CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

According to United Nations Joint Programme on AIDS (UNAIDS, 2004), the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic remains a major public health problem worldwide, more so in sub-Saharan Africa where more than 70 percent of all People Living With HIV and AIDS (PLWHA) resides. Evidence shows that out of the 4.2 million people infected, 700,000 were children (UNAIDS, 2004).  In Nigeria, AIDS has left a staggering 1.2 million orphans, the largest in the world and 200,000 deaths occurred in 2005 (Federal Ministry of Health, 2006)

Federal Ministry of Health (2006) reported that the first case of HIV/AIDS was identified in Nigeria in 1986. Since then the HIV prevalence has grown exponentially from 1.8 percent in 1991 to 3.4 percent in 1993 to 5.4 percent in 1999 and 5.8 percent in 2001.  In 2003, the national adult prevalence was 5.0 percent. By the end of 2003, Nigeria was said to have the third highest number of people infected with HIV in the world after South Africa and India (Federal Ministry of Health, 2006).

Family Health International (2006) shows that results from the 2005 survey revealed the overall national HIV prevalence for adults is 4.4 percent. This figure however conceals significant difference between states from 1.6 percent in Ekiti and 1.8 percent in Jigawa to 8.0 percent in Akwa Ibom and 10.0 percent in Benue state.  This divergence and irregular patterns of HIV prevalence rates and trends across states demonstrate that dynamics of the epidemic are different in each state.  The 2005 HIV Counselling and Testing (HCT) survey revealed that all states of Nigeria have a prevalence of greater than 5 percent. Young women in the 20-29 years age bracket, have the highest prevalence rates (4.7 percent for the 20-24 age group and 4.9 percent for the 25-29 age group) and urban populations generally have a higher prevalence than rural areas (Family Health International, 2006). More than 90 percent of PLWHA were in the developing world and about 70 percent of cases were in sub-Saharan Africa (Family Health International,2006).

Internationally, since the AIDS epidemic began, more than 20 million deaths have been attributed to AIDS.  The current estimate of the disease worldwide indicates a   prevalence of   more than 33 million HIV infections; nearly two-thirds of these cases are in developing countries, generally in sub-Saharan Africa and Southeast Asia (Kassler, Alwano-Edyegu, Marum, Biryahwabo, Kataaha and Dillon, 2001).  The result from the study conducted by Oniyangi (2005) supported that 72 percent of respondents agreed that HIV/AIDS was common among the youths.

As of December 31,2000, a total of 774,467 persons were reported with AIDS and 448,000 of these persons had died, the number of people living with HIV/AIDS 322,865 was the highest reported.  Like in the United States, approximately 275,000 of these persons might not know they are infected (Centres for Disease Control, 2001).

According to Centres for Disease Control and Prevention (2006), globally, HIV counselling and testing is recognized as a priority in the national HIV programme because it forms the gateway to HIV/AIDS prevention, care, treatment, support interventions, and a vital component for the expansion of access to comprehensive care for PLWHA. The utilization of HIV counselling and testing services is disappointingly low because of psychological and social barriers; and   people fear learning that they are infected with a disease that is fatal and stigmatizing (Nicole, Agatha, Lauren, Eitan, Rebecca and Sarah, 2009).

       The government of Nigeria has demonstrated a high level of commitment to fight the HIV and AIDS epidemic.  In response to the epidemic, the federal government launched the multi-sectoral approaches to HIV/AIDS prevention and control. In 2001, the National Action Committee on AIDS (NACA) was constituted to coordinate all HIV/AIDS responses of the various sector of the country (Federal Ministry of Health, 2006).  His Excellency, Chief Olusegun Obasanjo launched the National HIV and AIDS policy, providing guidance for HIV and AIDS intervention and prevention strategies. The strategies include HIV Counselling and Testing, which aim at enabling people to know their HIV status and reducing high-risk behaviour (Family Health International, 2006; Federal Ministry of Health, 2006).

Tao, Irwin and Kassler (2001) asserted that despite several advances in HIV prevention and care, a substantial number of opportunities for HIV prevention through Voluntary Counselling and Testing (VCT) are missing. At a publicly funded site, approximately 70 percent of persons tested received their result and information regarding the test, but fewer person likely received HIV prevention counselling and referrals (UNAIDS, 2005). In private settings, a lower proportion of all clients are tested and few receive prevention counselling and referral.

British Infection Society (2008) opined that with the continued growing numbers of HIV infected individuals, physicians need to recognize acute HIV infection as well as screen for asymptomatic infections.  Early diagnosis of acute HIV infection can help identify clients who may be eligible for anti retroviral treatment, which has been shown to delay the progression to AIDS and death. Rapid HIV testing may also be useful to quickly confirm HIV status in a person not known to be HIV positive who presents with AIDS-defining illness (British Infection Society,2008).

There are increasing efforts to encourage young people in utilizing voluntary counseling testing services. However, few programmes are currently providing counselling and testing   as well as post-test services that are tailored to the special needs of young people.  Many adolescents in sub-Sahara Africa are sexually experienced and when entering into sexual relationship for the first time, do not use any form of contraception (Federal Ministry of Health, 2005). This leave them vulnerable to HIV infection, sexually transmitted infections (STIs), and unplanned parenthood. Access by young people (particularly girls) to sexual and reproductive health services in developing countries remain a major challenge (Akinso, 2003). 

Akinso (2003) further expressed that the usual display of HIV and AIDS people on the media is capable of creating fear in the minds of the members of the public.  In many cultures in Nigeria, HIV/AIDS is perceived as an evil disease and no one would want to be identified with such an evil disease that discourages many people from taking advantage of screening to know their status.  Even those that know their status shy away from counselling because they do not want to be identified with such an evil disease.

Above all, this study shall deal extensively into examination of college students’ level of awareness and acceptability of voluntary HIV counselling and testing.

1.2   Statement of the Problem

Despite series of jingles, public enlightenment campaigns and health talk on availability of voluntary HIV counselling and testing in all public health institutions in Nigeria, patronage level of students to VCT centres is still low.

In Nigeria, Federal Ministry of Health (2006) reported that young people aged 15-24 years are among the people who are  likely to be infected with HIV. For example, UNAIDS (2005) reported that all states of Nigeria have a prevalence rate of over 1 percent, Federal Capital Territory and 10 states have a prevalence rate greater than 5 percent.  Young women in the 20-29years age bracket, have the higher prevalence rate, 4.7 percent for the 20-24 years age group and 4.9 percent for the 25-29 years age group.  Young people are at the centre of the global HIV/AIDS epidemic. An estimated 11.8 million young people aged 15-24 years are living with HIV/AIDS, yet only a fraction of them know they are infected (UNAIDS,2005)

        Oyo State Ministry of Health (2003) reported   the result of the national sero-surveillance prevalence study which shows the following for Oyo State; 1992 (0.1 percent), 1994 (0.2 percent), 1996 (0.2 percent), 1999 (3.5 percent) and 2001 (4.2 percent). In addition, the figures from Oyo State central blood screening have shown an average sero-prevalence rate of 2 to 3 percent among blood donors.

Nkoli, Benjamin and Obinna (2005) in their recent study on VCT for HIV/AIDS among students in tertiary institutions, Nigeria revealed that the awareness of voluntary HIV counselling and testing is quite high among students but this does not reflect on the attendance at VCT clinics which is quite low compared to the awareness.

Therefore, considering the victim age of HIV/AIDS and other scholarly reports, the researcher deem it fit to investigate the level of awareness and acceptability of voluntary HIV counselling and testing among selected college students in Oyo metropolis

1.3   Research Questions

1.   Will gender influence acceptability of HIV testing among college students?

2.   Will age influence knowledge of   importance and acceptability of HIV testing among college students?

3.   Will socio – economic background influence accessibility to sources and acceptability of HIV testing among college students?

4.   Will religion influence willingness and acceptability of HIV  testing among college students?

5.   Will parental educational background influence awareness of rapid HIV test and acceptability of HIV testing among college students?

1.4   Research Hypotheses

1.   Gender will not significantly influence acceptability of HIV testing among college students.

2.   Knowledge of   importance of voluntary HIV counselling and testing will not significantly influence acceptability of HIV testing among college students on the basis of age.

3.   Accessibility to sources of voluntary HIV counselling and testing will not significantly influence acceptability of HIV testing among college students on the basis of socio – economic background.

4.   Willingness to know HIV status will not significantly influence acceptability of HIV testing among college students on the basis of religion.

5.   Awareness of HIV rapid test will not significantly influence acceptability of HIV testing among college students on the basis of parental educational background.

1.5   Purpose of the Study

    1. To ascertain the influence of gender on acceptability of HIV testing among college students.

    2.  To find out the influence of age on knowledge of   importance of voluntary HIV counselling and testing and acceptability of HIV testing among college students.

     3.  To investigate the influence of socio economic background on accessibility to sources of voluntary HIV counselling and testing and acceptability of HIV testing among college students.

     4.  To examine the influence of religion on willingness to know HIV status and acceptability of HIV testing among college students.

      5. To determine the influence of parental educational background on awareness of rapid HIV test and acceptability of HIV testing among college students.

1.6   Significance of the Study

          The rationale for this study is to have the proper understanding of the awareness level and to ascertain if the college students are accepting Voluntary HIV Counselling and Testing (VHCT) free of coercion and made available within their environment. The study will benefit the national, state and local education sectors to see at a glance whether college students in Oyo metropolis are accepting HIV voluntary counselling and testing. The Non-Governmental Organizations (NGOs) will equally assist the education sector in scaling up measures to adopt for better participation of those students if their participation level in HIV testing is low.

          In addition, the study is significant because it will put hands of government at all levels (federal, state and local) on desk majorly on strategies to employ in raising awareness level of students on HIV/AIDS and making them actively involved in HIV testing session.  Religious leaders as one of the beneficiaries will be able to preach more on morals and encourage their members who are students to embrace VHCT for their health benefit. Also, the study will help the community members to be fully aware of the importance of VHCT and thereby make them have positive attitude towards its acceptability.

1.7   Scope and Delimitation of the Study                   

          This study is delimited to students of two colleges of education in Oyo metropolis

i.         Emmanuel Alayande College of Education (EACOED) which comprises of two campuses – Erelu and Isokun. Erelu campus is located in Atiba local government while Isokun campus is located in Oyo West local government area of Oyo town.

ii.       Federal College of Education (Special) (FCE(sp)) is located in Afijio local government.

Questionnaire will be mainly used to elicit information on the research topic and variables like influence of gender, age, socio-economic background, religion and parental educational background on knowledge of importance, accessibility to sources of VHCT, willingness to know HIV status and awareness of rapid HIV test, will be dealt with. A well structured questionnaire validated and tested for reliability shall be research instrument for this study. However, data to be collected will be analysed using frequency counts and percentages; and inferential statistics of chi-square analysis.

1.8   Operational Definition of Terms

i.        HIV – Human Immunodeficiency Virus is a germ causing Acquired Immune Deficiency Syndrome (AIDS).

ii.       AIDS – Acquired Immune Deficiency Syndrome is referred to the most advanced stage of HIV infection.

iii.      Positive test – A blood sample that is reactive after a repeated test.

iv.      HIV test – A laboratory procedure that detects antibodies to HIV.

v.       Pandemic – Worldwide occurrence of a disease.

vi.      Rapid HIV test – A test to detect antibodies to HIV that can be collected and processed within a short interval of time.

vii.     Antiretroviral – Drugs prepared to prevent HIV from replicating in HIV – infected person(s).

viii.    Prevalence – The number or percentage of persons in a given population with a disease or condition at a given point in time.

List of Abbreviations

i.             HIV – Human Immunodeficiency Virus

ii.           AIDS – Acquired Immune Deficiency Syndrome

iii.          HCT – HIV Counselling and Testing

iv.          PLWHA – People Living With HIV/AIDS

v.            ARV – Anti Retro Viral

vi.          VCT – Voluntary Counselling and Testing

vii.        NACA – National Action Committee on AIDS

viii.       CT – Counselling and Testing

ix.          STIs – Sexually Transmitted Infections

x.           VHCT –Voluntary HIV Counselling and Testing