HIV/AIDS in Ghana

Prevalence

The HIV/AIDS epidemic in Ghana seems to be progressing slowly. The Government of Ghana estimated the number of adults and children living with HIV as of 2004 at 404,000. The Joint United Nations Program on HIV/AIDS (UNAIDS) estimated the HIV prevalence in adults to be 3.1% at the end of 2003, with an estimated 350,000 people living with HIV/AIDS. Ghana’s 2003 Demographic and Health Survey reported prevalence at 2.2% among the 9,000 people who agreed to be tested. [http://www.usaid.gov/our_work/global_health/aids/Countries/africa/ghana_05.pdf "Health Profile: Ghana"] . USAID (March 2005). PD-notice]

Ghana’s system of HIV surveillance for women attending antenatal clinics has functioned well since its establishment in 1994. Sentinel surveys of 21 antenatal clinic sites in 2002 reported a range from 3.2% to 9.1% in prevalence among pregnant women. In 2002, the median HIV prevalence at four of these sites in Accra was 4.1%; elsewhere in Ghana, prevalence in antenatal clinics ranged from 3.2% to 3.4%.

HIV prevalence is highest in the Eastern Region of Ghana and lowest in the northern regions of the country. Prevalence is generally higher in urban areas, in mining and border towns, and along main transportation routes. HIV-1 accounts for 92% of HIV cases in Ghana; another 7.4% of reported HIV cases are dual infections with HIV-1 and HIV-2. Only 0.5% of HIV cases were exclusively HIV-2. Heterosexual intercourse is the mode of transmission for about 80% of HIV cases, with mother-to-child transmission accounting for another 15%. According to the 2003 Demographic and Health Survey, HIV prevalence is very low among most younger age groups, as relatively few are infected during their youth (with the exceptions of infants infected through their mothers). The infection peaks late, compared to other countries, at 35–39 years for women and 40–45 years for men. The infection levels are highest in middle income and middle educational groups, with the poor and unemployed less affected.

Though evidence is still being gathered for making program decisions, some populations thought to be at risk include sex workers, transport workers, prisoners, sexual partners of people living with HIV/AIDS, and men who have sex with men and their female sexual partners. HIV prevalence among uniformed services is not fully established.

Approximately 9,600 children under age 15 are living with HIV/AIDS, and at the end of 2003, nearly 170,000 children under age 17 had lost one or both parents to AIDS. At that time only a few thousand of these children had received assistance such as food aid, health care, protection services, or educational or psychosocial support.

There is widespread knowledge of HIV and modes of transmission—with awareness of AIDS estimated at greater than 95%—although fear and stigmatization of HIV-positive people remain high. Ghanaians are at risk of further HIV spread for a variety of reasons, including engaging in transactional sex, marriage and gender relations that disadvantage women and make them vulnerable to HIV, inaccurate perceptions of personal risk, and stigma and discrimination toward people living with HIV/AIDS.

National response

The Ghana AIDS Commission is the coordinating body for all HIV/AIDS-related activities in the country; it oversees an expanded response to the epidemic and is responsible for carrying out the National Strategic Framework on HIV/AIDS for the 2001–2005 period. The Ghana AIDS Commission is currently reviewing the National Strategic Framework II, covering 2006–2010, with stakeholders, and bilateral and multilateral partners. The frameworks set targets for reducing new HIV infections, address service delivery issues and individual and societal vulnerability, and promote the establishment of a multisectoral, multidisciplinary approach to HIV/AIDS programs.

Ghana’s goal is to prevent new HIV infections as well as to mitigate the socioeconomic and psychological effects of HIV/AIDS on individuals, communities, and the nation. The first national strategic plan focused on five themes: prevention of new infections; care and support for people living with HIV/AIDS; creation of an enabling environment for a national response; decentralization of implementation of HIV/AIDS activities through institutional arrangements; research; and monitoring and evaluation of programs.The second national strategic plan, currently in process, focuses on: policy, advocacy, and enabling environment; coordination and management of the decentralized response; mitigating the economic, sociocultural, and legal impacts; prevention and behavior change communication; treatment, care, and support; research and surveillance; and monitoring and evaluation.

Multilateral and bilateral partners, nongovernmental organizations (NGOs), and civil society organizations actively participate in the national response, with more than 2,500 community-based organizations and NGOs reportedly implementing HIV/AIDS activities in Ghana. Substantial funding for HIV/AIDS activities is received from the United States, the United Kingdom, the Netherlands, Denmark, Japan, Canada, and United Nations agencies. Activities include the five-country, World-Bank-led HIV/AIDS Abidjan-Lagos Transport Corridor project; the World Bank-funded Treatment Acceleration Program for public-private partnership in HIV/AIDS management; the World Health Organization (WHO) 3X5 initiative; the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

Following the Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS in 2001, the Government of Ghana earmarked 15% of its health budget for HIV/AIDS activities, and all ministries were asked to create an HIV/AIDS budget line. Available funding to support Ghana’s response to the HIV/AIDS epidemic includes about $6.7 million from GFATM; about $12 million from multilateral partners, including the World Bank; and about $8 million from bilateral donors. Based on the level of funding already committed by the national government and its donors, WHO estimates a $5 to $12.8 million funding gap for HIV/AIDS activities in Ghana for the period 2004–2005.

References