Despite the ongoing extensive anti-HIV/AIDS campaigns, the total number of people living with HIV in Ghana is projected to increase to 317,872 by 2015 from 272,780 in 2010, states the Ghana AIDS Commission in its National HIV& AIDS Strategic Plan 2011-2015.

But the good news is that deaths arising from AIDS are expected to decline in the three year. In 2010, the estimated number of AIDS related deaths was 18,479 but is projected to decrease to about 15,618 deaths in 2015.

According to the strategic plan, the key determinants of the spread of HIV in the country are revealed in studies such as the Ghana Demographic Health Survey of 2008, Modes of Transmission Study (2009) and the HIV Epidemic Analysis of 2010.

The determinants of HIV include the marginalisation of Most at Risk Populations (MARPs). The MARPs include female sex workers, men who have sex with men and injecting drug users. The MARPs have difficulties accessing HIV preventive services due to stigmatisation and discrimination, social hostility, fear of job loss and families, and "eleven verbal physical violence."

"Legal barriers also hinder service providers from reaching these groups given the criminalization of MARPs activities. The size of these populations is also not known and services may not be reaching a significant number of them as a result, the MARPs continue to contribute to a significant proportion of new HIV infections," the strategic plan elaborated.

Another determinant of HIV is low condom use, indicates the plan. Although the awareness of HIV prevention among the general populations and MARPs is high, this knowledge has not adequately been translated to behavioral change. The DHS found that 25% and 45% of females and males respectively are reported to have used condoms during high risk sex behaviour. Low condom use has been attributed to socio-cultural stereotypes and beliefs, especially among the youth and older people.

Multiple concurrent sexual partners is a determinant that the plan identified. The DHS data shows that men tend to have more multiple sexual partners than women. One per cent of women reported having more than nine partners in the last 12 months during DHS compared to 1.1% during DHS of 2003. "On the other hand, the percentage of men reporting having more than 2 partners increased from 9.9% (DHS2003) to 11.4% (DHS2008)".

Stigma and discrimination is a significant factor in Ghana and is a hindrance to accessing HIV prevention services, resulting in exposure to HIV infection, says the plan. DHS 2008 shows that 32% of women and 43% of men would buy fresh food from a shopkeeper living with HIV, while 62% of women and 66% of men reported that an HIV-positive teacher should be allowed to continue teaching.

"The percentage expressing accepting attitudes on all four measures of stigma and discrimination is just 11% of women and 19% for men aged 15-49. HIV related stigma hinders access to services and consequently contributes to new HIV infections," reveals the plan.

The gender factor determinant is noteworthy. The plan points out that women are disproportionately affected by HIV. Men who are clients of sex workers and those with multiple sex partners act as a bridge population spreading HIV infection to their regular female partners.

It is also heart-warming that the estimated number of children infected by HIV annually is expected to decrease from 3,354 in 2010 to 3,225 in 2015. According to the DHS 2008, however, less than 1% of children under 18 years have both parents dead while 8% have one or both parents dead. AIDS contributes about 12% of the total number orphans in the survey.

The plan also states that orphaned children are at a great risk of dropping out of school due to lack of money and the need to take care of a sick relative. DHS 2008 found out that the proportion of children of ages 0-14 attending school whose both parents are dead is 67%.

The projections on the number of orphans due to AIDS related deaths show the need for the strategic plan to strengthen and scale up interventions for supporting orphans and vulnerable children.

By Laud Nartey