Rural-urban determinants of HIV/AIDS testing uptake among Ghanaian women of reproductive age

Although Ghana has made modest progress in the fight against HIV, the prevalence among women remains high, with 66% of people living with HIV in the country being females. Besides, approximately 71% of people with HIV in Ghana know their status compared with the global average of 85% and the WHO target of 95%. This relatively low percentage of people with HIV, knowing their status, tends to derail Ghana's attainment of SDG 3.3. Against this backdrop, this paper examines the drivers of HIV testing status among women of reproductive age in Ghana to inform policy.

We analysed a nationally representative sample of 14,997 women aged 15-49 from the 2022 Ghana Demographic and Health Survey (GDHS). A pooled and disaggregated (rural vs. urban) multiple logistic regressions were estimated to examine the drivers of HIV testing uptake among women in Ghana.

Approximately 54% of the sampled women had ever tested for HIV. Women residing in urban areas had a high HIV testing status (58.83%) relative to their counterparts in rural areas (48.91%). At the bivariate level, ever-married (66%) and pregnant women (69%) had a higher HIV testing uptake relative to their never-married (39%) and not-pregnant (52%) counterparts. Findings from the multivariate logistic regressions highlight significant similarities in the drivers of HIV testing among rural and urban women, albeit some of the predictors are exclusive to either rural or urban areas. HIV testing is significantly predicted by wealth status, education, age, marital status, employment, pregnancy status, and administrative region of residence. Though women in the richer and richest wealth categories were more likely to undertake HIV testing in both urban and rural areas, the positive effect was more pronounced among women residing in urban areas. Besides, the level of education predicted the HIV testing status of women in both rural and urban areas, albeit the effect was more pronounced in the rural areas. Moreover, pregnant women in the urban areas were more likely to test for HIV relative to their counterparts in the rural areas.

The study demonstrated the need to target women of lower socio-economic status and those pregnant, especially in rural areas, for HIV public health education interventions. Such interventions are crucial in increasing HIV testing to avert severe HIV/AIDS morbidity through appropriate ART and thus avoid preventable deaths. The study also highlights the need to improve the availability of testing kits in rural areas to address the supply-side challenges facing public health facilities in rural areas.