinic in Dar Es Salaam,
68 Tanzania Abstract C308, presented at the 13th International Conference on
HIV/AIDS, Durban South Africa.
14

15. Mansergh, G., Haddix, A., Steketee, R.. (1998). Cost-effectiveness of zidovudine to prevent
mother to child transmission of HIV infection in a sub-Saharan Africa. JAMA, 280
(1). Pp. 30-31
Ministry of Health (MOH). (2001). National AIDS/STI Control Programme Disease Control
Unit, Ministry of Health, Accra.
Nuwaha, F., Kabatesi, D., Muganwa, M. and Whalen, C. C. (2002). Factors Influencing
Acceptability of Voluntary Counselling and Testing for HIV in Bushenyi District Of
Uganda. East African Medical Journal Vol. 79 No. 12 December 2002.
Peltzer, K., Matseke, G., Mzolo, T. and Majaja, M. (2009). Determinants of knowledge of
HIV status in South Africa: results from a population-based HIV survey. BMC Public
Health; 2009, 9:174.
Shisana, O., Rehle, T., Simbayi, L. C., Parker, W., Zuma, K., Bhana, A., Connolly, C.,
Jooste, S. and Pillay, V. (2005). South African national HIV prevalence, HIV
incidence, behaviour and communication survey. Cape Town: HSRC Press; 2005.
Straus, A. and Corbin, J. (1998). Basics of Qualitative Research. Newbury Park, California,
Sage Publications.
Theuring, S., Mbezi, P., Luvanda, H., Jordan-Harder, B., Kunz, A. and Harms, G. (2009).
Male involvement in PMTCT services in Mbeya Region, Tanzania. AIDS Behav, 13
(Suppl1):92–102.
UNAIDS. (2000). VCT: UNAIDS Technical Update, May 2000.
UNAIDS. (2010). Report on the global aids epidemic. ―UNAIDS/10.11E | JC1958Eǁ.
http://www.unaids.org/documents/20101123_GlobalReport_em.pdf (Accessed on
January 26, 2012).
UNAIDS. (2008). Report on the global AIDS epidemic.
15

16. http://www.unaids.org/en/dataanalysis/epidemiology/2008reportontheglobalaidsepide
mic/ (Accessed: 19th March 2012).
UNAIDS. (2001). The impact of Voluntary Counselling and Testing: a global review of the
benefits and challenges. Joint United Nations Programme on HIV/AIDS.
UNAIDS/01.32E. http://data.unaids.org/publications/irc-pub02/jc580-vct_en.pdf
(Accessed: November 19, 2010).
UNAIDS. (2000). Voluntary counselling and testing (VCT). UNAIDS Best Practice
Collection. Technical Update, Pp. 1–12.
UNFPA, and IPPF. (2004). Integrating HIV Voluntary Counselling and Testing Services into
Reproductive Health Settings: Stepwise Guidelines for Programme Planners,
Managers and Service Providers.
UNFPA. (2002). HIV Prevention Now Programme Briefs No.5- Voluntary Counselling and
Testing (VCT) for HIV Prevention - April 2002.
WHO/UNAIDS. (2012). Global HIV/AIDS Response Epidemic update and health sector
progress towards Universal Access. 2011 Progress Report. World Health
Organization 2012.
WHO/UNAIDS. (2009). Towards Universal Access: Scaling up priority HIV/AIDS
interventions in the health sector; 2009 Progress Report. World Health Organization
2009.
WHO/UNAIDS/UNICEF. (2007). Towards universal access: Scaling up priority HIV/AIDS
interventions in the health sector. Progress Report. Geneva, Switzerland: WHO,
UNAIDS and UNICEF.
Wolitski, R. J., MacGowan, R. J., Higgins, D. L., and Jorgensen, C. M. (1997). The effects of
HIV counseling and testing on risk-related practices and help-seeking behaviour.
AIDS Education and Prevention, 9(3 Suppl), 52–67.
16

17. Wringe, A., Isingo, R., Urassa, M., Maiseli, G., Manyalla, R., Changalucha, J., Mngara, J.,
Kalluvya, S. and Zaba, B. (2008). Uptake of HIV voluntary counselling and testing
services in rural Tanzania: implications for effective HIV prevention and equitable
access to treatment. Trop Med Int Health, 13(3):319-27.
Wyss, S., Ablordeppey, J., Okrah, J. and Kyei, A. (2007). Reaching disenfranchised youth
and mobile populations in Ghana through voluntary counselling and testing services
for HIV. African Journal of AIDS Research, 6(2). Pp. 121 — 12.
Yeager, R., Hendrix, C. W. and Kingma, S. (2000). International military human
immunodeficiency virus/acquired immunodeficiency syndrome policies and
programs: strengths and limitations in current practice. Mil Med, 165(2). Pp. 87-92.
17