Ghana

1.  General and Epidemiological Data

1.1.    General Data

With a total area of 238,540 km² of which 93,200 km² is for agricultural purposes, Ghana is bounded to the West by the Ivory Coast, Burkina-Faso to the North, Togo to the East and the Atlantic Ocean to the South. Its capital is ACCra and its population was estimated in 1999 at over 19 million inhabitants.

In the economic respect, Ghana (the former Gold Coast) mainly derives its resources from the exploitation of gold, electricity generation and cocoa production, but has regularly been experiencing ups and downs. In 1993, rehabilitation efforts were undertaken and up to 1996, the country had experienced a strong economic growth encouraged by rises in prices for cocoa and increase in gold production. However, in 1997, the drop in gold prices increased the budgetary deficit which precipitated the depreciation of the national currency, the Cedi. The coup de grace was to be given a year later: the country experienced a serious electricity shortage caused by drought which led to a drop in the water level of the Akossombo dam. This crisis not only affected Ghana, but also Togo and Benin which procure electricity in Ghana. The industrial and handicraft activities were severely affected.

At the socio-sanitary level, Ghana's situation is precarious. Despite the efforts of the government to improve the situation, the socio-sanitary indicators remain below the standards required by the WHO. Life expectancy at birth is 58 years. The health infrastructure is inadequate, the personnel/inhabitant ratio is 1 doctor for 25,000 inhabitants and one nurse for 2,750 inhabitants.

1.2.    Epidemiological Data

The first AIDS cases were reported in 1986, among prostitutes. In 1987, the analysis of the distribution of AIDS cases showed that the most affected regions were the Eastern Region (49%), Greater ACCra (23%), and Ashanti Region (10.3%). The (M/F) sex ratio was 1/12 in 1986 and 1/6 in 1987.

Asamoah-Odei reported the results of four years followed by STI consultations in ACCra (Western Blot) which showed an increase in seroprevalence: in 1988, 2.1% (N=410); in 1989, 4.3% (N=347); in 1990 5.5% (N=293); in 1991, 8.6% (N=70)

The pattern of AIDS cases since 1986 is as follows:

It has been estimated that at best, the cases reported aCCounted for only about 50% of all AIDS cases in the country and that over 30,000 cases had indeed arisen.

Equally among men as well as among women, it is those who are between 20-29 years and 30-39 years which are most affected by AIDS. The women seem to contract the disease at an earlier age than men: 38.6% of female cases among the 20-29 year age group as against 19% for men; on the other hand, among the 30-39 year group, 50.2% male cases as against 36.5% of female cases.

The majority of the cases reported come from the Ashanti Region and the Easter Region (over 50% for the two). At the end of December 1995, a total cumulative of 17,564 AIDS cases were reported: from January 1996 to 30 June 1996, 1,166 cases were reported, bringing the cumulative total to 18,730 cases.

ACCording to national data, the cumulative number of cases in December 1999 was estimated at 400,000 cases. The prevalence rate in the adult population is 4.6%. The principal mode of transmission is heterosexual: 75.80% followed by the vertical transmission mode: 15% by blood and 5% by blood products.

2.  National AIDS Infection Control Policy

2.1.    Background to AIDS Control

Just as its neighbours, Ghana has not been spared from the expansion of the AIDS epidemic, the determining factors are superimposed on those of these countries. The ethnic conflicts which periodically shake the North of the country or the construction of the Akosombo dam cause massive displacement of the population; these contributed to increases in the cases of HIV infection. The National AIDS Control Programme was designed in 1987.

2.2.    Strategy Thrusts of HIV/AIDS Infection Control

The HIV/AIDS control strategy in Ghana is summarised in a three-stage plan of action:

· 1987 to 1988: short-term interventions

· 1989 to 1999: medium-term interventions

· 1996 to 2000: extension of the programme

The objectives of the programme are to reduce the new cases of contamination as well as the impact of the infection on the life of the individual, his family and community.

The priority interventions cover:

• the promotion of condoms
• the prevention of STIs
• safety of blood transfusion
• infection control
• the promotion of protected sexual relations
• therapeutic care of patients
• basic health care delivery and counselling

2.3. Stakeholders Involved in AIDS Control

Since the context of application was multi-sectoral, the fight against AIDS does not only involve the National AIDS and STI Control Programme. Several other stakeholders are involved in this fight; they can be grouped into several categories such as:

· The Non-Governmental Organisations which are numerous and mainly intervene through awareness-raising information activities.

· Associations particularly those of PLWAs

· The private sector, particularly some enterprises such as the mining company in Tarkwa and Obuasi, the Coca Cola Company designed information and awareness-raising programmes for its personnel

· The bilateral and multilateral partners which are many and provide a technical and financial support to the programme

· The civil society for its part, is involved in the fight in several sectors of the national economy.

· Churches, denominational associations, ecumenical organisations and the Muslim community: they are deeply involved through awareness-raising, education for the moral and spiritual integrity of citizens

· Traditional leaders who constitute an indispensable group to which the communities resort to, be it in the rural or urban areas.

3.  Position and Involvement of Churches

During our mission to Ghana, we met leaders of the Protestant, Evangelical, Methodist, Presbyterian and Catholic churches. We also discussed with the co-ordinators of the AIDS Control Programme, ecumenical organisations such as the Young Men's Christian Association (YMCA-UCJG) and the Christian Council.

3.1.    Perception of the Churches

In the opinion of all, AIDS is a disease caused by a virus called HIV in the organism and it cannot be considered as a divine punishment. This explains why Churches play a prominent role in the dissemination of preventive measures.

The Evangelical Presbyterian Church of Ghana

Our God is a God of Love and forgiveness. To consider AIDS and its consequences as a punishment from God is to attribute to God a feeling of vengeance. Meanwhile, a divine punishment would take more dramatic proportions. If the painful experience of AIDS can make a sufferer repent his acts, it is precluded to consider AIDS as a punishment which God is using to strike at innocent victims. The Church, the body of Christ, must be a place of peace and solace for AIDS sufferers. Thus, being HIV positive must not be an opportunity for rejection but for aCCeptance and compassion. The situation of the infected faithful must be seen as affecting the entire community, all Church members.

The Methodist Church of Ghana

Since two years the Methodist Church of Ghana made the commitment to fight AIDS within the framework of its pastoral mission, because AIDS has become a crisis which the Church must deal with. Thus, it has been striving to participate in efforts which have already been made in several fields to provide care, support and solace to the PLWAs. Its concern is also to make the faithful become aware of their vulnerability to the infection and to avoid it.

Neither does the Methodist Church consider AIDS as a divine punishment. God is Love. He is not a God of vengeance who punishes. AIDS is a consequence of human acts resulting in innocent victims (spouses, children, families...) who are often seriously affected in social, economic, moral and spiritual respects. AIDS is like an indicator which reveals to us the numerous deviations of our sexual life; it call us to order and invites us to return to ethical and moral works and to adopt the behaviour of men created in the image of God.

The Catholic Church of Ghana

We held a discussion with the Reverend Father Amegadzie in Ho and the Reverend Kpeglo in ACCra. In the opinion of these priests, the AIDS epidemic poses an unprecedented challenge to the entire Christian community. It reminds Christians, particularly the elite, of their duties to inform for a positive change in behaviour and to train the body and spirit. God is love and AIDS cannot be a punishment from God. However, there are situations which arise from bad behaviour through which God brings man back to normal life. The factors of the rapid propagation of the epidemics which they mentioned include sexual promiscuity, homosexuality which is in vogue among the young men, poverty leading young girls to prostitution, ignorance and the motivation to use condoms.

The Presbyterian Church of Ghana

In the process of the performance of its mission which is that of the full development of the human being, the Presbyterian Church of Ghana combined the evangelisation action with the promotion of health including the struggle against AIDS. The HIV/AIDS infection is seen as a challenge, a serious problem which threatens the life of the faithful. This explains why for the celebration of the “Christian Family Week” which took place from 7 to 13 August 2000, the theme chosen was “HIV/AIDS a social crisis, a challenge for the Church”. The opening ceremonies of the events were marked by a message from the United Nations Secretary General, Mr. Kofi Annan to the Presbyterian Church of Ghana, which was read to the Assembly.

3.2. Involvement of the Churches in Prevention

With regard to the prevention measures, all Churches unanimously adopt the same strategies of the sensitisation of the faithful with the classical methods advocated. However, there are peculiarities specific to each Church relating to the biblical perception of the AIDS phenomenon.

The Evangelical Presbyterian Church of Ghana

Priority is given to youth because they are the most vulnerable. They are the special target of the prevention messages. The three key points of the messages which are communicated to them are sexual abstinence before marriage, mutual fidelity of the couple, and where necessary, the use of the condom.

The Methodist Church of Ghana

In his excellent work “Stewardship”, the Reverend pastor Emmanuel Asante developed the points of view of the Methodist Church of Ghana on the ethical, theological, and social aspects of the HIV infection. The use of condom as a means of prevention does not resolve the AIDS problem. For a Christian, the use of the condom is tolerated only by couples as a means of protection in the event of infection. For other situations, the Church must insist on training based on abstinence before marriage and mutual fidelity of the couple. The promotion of the utilisation of condom as a protection against the STIs is not aCCeptable outside marriage. Chastity, fidelity and virtue should be sustained and encouraged. These noble qualities alone are sufficient to guarantee total security for the population and protect them against the infection and the disease.

The Catholic Church

Chastity, abstinence, fidelity of couples are the basis of the prevention measures supported by the Catholic Church. The use of condoms as a prevention measure is prohibited. Thus, in order to encourage the assimilation of human and evangelical values, with a view to a real change of behaviour, each parish organises discussions on natural family planning and responsible sexuality.

The Presbyterian Church of Ghana

The Presbyterian Church of Ghana insists on abstinence before marriage and fidelity of the couple. In order to bring the faithful to comply with these prevention rules, future spouses and couples follow the teachings on the biblical significance of sexuality. The use of condom is authorised only for couples where there is risk of contamination of a spouse.

3.3.    Position of Churches on Serological Test

The HIV serology is a test whose importance and usefulness are acknowledged by all Churches. However, no Church systematically requests it, neither before marriage nor from married couples. In the view of all leaders, it would be good to recommend it, however the decisions of the test must be a consent of the two spouses.

Since the basis of a marriage is the aCCeptance by the parties to live together regardless of their conditions, being HIV positive is a “cross”like any other disease or serious aCCident whose consequences should be aCCepted.

3.4.    Involvement of the Churches towards the Care of Patients and Orphans

The Evangelical Presbyterian Church of Ghana

The EP-Church does not yet organise management activities. The cases of the patients declared are those reported by the hospitals of the Church (Warawara). However the Church should envisage activities that include visiting the patients at home in order to help them materially, morally and spiritually. It should assist the patients out of silence, despair, fear, anguish and reconcile them with all the faithful.

The Presbyterian Church of Ghana

For the implementation of the health component of its mission, the Church has a large infrastructure which is composed of four big hospitals at Agogo, Bawku, Dormaa, Donkokron, and twenty health centres and clinics. The nursing personnel are trained at two schools at Agogo and Bawku.

In 1999, two studies were conducted on the HIV/AIDS infection in hospitals belonging to the Church. At the Dormaa Presbyterian hospital, 107 patients out of 1,247 or 8.60% had a HIV positive serology. Among them, 60 are male and 47 are female; 16 of them have already died. Another study conducted at the Agogo Presbyterian hospital showed that out of 1,388 persons surveyed 202 or 14.55% were affected by the HIV infection.

The Catholic Church

At the parish level, there is not any structure responsible for the care of patients and orphans. The cases identified are referred to other NGOs, health associations or centres. However, aCCording to the view of two priests whom we met, AIDS is much more than an infectious disease. It poses complex problems of an ethical, economic, health, social and legal nature. Confronted with these problems, the Catholic Church must be involved in solidarity pastoral work in favour of the sick, orphans and their relatives.

4.  Poverty and Human Rights

The fight against poverty and human rights forms part of social pastoral and humanitarian work of all Churches.

4.1.    E.P. (Evangelical Presbyterian) Church of Ghana

E. P. Church has training facilities such as 6 agricultural centres, 22 centres running development projects where unemployed youth can receive training. Systematic distribution of food, clothes or financial support to the poor or orphans is not organised. The decision to assist the needy is subject to the discretion of the leaders of each parish.

4.2.    Methodist Church of Ghana

Just like other Churches, within the Methodist Church there is not an organisation responsible for the systematic care of the poor. Nonetheless, within these structures, the Church has a department of rural and social development which intervenes in assisting the urgent needs of the poor.

4.3.    Presbyterian Church of Ghana

It began a programme in the pilot zones in 1997, however, today, a long term strategy has been envisaged and provides for the promotion of income-generating activities specially for the unemployed. No position nor initiative concerning the promotion of Human Rights was reported to us.

5.  Ecumenical Organisations

5.1. The Christian Council of Ghana

The Christian Council which currently comprises 14 Church members and remains open to other religious denominations was brought to express its position in particular with the Episcopal Council Conference of Catholic Churches on crucial problems facing the nation such as the presidential elections, educational reform, drug trafficking, security services, the economy, and Human Rights.

For the Christian Council of Ghana, AIDS is a disease which has attained alarming proportions which respects neither sex, age nor skin colour, nor religious confession. The virus destroys a person's immune system, makes him vulnerable to diseases and infections and ends up by killing him. The HIV infection is truly present in Ghana. It is a very serious social, humanitarian, economic development and public health challenge of all times.

In order to express their commitment to the struggle against AIDS, Church members of the Christian Council chose the HIV/AIDS infection as the theme for the celebration of the Christian family week of the year 2000. The celebration of this Christian family week took place from 7 to 14 April 2000.

All the Church members participated in the events in their parishes. Lectures and debates were organised; biblical and theological approaches to HIV/AIDS were developed by pastors in their sermons.

Biblical perception of HIV/AIDS

The Bible does not speak specifically about AIDS, it was written long before the discovery of the human immuno-deficiency virus. However, the Bible makes reference to risk behaviours by which individuals are infected by the HIV. There are also biblical concepts which can assist us to provide answers to those who are infected or affected and to establish relations between them. These biblical concepts can also give us opportunities to involve ourselves in a pastoral ministry concerning AIDS.

“Since sexuality is a gift of God”it is only through marriage that we can put into practice the commandment which said “Be fertile, increase and multiply fill the earth...”. This sexuality is the most complete means of totally giving themselves to one another. Even though the Bible shows us how individuals must conduct interpersonal relations, men have deviated from the use of sex and adopted attitudes contrary to the Scriptures.

Prevention and care

The special role which Churches are to play is to educate and inform the faithful on responsible sexuality. The human dignity requires that each person is made to acquire a tender maturity through a specific education process, which consists in rediscovering the spiritual value of love and self-denial as the basis for the existence and control of risk behaviours. The Sunday school provides a unique opportunity for educating children and informing them on the reproduction process. The Christian Council of Ghana has several booklets in this connection.

The Churches must continue to provide diaconal services to the most vulnerable persons of society in order to warn them against HIV/AIDS because it is estimated that if the faithful who are already infected or who have risk behaviours are not managed by the Churches and supported through counselling by pastors, they can become a source of propagation of the disease.

The struggle against AIDS cannot suCCeed unless the Church is actively involved in it. It is only in the Churches that the PLWAs can find spiritual assistance and rediscover human dignity inherent in each person. In response to the needs of the sick, the Churches must provide them with medical care, counselling, social assistance and pastoral support. The material assistance in the form of food and clothing is also very useful and sometimes indispensable.

Patients who consent to visits to homes must be monitored by a team consisting of doctors, nurses, priests and social welfare workers.

5.2.    Ghana Young Men's Christian Association, YMCA

This organisation which brings together young people, both female and male, is very active in the country. It has established seventy centres in eight of the ten regions of the country. Its organisational structure is composed of a National Council, a National Executive Committee, regional and local Councils. It collaborates, just as in the Volta Region, with the Regional Department of Health, the National Culture Centre, the Christian Council, professionals associations and the Ghana Family Planning Association. It is also open to all Churches and religious communities.

The Association's point of view regarding its position on AIDS, is that it believes that adolescent sexuality has always been a problem, with the AIDS epidemic, the problem has to be recast in a more general perspective which ensures preventive and curative interventions. Not knowing any prevention method other than the condom and the pill, the adolescent youth are exposed to HIV contamination. The factors of this contamination are poverty, lack of expertise, violence, adverse social norms and early experimentation of sexuality.

A survey conducted in the youth population showed that among the youth between 8 and 13 years, 80% have already had their first sexual relations, 60% have already had an abortion.

The organisation stressed that the priority activity to be undertaken in the welfare centres of a pilot project include listening to the youth, discussions on issues which concern them, such as sexuality factors which make them more vulnerable to HIV infection as well as the methods of prevention.

The results obtained in the pilot zones of the extensive YMCA project of Ghana are very encouraging. The participatory approach was very effective through the opinion leaders, the support of the associations, football teams and Churches.

It was also observed that there was an increased awareness on the part of youth on the HIV/AIDS epidemics as well as the methods of prevention.

6.  Conclusion

Traditionally, the education of youth as responsible citizens and their social integration is the role of the extended family. Thus, the psychosocial orientation, the economic capacity of adolescents were carefully prepared by a cultural initiation to adult life. This cultural initiation mechanism gave authority to the members of the traditional family to guide adolescents towards a controlled sexual life, a planned marriage, responsible parenthood and harmonious family life. Immigration from the family environment to the economically more attractive zones and the modern socio-cultural habits have led to a dislocation of the traditional family and the destruction of its educational role.

Confronted with this situation, the Social Welfare Department, officially responsible in assisting parents and young people, is unable to assure responsibility for the educational problems of the youth, for the lack of well designed programmes and adequate equipment.

At the level of the Churches, pastoral support must be provided by a team of trained persons. These teams which provide care and material assistance must discuss religious issues with the hospitalised, as well as pray and read the Bible with them in order to strengthen them in their faith.