F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.109648.1 Research Article Articles Knowledge and attitudes regarding HIV/AIDS and its prevention among Ghanaian women

[version 1; peer review: 1 approved with reservations]

 Laari Jacob Loonin Conceptualization Data Curation Resources Supervision Writing – Original Draft Preparation Writing – Review & Editing 1 Alhassan Abdul Rauf Conceptualization Data Curation Formal Analysis Funding Acquisition Methodology Resources Software Supervision Validation Visualization Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0003-2252-2646 a 2 School of Hygiene, Tamale Teaching Hospital, Tamale, 00233, Ghana Surgery, Tamale Teaching Hospital, Tamale, 00233, Ghana alhassana84@yahoo.com

No competing interests were disclosed.

 24 6 2022 2022 11 701 22 4 2022 Copyright: © 2022 Laari JL and Alhassan AR 2022 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: HIV/AIDS is still a major public health issue around the world, especially in Sub-Saharan Africa (SSA), where this has resulted in unquantifiable human suffering, social and cultural disruption, and enormous economic losses.

Methods: This study aims to assess women’s knowledge and attitude toward HIV/AIDS and its prevention in Ghana.

To perform an analytic cross-sectional study, this study used data (the women in reproductive age 15-49 years dataset) from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. Bivariate analysis was done using chi-square and predictor variables were identified using binary logistics regression.

Results: This study recorded good HIV knowledge and attitude levels of 81.9% and 10.5%. Factors that predicted only good HIV knowledge levels were ethnicity, and disability status. Also, predictors of only good attitude level were type of residence and marital status. Factors implicated in the prediction of both good knowledge and attitude levels were age, educational status, region of orientation, health insurance status, economic status, and media exposure.

Conclusions: This study recorded a good HIV knowledge level among the majority of the women, but recorded most respondents having a poor attitude toward HIV.

 HIV/AIDS Knowledge Attitudes Women Ghana The author(s) declared that no grants were involved in supporting this work. Introduction

HIV/AIDS is still a major public health issue around the world, especially in Sub-Saharan Africa (SSA), where this has resulted in unquantifiable human suffering, social and cultural disruption, and enormous economic losses, according to UNAIDS, which estimates that there are 36.7 million people are living with HIV (PLHIV) worldwide, with 25.6 million in SSA ( UNAIDS, 2016). According to UNAIDS, 274,600 people are living with HIV in Ghana, with 9,200 deaths attributable to AIDS and an HIV prevalence of 2.4 percent ( UNAIDS, 2016).

Patients with HIV infection may be ignorant of their infection and transfer it to others because they are asymptomatic for years ( Ataei, Shirani, Alavian, & Ataie, 2013). HIV can be spread by the use of unsterilized tools in therapeutic injections, blood transfusions, mother-to-child transmission (MTCT), unsafe sexual behaviors, and several aesthetic procedures such as tattooing, piercing, pedicure, and barbershop shaving ( Patel et al., 2015).

HIV prevention in Ghana has mostly focused on sexual contact, blood transfusion, and MTCT. The reality that far more than 90% of HIV transmission happens via a mix of these channels must have influenced their decision ( UNFPA, 2014). Women in various places have been disproportionately impacted by HIV since the outbreak of the global epidemic. Women now account for over half of all HIV-positive people, and AIDS-related illnesses represent the top cause of mortality among women aged 15 to 49 ( USAIDS, 2019).

Adolescent girls (ages 10-19) and young females (ages 15-24) make up a significant number of new HIV infections. In 2017, 7,000 adolescent girls and young women tested positive for HIV ( USAIDS, 2017). This is considerably greater than the incidence of new HIV infections among young males, with young women being twice as likely as their male counterparts to contract the virus ( USAIDS, 2017).

About 80% of new HIV infections in Sub-Saharan Africa are accounted for by young adolescents, although they form only 10% of the population. In the worst-affected nations, girls account for 80% of HIV infections among teenagers, and they are significantly more likely than adolescent boys to be infected ( USAIDS, 2019).

The transmission of HIV is hampered by a lack of HIV preventive knowledge and a poor attitude toward prevention ( Obidoa, M’Lan, & Schensul, 2012; Fagbamigbe, Lawal, & Idemudia, 2017; Bamise, Bamise, & Adedigba, 2011). According to a study conducted in Nigeria, women's understanding and attitudes about HIV/AIDS in Nigeria require more attention to meet the worldwide goal of eradicating epidemics and other infectious diseases by 2030 ( Yaya et al., 2018). While gender differences in HIV awareness are linked to education, household wealth, and geographic position (rural vs. urban), other factors such as education, household wealth, and geographic location (rural vs. urban) also play a role ( Yaya et al., 2018). In SSA, Asia, and Latin America, the positive association between lower socioeconomic studies and HIV progression is proven ( Ramjee & Daniels, 2013; Idele et al., 2014). Women in low-income households are frequently unaware of the dangers of HIV/AIDS. While poor socioeconomic status has been associated with risky sexual behavior and increased HIV sensitivity, new research suggests that economic inequality, is a factor in HIV transmission ( Piot, Greener, & Russell, 2007).

Promoting women's HIV/AIDS knowledge and attitudes is critical for avoiding and controlling the epidemic. However, there is little research in Ghana that links HIV/AIDS awareness among adult women to their attitudes toward those living with the disease. Using nationally representative Multiple Indicator Cluster Survey data, this study aims to assess women’s knowledge and attitude toward HIV/AIDS and its prevention in Ghana.

 Methods The survey and sampling design

To perform an analytic cross-sectional study, this study used data (Women in reproductive age 15-49 years dataset) from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. From October 2017 to January 2018, the Ghana Statistical Service gathered data with the assistance of collaborators including the Ministries of Health, Education, Sanitation and Water Resources, Gender, Children and Social Protection, Ghana Health Service, and Ghana Education Service. Under the Statistics for Results Facility – Catalytic Fund, UNICEF provided technical help, while UNICEF, KOICA, UNDP, USAID, and the World Bank provided financial assistance (SRF-CF).

The sample frame was the 2010 Ghanaian Population and Housing Census (PHC). All women between the ages of 15 and 49 years who were either inhabitants or guests who slept in selected residences the night before the survey (14,374) were included.

 Ethical consideration

The studies were conducted using MICS data that was made publicly available. Institutions that ordered, funded, or oversaw the surveys were responsible for ethical procedures. Each participant's verbal consent was gained, and minors aged 15-17 years were individually interviewed after adult approval was secured in advance from their parents or caretakers. All participants were made aware of the voluntary nature of their involvement, as well as the confidentiality and anonymity of their data. Respondents were also advised of their right to refuse to answer any or all of the questions, as well as their freedom to end the interview at any moment.

 Data analysis

The data was analyzed using SPSS version 20. (IBM Corp., 2011, and NY). Tables with frequencies and percentages were used to present the results of categorical variables including sample characteristics. The link between the dependent and independent variables was determined using the chi-square test. A binary logistic regression model was used to identify the predictive determinants of HIV knowledge and attitude levels. And results were given as exponentiated B coefficients or adjusted odds ratios (AOR) with matching confident intervals (CI). A p-value of 0.05 was used to determine the research's statistical significance.

 Results Sample description

Table 1 describes the women included in this study, most (40.6%) of them were within the youth age group (15-24 years), and the majority (78.5%) had history of attending school. In terms of the type of residence more than half of them (51.2%) were from rural areas, most (13.8%) from the Ashanti region, and the majority (38.2%) were of the Akan tribe. About 43.5% of them were married and the majority (91.1%) were without functional difficulties. In terms of media exposure most (88.0%) were not at all into new paper reading, and only 28.6% of them were listening to the radio every day, majority of them never used computers or tablets and never used the internet ( Table 2).

Demographic characteristics of respondents.
Variable Frequency Percentage
Age group 15-24 years 5836 40.6%
25-34 years 3837 26.7%
35 years and above 4701 32.7%
Ever attended school Yes 11283 78.5%
No 3091 21.5%
Area Urban 7134 48.8%
Rural 7475 51.2%
Marital status Married 6246 43.5%
Co-habitation 1655 11.5%
Single 6473 45.0%
Region Western 1350 9.2%
Central 1319 9.0%
Greater Accra 1830 12.5%
Volta 1303 8.9%
Eastern 1440 9.9%
Ashanti 2022 13.8%
Brong Ahafo 1323 9.1%
Northern 1499 10.3%
Upper East 1170 8.0%
Upper West 1353 9.3%
Ethnicity Akan 5577 38.2%
GA/Dangme 1142 7.8%
Ewe 1758 12.0%
Guan 513 3.5%
Gruma 600 4.1%
Mole Dagbani 3212 22.0%
Grusi 598 4.1%
Mande 73 0.5%
Other 1131 7.7%
Health insurance Yes 8152 56.7%
No 6222 43.3%
Functional difficulties (age 18-49 years) Yes 1125 9.0%
No 11403 91.0%
Wealth index quintile Poorest 3383 23.5%
Second 2412 16.8%
Middle 2680 18.6%
Fourth 2720 18.9%
Richest 3179 22.1%
Exposure to modern media.
Variable Count Table N %
Frequency of reading newspaper or magazine Not at all 12645 88.0%
Less than once a week 875 6.1%
At least once a week 653 4.5%
Almost every day 201 1.4%
Frequency of listening to the radio Not at all 5035 35.0%
Less than once a week 2346 16.3%
At least once a week 2889 20.1%
Almost every day 4104 28.6%
Ever used a computer or a tablet Yes 2455 17.1%
No 11919 82.9%
Ever used internet Yes 2005 14.6%
No 11713 85.4%
Knowledge on HIV prevention

Table 3 reports the HIV prevention knowledge variables that respondents were assessed on. Their responses to these questions were recorded as 1 for correct answer and 0 for incorrect answer and composite scored. Those with composite scores of 5 and below were categorized as having a poor knowledge level regarding HIV prevention and those composite scores of 6 and above were classified as having a good knowledge level regarding HIV prevention. At the end of the categorization the majority (81.9%) had a good knowledge level regarding HIV prevention and the remaining (18.1%) had a poor knowledge level. Further analysis revealed that all under-studied independents variables of the respondents were significantly associated with the dependent variable (HIV knowledge level) (P < 0.001) as presented in Table 5.

HIV or AIDS knowledge variables.
Variable Frequency Percentage
Ever heard of HIV or AIDS Yes 13353 92.9%
No 1020 7.1%
Can avoid HIV by having one uninfected partner Yes 10964 82.1%
No 1923 14.4%
Don’t know 464 3.5%
No response 2 0.0%
Can get HIV from mosquito bites Yes 3733 28.0%
No 8346 62.5%
D 1272 9.5%
No response 2 0.0%
Can avoid HIV by using a condom correctly every time Yes 9780 73.2%
No 2655 19.9%
Don’t know 917 6.9%
No response 1 0.0%
Can get HIV by sharing food with a person who has HIV Yes 3770 28.2%
No 8925 66.8%
Don’t know 657 4.9%
No response 1 0.0%
Can get HIV through supernatural means Yes 7007 52.5%
No 5139 38.5%
Don’t know 1206 9.0%
No response 1 0.0%
Healthy-looking person may have HIV Yes 10950 82.0%
No 1971 14.8%
Don’t know 432 3.2%
HIV from mother to child during pregnancy Yes 9392 70.3%
No 3111 23.3%
Don’t know 850 6.4%
HIV from mother to child during delivery Yes 8781 65.8%
No 3438 25.7%
Don’t know 1134 8.5%
HIV from mother to child through breastfeeding Yes 10976 82.2%
No 1690 12.7%
Don’t know 687 5.1%
Aware of drugs used to reduce the risk of transmission to the baby Yes 9107 76.9%
No 1597 13.5%
Don’t know 1136 9.6%
HIV/AIDS knowledge level Poor knowledge level 2603 18.1%
Good knowledge level 11770 81.9%
Attitude towards HIV

Table 4 reports the HIV attitude variables that women were assessed on. Their responses to these questions were recorded as 1 for correct answer and 0 for incorrect answer and composite scored. Those with composite scores of 3 and below were categorized as having poor attitude levels towards HIV and those composite scores of 4 and above were classified as having good attitude levels towards HIV. At the end of the categorization the majority (89.5%) had a poor attitude level towards HIV and the remaining (10.5%) had a good attitude level towards HIV. Further analysis revealed that all under-studied independents variables of the respondents were significantly associated with the dependent variable (attitude level towards HIV) (P < 0.05) as presented in Table 5.

HIV or AIDS attitude variables.
Variable Frequency Percentage
Would buy fresh vegetables from a shopkeeper with AIDS virus Yes 3373 25.3%
No 9846 73.7%
Don’t know/Not sure/Depends 133 1.0%
No response 1 0.0%
Children living with HIV should be allowed to attend school with other children Yes 5882 44.1%
No 7060 52.9%
Don’t know/Not sure/Depends 411 3.1%
People hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive Yes 11533 86.4%
No 1337 10.0%
Don’t know/Not sure/Depends 483 3.6%
People talk badly about people living with HIV, or who are thought to be living with HIV Yes 11789 88.3%
No 1248 9.3%
Don’t know/Not sure/Depends 316 2.4%
People living with HIV, or thought to be living with HIV, lose the respect of other people Yes 11633 87.1%
No 1397 10.5%
Don’t know/Not sure/Depends 323 2.4%
Agreement with the following statement: I would be ashamed if someone in my family had HIV Agree 7860 58.9%
Disagree 5254 39.3%
Don’t know/Not sure/Depends 238 1.8%
No response 1 0.0%
Fear of getting HIV in contact with the saliva of a person living with HIV Yes 9878 74.0%
No 3027 22.7%
Says She Has HIV 9 0.1%
Don’t know/Not sure/Depends 439 3.3%
HIV/AIDS attitude level Poor attitude level 11945 89.5%
Good attitude level 1408 10.5%
Factors associated with HIV/AIDS knowledge and attitude.
Factor HIV/AIDS knowledge level X 2 P-value HIV/AIDS attitude level X 2 P-value
Poor Good Poor Good
Age group 15-24 years 1033 4802 21.8 <0.001 4909 553 4.8 0.09
25-34 years 625 3212 3162 411
≥35 years 945 3756 3874 444
Attended school Yes 1516 9767 773.2 <0.001 9621 1215 27.2 <0.001
No 1087 2003 2324 193
Area Urban 832 6181 360.3 <0.001 5896 915 123.1 <0.001
Rural 1771 5589 6049 493
Marital status Married 1313 4933 65.1 <0.001 5092 564 21.6 <0.001
Co-habitation 243 1412 1455 127
Single 1047 5425 5398 717
Region Western 174 1151 589.5 <0.001 1198 69 217.7 <0.001
Central 165 1138 1141 116
Greater Accra 168 1615 1512 236
Volta 218 1067 1149 71
Eastern 186 1226 1285 78
Ashanti 289 1715 1647 285
Brong Ahafo 280 1023 1056 109
Northern 507 972 1099 127
Upper East 210 936 885 194
Upper West 406 927 973 123
Ethnicity Akan 657 4837 474.9 <0.001 4797 555 27.6 0.001
GA/Dangme 135 991 974 121
Ewe 234 1488 1517 136
Guan 106 399 417 51
Gruma 185 405 458 35
Mole Dagbani 838 2324 2433 326
Grusi 151 439 443 71
Mande 17 56 56 9
Other 277 829 847 104
Health insurance Yes 1338 6814 36.6 <0.001 6693 952 69.0 <0.001
No 1265 4956 5252 456
Functional difficulties Yes 242 883 15.2 <0.001 936 81 8.9 0.003
No 1927 9476 9491 1173
Wealth index quintile Poorest 1087 2296 805.9 <0.001 2572 220 233.4 <0.001
Second 532 1880 2060 155
Middle 441 2238 2331 208
Fourth 301 2419 2389 270
Richest 242 2937 2593 555
Frequency of reading newspaper or magazine Not at all 2482 10162 164.4 <0.001 10537 1108 141.3 <0.001
Less than once a week 61 814 722 141
At least once a week 50 603 548 99
Almost every day 10 191 138 60
Frequency of listening to the radio Not at all 1324 3710 382.3 <0.001 3969 411 19.9 <0.001
Less than once a week 412 1934 2011 206
At least once a week 350 2539 2477 335
Almost every day 517 3587 3488 456
Ever used a computer or a tablet Yes 139 2316 309.4 <0.001 2011 431 159.9 <0.001
No 2464 9454 9934 977
Ever used internet Yes 107 1898 279.7 <0.001 1687 311 87.5 <0.001
No 2476 9236 9762 939
Predictors of good HIV prevention knowledge

All understudied independent variables (demographic characteristics and media exposure) of the respondents were significantly associated with the dependent variable (HIV knowledge level) and were therefore included in the binary logistics model. The model revealed the following factors as predictors of good knowledge on HIV prevention: age, history of education, region of orientation, ethnicity, health insurance status, wealth index, radio use, computer or tablet use, and internet use ( Table 6).

Binary logistics regression for predictor factors of HIV knowledge and attitude level.
Factor HIV/AIDS Knowledge level HIV/AIDS Attitude level
AOR 95% C.I. for AOR 95% C.I. for AOR
Lower Upper P-value AOR Lower Upper P-value
15-24 years .070 .021
25-34 years 1.176 1.019 1.356 .027 1.187 .995 1.415 .057
≥ 35 years 1.147 .994 1.323 .060 1.304 1.080 1.574 .006
Attended School (No/Yes) .458 .404 .519 .000 .801 .656 .978 .029
Area (Rural/urban) .903 .791 1.032 .133 .741 .626 .878 .001
Married .614 .006
Co-habitation 1.089 .917 1.293 .331 1.157 .922 1.451 .207
Single 1.013 .888 1.157 .843 1.312 1.112 1.547 .001
Western .000 .000
Central .990 .760 1.289 .938 2.195 1.507 3.196 .000
Greater Accra .897 .677 1.188 .447 2.092 1.456 3.006 .000
Volta .856 .632 1.159 .314 1.275 .805 2.021 .300
Eastern .972 .749 1.260 .828 1.411 .949 2.099 .089
Ashanti .734 .580 .929 .010 3.255 2.319 4.567 .000
Brong Ahafo .645 .506 .821 .000 2.348 1.610 3.426 .000
Northern .722 .560 .930 .012 4.952 3.259 7.522 .000
Upper East 1.759 1.314 2.354 .000 8.407 5.524 12.794 .000
Upper West .955 .732 1.247 .735 5.524 3.587 8.507 .000
Akan .032 .131
GA/Dangme .878 .690 1.118 .292 1.188 .913 1.546 .199
Ewe .979 .772 1.242 .862 1.158 .875 1.533 .304
Guan .907 .674 1.220 .518 1.421 .975 2.070 .067
Gruma .864 .663 1.126 .278 .679 .424 1.086 .106
Mole Dagbani .772 .638 .936 .008 .849 .647 1.113 .236
Grusi .683 .523 .892 .005 1.020 .708 1.469 .916
Mande .518 .276 .973 .041 1.576 .680 3.654 .289
Other .728 .593 .893 .002 .967 .732 1.276 .811
Health insurance (No/Yes) .898 .811 .994 .039 .755 .658 .866 .000
Disability (No/Yes) 1.220 1.037 1.436 .016 1.158 .900 1.490 .253
Poorest .000 .000
Second 1.286 1.114 1.484 .001 1.153 .900 1.477 .259
Middle 1.529 1.298 1.801 .000 1.339 1.039 1.724 .024
Fourth 1.958 1.616 2.372 .000 1.440 1.108 1.872 .006
Richest 2.299 1.830 2.889 .000 2.104 1.599 2.767 .000
Frequency of reading newspaper or magazine
Not at all .597 .006
Less than once a week 1.200 .860 1.673 .284 1.224 .953 1.572 .113
At least once a week .991 .678 1.450 .964 .973 .714 1.325 .860
Almost every day .716 .317 1.618 .422 2.382 1.409 4.028 .001
Frequency of listening to the radio
Not at all .000 .480
Less than once a week 1.252 1.083 1.449 .002 .970 .791 1.191 .774
At least once a week 1.620 1.390 1.888 .000 1.124 .934 1.353 .216
Almost every day 1.461 1.280 1.668 .000 1.069 .899 1.272 .450
Ever used computer or tablet (No/Yes) .636 .489 .829 .001 .771 .630 .945 .012
Ever used internet (No/Yes) .552 .430 .710 .000 .834 .687 1.014 .068
Constant 9.169 .000 .033 .000

Relative to the respondents’ age group of 15-24 years, the likelihood of a good HIV knowledge level was 17% more for women of the age group of 25–34 years (AOR = 1.17, 95%, C.I. = 1.02–1.36). Those with no educational history were 54% less likely to have good HIV prevention knowledge when compared to those with educational attendance history (AOR = 0.46, 95%, C.I. = 0.40–0.52).

In terms of regional prediction, a good HIV knowledge level occurred 76% more for women from the Upper East region relative to women from the Western region (AOR = 1.76, 95%, C.I. = 1.31–2.35). Meanwhile, women from the Ashanti region, Brong Ahafo Region, and Northern region were less likely to have good HIV prevention knowledge when compared to those from the Western region. Women from Ashanti region were 27% less likely (AOR = 0.73, 95%, C.I. = 0.58–0.93), women from Brong Ahafo region were 35% less likely (AOR = 0.65, 95%, C.I. = 0.51–0.82), and women from Northern region were 28% less likely (AOR = 0.72, 95%, C.I. = 0.56–0.93).

Also, respondents’ ethnicity predicted their good HIV knowledge level. Relative to women from the Akan tribe, women from the Mole Dagbani tribe were 23% less likely to have a good HIV knowledge level (AOR = 0.77, 95%, C.I. = 0.64–0.94), women from the Grusi tribe were 32% less likely to have good HIV knowledge (AOR = 0.68, 95%, C.I. = 0.52–0.89), women from the Mande tribe were 48% less likely to have good HIV knowledge (AOR = 0.52, 95%, C.I. = 0.28–0.97) and lastly women from other tribes not specified in this current study were 27% less likely to have a good HIV knowledge level (AOR = 0.73, 95%, C.I. = 0.59–0.89).

Those without health insurance were 10% less likely to have good HIV knowledge as compared to those with health insurance (AOR = 0.90, 95%, C.I. = 0.81–0.99). Also, those with no disability were 22% more likely to have good HIV knowledge as compared to those with a disability (AOR = 1.22, 95%, C.I. = 1.04–1.44).

The increased wealth index status of the women positively predicted HIV good knowledge, women of the second wealth index were 29% more likely to have good HIV knowledge when compared to those of the poorest wealth index (AOR =1.29, 95%, C.I. = 1.11–1.48). Also, women of the middle wealth index were 53% more likely to have good HIV knowledge when compared to those of the poorest wealth index (AOR = 1.53, 95%, C.I. = 1.30–1.80). Again, women of the fourth wealth index were 96% more likely to have good HIV knowledge when compared to those of the poorest wealth index (AOR = 1.96, 95%, C.I. = 1.62–2.37). Finally, women of the richest wealth index were 130% more likely to have good HIV knowledge when compared to those of the poorest wealth index (AOR =2.30, 95%, C.I. = 1.83–2.89).

Finally, women's exposure to media predicted their HIV knowledge. Women who spent less than a week listening to the radio were 25% more likely to have good HIV knowledge when compared to those who did not listen to the radio at all (AOR = 1.25, 95, C.I. = 1.08–1.45). Also, women with at least once a week listening to the radio were 62% more likely to have good HIV knowledge when compared to those who did not listen to the radio at all (AOR = 1.62, 95, C.I. = 1.40–1.89). Women who spent almost every day listening to the radio were 46% more likely to have good HIV knowledge as compared to those who did not listen to the radio at all (AOR = 1.46, 95, C.I. = 1.28–1.67). With computer and internet use, those who did not ever use of computer or tablet were 34% less likely to have good HIV knowledge when compared to those who had used computers or tablets (AOR = 0.64, 95%, C.I. = 0.49–0.83). Those who had never used the internet were 45% less likely to have good HIV knowledge as compared to those who had ever used computers or tablets (AOR = 0.55, 95%, C.I. = 0.43–0.71).

 Predictors of a good attitude towards HIV

All of the respondents’ understudied independent variables (demographic characteristics and media exposure) were significantly associated with the dependent variable (attitude level towards HIV) and were therefore included in the binary logistics model. The model revealed the following factors as predictors of a good attitude level towards HIV: age, ever attended school, residence type, region of orientation, health insurance status, wealth index, media exposure, and marital status.

Women aged 35 years and above were 30% more likely to have a good attitude toward HIV as compared to women of the age group 15-24 years (AOR = 1.30, C.I. = 1.08–1.57). A good attitude toward HIV was 20% less likely among those without a history of education attendance as compare to those with a history of attending education (AOR = 0.80, 95, C.I. = 0.66–0.98). Rural women were 36% less likely to have a good attitude towards HIV when compared to those from urban residences (AOR = 74, 95%, C.I. = 0.63–0.88). Those with the ‘single’ marital status were 31% more likely to have a good attitude toward HIV as compared to those married (AOR = 1.31, 95%, C.I. = 1.11–1.55). With regard to regional prediction, all the studied regions positively predicted good attitudes toward HIV relative to the Western region.

Regarding health, women with no health insurance were 24% less likely to have a good attitude towards HIV as compared to those with health insurance (AOR = 0.76, 95%, C.I. = 0.66–0.87). Considering the wealth index, women of the middle wealth index were 34% more likely to have a good attitude towards HIV as compared to those of the poorest wealth index (AOR = 1.34, 95%, C.I. = 1.03–1.72). Women of the fourth wealth index were 44% more likely to have a good attitude towards HIV as compared to those of the poorest wealth index (AOR = 1.44, 95%, C.I. = 1.11–1.87). Lastly, women of the richest wealth index were 110% more likely to have a good attitude towards HIV as compared to those of the poorest wealth index (AOR = 2.10, 95%, C.I. = 1.60–2.77).

Finally, media exposure predicted a good attitude towards HIV, those who read newspapers or magazines almost every day were 138% more likely to have a good attitude toward HIV as compared to those who don’t read at all (AOR = 2.38, 95%, C.I. = 1.41–4.03). Those who did not ever use computers or tablets were 33% less likely to have a good attitude toward HIV as compare to those with ever use (AOR = 0.77, 95%, C.I. = 0.63–0.95).

 Discussion

The United Nations (UN) has recognized good HIV/AIDS education as a requirement for people to undertake preventive sexual behaviors. One of its goals for avoiding HIV transmission was to have ‘95% aged 15–24 years old properly identify measures to prevent HIV transmission and reject main misconceptions' by 2010 ( UNAIDS, 2002). In this current analytic cross-sectional study focused on knowledge, and attitudes regarding HIV/AIDS prevention among Ghanaian women, the majority (81.9%) of the women had a good knowledge level on HIV prevention. In terms of knowledge level, this study is consistent with earlier studies but inconsistent when it comes to attitude ( Iqbal et al., 2019; Bhagavathula AS, 2015; Quarm, Mthembu, Zuma, & Tarkang, 2021). These studies all recorded good knowledge levels, though lower as compare to the current study and positive attitude towards HIV higher compare to this present study. The current study's greater knowledge level compared to prior studies could be attributed to the long-term health education that has been taking place in ANCs in Ghana ( Nyarko, Pencille, Akoku, & Tarkang, 2021). Despite having a high degree of adequate information about higher prevention, the current investigation found a low level of a positive attitude toward HIV. In this present study, all understudied independents variables of the respondents were significantly associated with HIV knowledge and attitude level with chi-square analysis.

Relative to respondents’ age group of 15-24 years, the likelihood of a good HIV knowledge level was 17% more for women of the 25-34 years age group. Also in the Nigerian study, a higher HIV knowledge score was predicted by increased respondent age ( Yaya et al., 2018). In an earlier study the educational level of respondents had an influence on their HIV knowledge level and this is reported similarly in the current study, as those with no educational history were less likely to have good knowledge when compared to those with educational attendance history ( Nyarko, Pencille, Akoku, & Tarkang, 2021). Adding up some studies also revealed that women with higher education (tertiary) were more likely to have a thorough knowledge of HIV/AIDS than women with no education ( Yaya, Bishwajit, Danhoundo, & Seydou, 2016a; Yaya, Bishwajit, Danhoundo, Shah, & Ekholuenetale, 2016b).

Indeed, according to Gillespie et al., those who are wealthier and more educated will have better access to reproductive healthcare and, as a result, better information on health-related issues like HIV/AIDS ( Gillespie, Kadiyala, & Greener, 2007). Wealth and better education, which indicate a higher socio-economic standing, have been proven to play a role in influencing the decision to engage in safer sexual behavior ( De Walque, Jessica, June, & Jimmy, 2005; Glynn JR, 2004). Also, in this present study, an increase in the wealth index status of the women positively predicted HIV good knowledge, women of second, middle, fourth, and richest wealth index were more likely have good HIV knowledge as compared to those of poorest wealth index. Also in this current study, those with health insurance and no disability were likely to have good HIV knowledge.

A study in Nigeria revealed that good HIV knowledge was more likely in the north when compared to the south ( Yaya et al., 2018). Also, in the present study in Ghana, good HIV knowledge was more likely for women from the north (Upper East region) relative to women from the south (Western region). In this current study, women with exposure to radio, computer, and internet use were likely to have good HIV knowledge. The impacts of mass media campaigns against HIV transmission were demonstrated to be effective in 13 Sub-Saharan Africa (SSA) countries by regulating safe sex behavior ( Yaya et al., 2018).

Adolescent girls (ages 10–19) and young females (ages 15–24) make up a significant number of new HIV infections. In 2017 7,000 adolescent girls and young women tested positive for HIV ( USAIDS, 2017). The transmission of HIV is encouraged by poor attitudes toward prevention ( Obidoa, M’Lan, & Schensul, 2012; Fagbamigbe, Lawal, & Idemudia, 2017; Bamise, Bamise, & Adedigba, 2011). This present study confirms that poor attitude towards HIV could be one of the reasons for the high prevalence of HIV among younger individuals. In this study, women aged 35 years and above were likely to have a good attitude toward HIV when compared to women of the age group 15–24 years. This was equally reported in a similar study in Nigeria ( Yaya et al., 2018).

Analysis of the attitude survey for the influence of higher education on attitude revealed an association between the two, and this present study confirmed that ( Brennan et al., 2015). Also, this present study result is not different from an earlier similar study in Nigeria ( Yaya et al., 2018). Urbanization in Ghana influences the availability of higher quality education, media exposure, healthcare, and economic opportunities ( Crookes, 2015). This explains the reason for more likelihood of good attitude among those from urban areas, health insurance availability, media exposure, and better economic status in this current study and that of what was done earlier in Nigeria ( Yaya et al., 2018). In Ghana, more urbanization is associated with the south as compared to the north, but this study result rather indicated more likelihood of good HIV attitude among those from the north (Upper East, Upper West, and Northern regions) as compared to those from the south (Western region). In a Nigerian study, a similar result was revealed ( Yaya et al., 2018).

Finally, those who were single in terms of marital status were more likely to have a good attitude toward HIV as compared to those who were married, and the same was reported in a similar study in Tajikistan ( Zainiddinov, 2019). However, as reported in an earlier study, married women in Nigeria were more likely to have a good attitude towards HIV ( Gebremedhin, Youjie, & Tesfamariam, 2017).

The use of cross-sectional data, which is insufficient to demonstrate causality, is a disadvantage of this study. Furthermore, because the study relied on secondary data, it was impossible to quantify key characteristics such as exposure to behavior change communication via HIV/AIDS-related treatments across different groups and across time.

 Conclusion

This study recorded a good HIV knowledge level among the majority of the women but recorded most respondents as having a poor attitude toward HIV. Factors implicated in the prediction of both good knowledge and attitude levels were: age, educational status, region of orientation, health insurance status, economic status, and media exposure.

 Recommendation

These findings can be used by health knowledge and awareness programs to better define target populations and plan intervention programs. Future research can employ a broader range of context-specific variables to better show the factors of HIV awareness and attitude in Ghana.

 Data availability

All data relating to the findings of this study are available from the Multiple Indicator Cluster Survey (MICS) website ( https://mics.unicef.org) upon request. The MICS 2017/18 dataset is available for download from the website after free registration.

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Competing interests: No competing interests were disclosed.

 26 6 2024 Copyright: © 2024 Dubare S 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

Peer Review Report

Title: Knowledge and attitudes regarding HIV/AIDS and its prevention among Ghanaian women

Authors: Jacob Loonin Laari, Abdul Rauf Alhassan

Summary

This study investigates the knowledge and attitudes regarding HIV/AIDS and its prevention among Ghanaian women using data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. The study highlights the levels of knowledge and attitudes and identifies predictors for both.

Abstract

The abstract succinctly presents the background, methods, results, and conclusions. The key findings are summarized well, providing a clear snapshot of the study's outcomes.

Strengths:

Clear articulation of study goals and methodology.

Summary of key results is straightforward and informative.

 Areas for Improvement:

The paper could benefit from a brief mention of the specific recommendations of the findings.

Detailed composite scores calculations, questions included etc might be beneficial in the methods section and maybe some supplementary tables.

A discussion of the limitations of the data or analysis (e.g., potential biases or unmeasured confounders) is necessary.

 Introduction

The introduction provides a comprehensive background on the significance of HIV/AIDS in Sub-Saharan Africa and the specific context of Ghana. It outlines the public health challenges, modes of transmission, and the need for improved knowledge and attitudes toward HIV/AIDS.

Strengths:

Detailed background with relevant statistics and references.

Clearly establishes the importance of the study.

 Areas for Improvement:

The introduction could be more concise. Maybe it could be organized a bit differently because some sections feel a bit repetitive and could be condensed to maintain reader engagement.

 Methods

The methods section describes the analytic cross-sectional study design, data sources, sampling, ethical considerations, and data analysis procedures.

Strengths:

Detailed description of data sources and sampling design.

Ethical considerations are well addressed.

Clear explanation of data analysis techniques.

 Areas for Improvement:

More detail on the specific survey questions used to assess knowledge and attitudes would enhance reproducibility.

Clarification on how composite scores were calculated and categorized.

 Results

The results section provides a comprehensive analysis of the demographic characteristics, knowledge, and attitudes of the respondents. It identifies significant predictors of good knowledge and attitudes.

Strengths:

Extensive use of tables to present detailed findings.

Clear reporting of statistical significance and odds ratios.

 Areas for Improvement:

The results section is dense with data; summarizing key findings in a few sentences at the beginning of each subsection could improve readability.

 Discussion

The discussion contextualizes the findings within the broader literature, comparing results with previous studies and exploring the implications for public health interventions.

Strengths:

Thoughtful comparison with prior research.

Clear articulation of the implications for HIV/AIDS prevention efforts in Ghana.

 Areas for Improvement:

The discussion could benefit from a more structured format, explicitly separating key findings, comparisons with other studies, and implications.

A discussion of the limitations of the data or analysis (e.g., potential biases or unmeasured confounders) is necessary.

Specific recommendations for policy or future research are somewhat scattered and could be consolidated for greater impact.

 Conclusion

The conclusion summarizes the key findings and emphasizes the need for targeted interventions to improve attitudes toward HIV/AIDS prevention among Ghanaian women.

Strengths:

Clear and concise summary of the study's main outcomes.

Areas for Improvement:

More concrete recommendations for policymakers and health practitioners would strengthen the conclusion.

 Overall Assessment

This study provides valuable insights into the knowledge and attitudes regarding HIV/AIDS among Ghanaian women, with robust analysis and clear implications for public health policy. The manuscript would benefit from some structural and editorial refinements to enhance clarity and impact.

Recommendations

Abstract: Include specific recommendations or implications of the findings.

Introduction: Condense repetitive sections for greater conciseness.

Methods: Provide more detail on survey questions and composite score calculations.

Results: Summarize key findings at the beginning of each subsection;

Discussion: Structure the discussion more clearly, discuss potential limitations. and consolidate recommendations.

Conclusion: Include more concrete policy and practice recommendations.

 With these improvements, the manuscript will be well-positioned to contribute significantly to the literature on HIV/AIDS prevention in Ghana.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Maternal and child health, AI, ML, substance use, Mental health, child Development, Women's health, Community-Based Participatory Research Program (CBPR), Coping mechanisms, epidemiology, study design, policy research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.