Men’s Adherence to HIV Testing in Ghana: The Role of Educational Level and Urban-Rural Dynamics

¹Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana

²Department of Biostatistics and Epidemiology, University of Health and Allied Sciences, Ho, Ghana

*Corresponding author: Anthony Edward Boakye, Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana, Tel: +233544006918, ORCID ID: 0000-0002-4017-8351; Emails: [email protected]; [email protected]

Received Date: March 31, 2025

Published Date: April 22, 2025

Citation: Boakye AE, et al. (2025). Men’s Adherence to HIV Testing in Ghana: The Role of Educational Level and Urban-Rural Dynamics. Mathews J HIV AIDS. 7(1):26.

Copyrights: Boakye AE, et al. © (2025).

ABSTRACT

Background: Globally, HIV transmission is ongoing in all countries making new infections hit around 1.5 million annually. Some evidence suggests that when people know their HIV status, they may be more likely to take steps to remain free from HIV. Objective: Based on this, the study aimed to investigate how educational level and urban-rural dynamics play a role in men’s adherence to HIV testing in Ghana. Methods: The 2022 DHS survey took place in Ghana and was conducted cross-sectionally with quantitative approach. Participants enrolled were 7,263 men age 15–59 years and 7,044 were successfully interviewed, yielding a response rate of 97%. The main fieldwork commenced on 17^th October 2022 and ended on 14th of January, 2023. In all, three (3) months were used to gather the data. Socio-demographic characteristics of participants were: age; date of birth; duration of residency; previous residency; literacy; education; access to media; mobile phone use; use of the internet and place of residence. The questionnaire used to gather the data was composed of HIV: knowledge of HIV, of ways of transmission, sources of information, behaviour to avoid STIs and HIV, stigma, history of HIV testing. Results: The study found primary education to be significantly related to men’s adherence to HIV testing at p<0.001, (OR=2.169, 95%CI ([1.689-2.786]). Secondary education was significant at p=0.001, (OR=3.877, 95%CI [3.221-4.666]). Higher education was significant at p=0.001, (OR=8.998, 95%CI [6.470-12.513]). Residing in rural setting was significant at p<0.001, (OR=0.367, 95%CI ([0.310-0.433]). Conclusion: Adherence to HIV testing among rural men in the study was low. This was attributable to urban-rural dynamics. Based on this, the study recommends that HIV testing services be made readily available in rural setting to empower men get tested regularly.

Keywords: Adherence, Educational Level, HIV Testing, Men, Urban-Rural Dynamics.

INTRODUCTION

Globally, HIV transmission is ongoing in all countries making new infections hit around 1.5 million annually [1-4]. To date, HIV has claimed an estimated 42.3 million lives worldwide [3]. In 2023, it was noted that approximately 86% of people living with HIV knew their HIV status globally [1] while about 5.4 million people did not know they had HIV and still needed access to HIV testing services [1]. Universally, knowledge of HIV status is lower among men and boys, and antiretroviral therapy coverage of men lags behind that of women [5]. Testing for HIV remains the critical first step for linkage into the HIV cascade of care [6-8]. However, HIV testing is normally affected by stigma, fear of a positive result, low awareness of HIV risk and how to navigate the healthcare system, absence of discreet testing environments and limited knowledge about testing and prevention [7,8]. Aside that, facilitators such as social support, knowledge of the effectiveness of treatment, education, awareness campaigns, convenient access, trust in healthcare providers and access to healthcare facilities also serve as militating factors to HIV testing [7,8]. Some evidence suggests that when people know their HIV status, they may be more likely to take steps to remain free from HIV [1,3,9]. It is clear that low HIV testing rates among men endanger their own health and increase their risk of unknowingly transmitting HIV to their sexual partners [10,11]. HIV testing is the gateway to lifesaving treatment for people living with HIV and a means to reinforce prevention among people who are free from HIV. This can decrease morbidity, mortality and risk of transmission, and contribute to people living longer and healthier lives [1,10,12].

Early testing allows for timely medical intervention and treatment, improving health outcomes and extending life [13,14]. Knowing one’s HIV status is crucial for preventing virus transmission, enabling individuals to take precautions and protect their partners [10,15,16]. HIV testing connects individuals to care, support, and resources, facilitating access to healthcare professionals and support networks [5,17-19]. World Health Organisation (WHO) recommends that people at increased risk of acquiring HIV should seek testing and treatment. The WHO’s 2022–2030 global health sector strategy on HIV aims to reduce HIV infections from 1.5 million in 2020 to 335 000 by 2030, and deaths from 680 000 in 2020 to under 240 000 in 2030 [20,21].

In general, HIV testing rates and early detection tend to be lower in rural areas compared to urban areas [22-24]. Urban areas often show higher HIV prevalence and better access to testing compared to rural areas [25-28], HIV/AIDS has long been viewed as an urban problem, while rural areas are often believed to be free of the pandemic [22,26]. This assumption is false, as HIV/AIDS is no longer restricted to urban centers [26]. Although most attention has been paid to urban areas, the number of people living with HIV/AIDS may, in absolute numbers, be greater in rural areas [22,25,26]. This is in part due to the fact that many of the countries that are most affected by HIV/AIDS are primarily rural [26,27]. In addition to other consequences of HIV/AIDS, the pandemic places strain on sustainable agriculture, which many rural households, especially those in developing countries, rely upon for food consumption [26,29,30]. HIV/AIDS has an additional impact on rural areas because many HIV+ urban dwellers choose to return to their village of origin when they become ill, placing a greater burden on rural areas to care for the increasing numbers of people living with HIV/AIDS [26,27,31].

This destructive disease (HIV) is not only a life-threatening condition, but it also affects economic and human development, while exacerbating the cycle of poverty [32]. Despite no cure or vaccine being available, education has proven to be among the most cost-effective ways to prevent the spread of this disease [32]. In fact, education can save lives, by providing individuals with the knowledge of understanding of why they should access HIV testing to know their HIV status and if the results are positive or negative it will help them to reduce the spread [32,33]. Testing and diagnostics are critical components of the United Nations’ 95-95-95 targets to end the HIV epidemic [34]. HIV testing services and infant diagnosis support the first target of 95% of people living with HIV to know their HIV status [34,35].

Although Ghana has made significant strides in increasing HIV testing rates, with national HIV status awareness rising from 43% in 2014 to 72% in 2023 [36-38]. However, there is, therefore, a greater gap in meeting all three 95–95–95 targets among men in Ghana [36,39,40]. Hence, a concern. Based on this, the study aimed at investigating how educational level and urban-rural dynamics play a role in men’s adherence to HIV testing in Ghana by specifically: 1) examining if educational level plays a role in men’s adherence to HIV testing in Ghana; 2) analysing whether urban-rural dynamics play a role in men’s adherence to HIV testing in Ghana. The study further hypothesised that there is no statistically significant relationship between level of education, urban-rural dynamics and men’s adherence to HIV testing in Ghana.

METHODS

Data Source

Data for the study were extracted from the 2022 GDHS. These datasets were carefully studied and data revolving these variables (educational level, urban-rural dynamics and HIV testing) were carefully extracted for analysis.

Sample Design

For the 2022 GDHS survey to achieve its objectives, a national stratified representative sample of 18,450 households was selected in 618 clusters, which resulted in 15,014 interviewed women age 15–49 and 7,044 interviewed men age 15–59 (in one of every two households selected). The sampling frame used for the 2022 GDHS is the updated frame prepared by GSS based on the 2021 Population and Housing Census.

Sampling Procedure

The sampling procedure used in 2022 GDHS is a stratified two-stage cluster sampling, designed to yield representative results at the national level, for urban and rural areas, and for each of the 16 regions, for most DHS indicators. Stage 1, 618 target clusters were selected from the sampling frame using probability proportional to size (PPS) for urban and rural areas in each region. Then the target number of clusters was selected with equal probability, systematic random sampling of the clusters selected in the first phase, for the urban and rural areas in each region. Stage 2, after selection of the clusters, a household listing and map updating operation was carried out in all the selected clusters, to develop a list of all the households in the cluster. The list served as a sampling frame for selection of the household sample. The household listing was carried out using tablet computers, with software provided by The DHS Program. A fixed number of 30 households in each cluster was randomly selected from the list for interview.

Inclusive and Exclusive

The inclusive criteria were a man who lives in Ghana and age 15–59years while men < 15years and 60years and older were excluded from the survey.

Measures

Independent Variables

The independent variables (IVs) in the study were educational level and urban-rural dynamics. These factors were carefully chosen to assess their influence on men’s adherence to HIV testing in Ghana. The variables were indicators themselves.

Dependent Variable

The dependent variable (DV) was HIV testing. HIV testing was itself an indicator. HIV has been on the run in Ghana therefore, it was necessary to ascertain men ever tested for HIV and know their status which would serve as a cue to action or a reminder for them to be making healthy decisions regarding sex in Ghana.

Questionnaires

Four questionnaires were used for the 2022 GDHS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s Model Questionnaires, were adapted to reflect the population and health issues relevant to Ghana. In addition, a self-administered Fieldworker Questionnaire collected information about the survey’s fieldworkers. For the purpose of this study only the components of Man’s Questionnaire are presented below.

The Man’s Questionnaire consists of following sections: 1) Background characteristics: age, date of birth, duration of residency, previous residency, literacy, education, access to media, mobile phone use, use of the internet; 2) Reproduction: children ever fathered, attending ANC and delivery for the most recent child under age 24 months; 3) Contraception: knowledge of contraception, information on family planning, discussion of family planning with a health provider, knowledge of the risk of pregnancy, attitude towards women who use contraception; 4) Marriage and sexual activity: marital status, age at first marriage, number of unions, age at first sexual intercourse, recent sexual activity, number and type of sexual partners, use of condoms, contraceptive use during last sex; 5) Fertility preferences: desire for more children, ideal number of children, gender preferences; 6) Employment and gender roles: employment, source of earnings, and decisions about use of earnings; house and land ownership, attitude towards wife beating; 7) HIV: knowledge of HIV, of ways of transmission, sources of information, behaviour to avoid STIs and HIV, stigma, history of HIV testing; 8) Other health issues: circumcision, smoking and alcohol use, health insurance coverage.

Fieldwork

The main fieldwork commenced on 17th October, 2022 and ended on 14th of January, 2023. In all, three (3) months were used to gather the data. Field assistants were assisted with computer tablets to collect the data.

Ethical Consideration

Ethical approval for this current study was not necessary because the dataset used were secondary in nature. Though, for these data to be collected, the program implementers (Ghana Statistical Service [GSS] and ICF) submitted the survey protocol to appropriate review boards for consideration. For instance, GSS obtained approval from Ghana Health Service Ethical Review Committee (ERC) and ICF also obtained approval to carry out the survey from the Institutional Review Board (IRB). This was necessary to assure that the survey procedures were in accordance with Ghana’s and ICF’s ethical research standards.

Data Processing and Analysis

Data extracted from the 2022 GDHS were analysed with frequency, percentages, Pearson’s chi-squared test of independence and binary logistic regression. Further, the frequency and percentages were used to summarise participants responses into proportions. The Pearson’s chi-squared test of independence was used to test whether there exists any relationship between the IVs and the DV or not. So that a decision can be made either to accept or reject the null hypotheses postulated in the study. However, the binary logistic regression was also used to test the influences the IVs have on the DV.

RESULTS

To be able to ascertain the proportion of men who had ever been tested for HIV and those never been tested for HIV in Ghana instigated a question which requested participants to indicate whether they had ever been tested for HIV or not, the results revealed that 69.0% had never been tested for HIV while almost a third (31.0%) reported ever tested for HIV.

Table 1 presents the outcome of educational level among men in Ghana. When men were asked about their level of education, the results revealed that more than forty per cent (45.2%) had secondary education while nearly thirteen per cent (12.9%) indicated primary education.

Table 1. Education Level among Men in Ghana

Table 2 has the outcome of Pearson’s chi-squared test of independence on educational level and men’s adherence to HIV testing in Ghana. This analysis was conducted to test the hypothesis there is no statistically significant relationship between educational level and men’s adherence to HIV testing in Ghana. Statistically significant relationship was found between educational level [p<0.001] and men’s adherence to HIV testing in Ghana.

Table 2. Relationship between Educational Level and Men’s Adherence to HIV Testing in Ghana

No: never tested Yes: tested.

Source: GDHS (2022).

In Table 3 has outcome of binary logistic regression of educational level and men’s adherence to HIV testing in Ghana. This analysis was conducted to ascertain the influences of educational level on men’s adherence to HIV testing in Ghana.

Table 3. Binary Logistic Regression of Education Level and Men’s Adherence to HIV Testing in Ghana

Overall, the logistic regression model after processing the data was significant at -2LogL = 3407.667; Nagelkerke R² of 0.144;