Influence of participation in decision making regarding sexual and reproductive health on HIV testing among married and cohabiting women in Ghana.

INTRODUCTION

HIV/AIDS remains a significant concern in sub-Saharan Africa (SSA), where women face heightened vulnerability due to biological, structural, cultural, and socioeconomic factors. HIV testing is central to prevention and control, yet uptake remains suboptimal. This study examined the association between participation in sexual and reproductive health (SRH) decision-making and HIV testing in Ghana.

METHODS

We analyzed cross-sectional data from the 2022 Ghana Demographic and Health Survey, including 7,867 married and cohabiting women aged 15-49. Participation in SRH decision-making was defined as the ability to refuse sex, make family planning and healthcare decisions independently or jointly with a spouse. Descriptive statistics, Rao-Scott chi-square tests, and logistic regression analyses were performed.

RESULTS

Overall, 77.0% of women reported ever testing for HIV, while 52.9% participated in SRH decision-making. HIV testing uptake was lower among women not involved in SRH decisions compared to those who were (72.8% vs. 80.6%; p < 0.001). After adjusting for potential confounders, lack of participation in SRH decision-making was associated with reduced odds of HIV testing (aOR: 0.79, 95% CI: 0.68-0.92, p = 0.002).

DISCUSSION: Efforts to strengthen women's autonomy in SRH decision-making may be an effective strategy to increase HIV testing uptake among married and cohabiting women.