Studies on HIV-related stigma/discrimination have found that stigma tends to be higher among people with low media exposure than among those with high media exposure [21]. In light of this, the present study investigated the association between exposure to mass media and whether or not HIV-infected female teachers should be allowed to teach in Ghana. The main finding of the study was that those who had access to mass media were more likely to agree that HIV-infected female teachers should be allowed to continue teaching at school than those who did not have access. to mass media. Our findings coincide with various studies conducted in other parts of sub-Saharan Africa and Asia, where media use was found to be generally associated with low levels of HIV-related stigma and reduced gap between individuals with a high and low level of education. [21, 27, 28]. Similarly, in the Greater Accra, Ashanti and Upper East regions, it has been suggested that mass media can effectively address HIV stigma nationwide [29]. It can be argued that adequate knowledge and awareness of the disease are the essential prerequisites for its prevention and control, since adequate knowledge is a basis for adopting appropriate attitudes and practices. [30,31,32]. This lends credence to the need to use television, radio, newspapers and other forms of mass media to carry out socio-behavioural education related to HIV stigma/discrimination. At the very least, exposing communities to information about HIV-related stigma could significantly improve community knowledge and understanding of the disease.
Another interesting finding was that those who had completed secondary or higher education were more likely to say that HIV-infected female teachers should be allowed to continue teaching in a school as opposed to those who had no formal education. The positive effects of formal education on HIV knowledge have been confirmed by numerous other studies. For example, in Nigeria and Kenya, it was known that people with a higher level of education and a higher wealth index are more sympathetic towards people living with HIV (PLHIV) [33, 34]. The association between formal education and knowledge of health protective behaviors is often explained by the fact that education increases cognitive abilities, numeracy and decision-making abilities and therefore improves abilities to adopt health protective behaviors [35]. Specifically, formal education influences knowledge about HIV and AIDS by providing people with the information needed to protect themselves against infection.
It was found that residents of rural areas were less likely to claim that female teachers infected with HIV should be allowed to continue teaching in a school than residents of urban areas. Previous studies have consistently indicated that mass media is more powerful among urban dwellers than among rural residents, which may lead to a widening gap between the two groups in approval of HIV-related stigma. [21, 33, 36]. The results imply that the social place in which this attitude prevails could be visualized at the intersection of other multiple identities. Similarly, the fact that stigma is high among people in rural communities is an indication that PLHIV in these communities might experience high levels of stigma. The previous study also found that, comparatively, cohabitants were less likely to approve that HIV-infected female teachers should be allowed to continue teaching in a school compared to married women. This could be attributed to pre-nuptial preparation and counseling arranged for couples prior to marriage. Before marriage is contracted, couples go through voluntary HIV/AIDS testing and counseling which improves their understanding of HIV/AIDS.
In agreement with previous studies [37, 38], the current study found that traditionalists were the least likely to argue that HIV-infected female teachers should be allowed to continue teaching in a school compared to Christian ones. A Ghana-based study also indicated that women who identified as Christian were more knowledgeable about modes of HIV transmission than women who followed traditional African religion or were not affiliated with any religion. [37]. This suggests that there is a likely relationship between religious affiliation and levels of knowledge about HIV/AIDS. This finding is consistent with a study conducted in Tanzania, where religious beliefs played a major role in shaping people’s perspectives on HIV and PLHIV. [38]. Nevertheless, a study in Mozambique found that Protestant women had a more comprehensive knowledge of HIV and AIDS than their Catholic counterparts. [39]. Such a finding suggests that policy makers need to pay more attention to non-Christian groups in their HIV/AIDS campaigns and take into account the differences between Christian groups.
The wealthy had a higher propensity to approve that HIV-infected female teachers should be allowed to continue teaching in a school compared to the poor. The result is in line with a study in Nigeria and Kenya which found that those with the highest wealth index are more sympathetic towards PLHIV [33, 34]. Probably, those with higher wealth status could own and have access to various mass media platforms, thereby exposing them to various information about HIV/AIDS. Our finding is similar to a previous study in Bangladesh in which the authors found that wealthy women had a higher likelihood of being exposed to media and information about HIV/AIDS. [36]. Similarly, those whose partners had completed secondary or higher education were more likely to argue that HIV-infected female teachers should be allowed to continue teaching in a school compared to those whose partners had no education. This could be due to the cascading effect of the partner’s knowledge on the couple, as it is known that there is greater awareness among educated and wealthy people about the prognosis of PLHIV and the availability of antiretroviral treatment. [34].
Finally, those at parity four or more were less likely to agree that HIV-infected female teachers should be allowed to continue teaching in a school compared to those at parity zero, much like the Grusi compared to the Akan. This could be due to the diversity of beliefs, perceptions and practices held by various ethnic groups. However, evidence suggests that eliminating stigma and discrimination will result in greater acceptance of PLHIV by community members [40]. Therefore, there is a need to promote positive and acceptable attitudes towards PLHIV among diverse ethnic groups and mothers of varying parity in Ghana. Admittedly, the current study did not provide likely reasons for the observed variations. Therefore, a study, preferably qualitative, is necessary to understand the phenomenon.
Strengths and weaknesses of the study
This study investigated the association between mass media and HIV-related stigma in Ghana and is the first of its kind to have done so. In addition, the study drew on survey data from the former ten major administrative regions of Ghana, thus representing the views of women in Ghana. The probability sampling approach employed in the survey helped to reduce sampling bias. The study further employed rigorous analytical procedures, thus improving the robustness of the results. However, a causal relationship cannot be established due to the cross-sectional nature of the survey. Additionally, issues surrounding HIV/AIDS, particularly stigma and discrimination, are sensitive, respondents may be biased in their responses due to social desirability bias. The study also focused on women only and the findings and conclusions are based on the opinions of women excluding men.
