Keywords: Nigeria, human immune deficiency virus, voluntary counselling and testing, students
Human Immune Virus (HIV) is a retrovirus that sets in motion the course of Acquired Immune Deficiency Syndrome (AIDS). Median HIV prevalence in Nigeria has steadily increased from 1.8% in 1991 to 5.8% in 2001, the range of HIV prevalence from 85 sites across the 36 states and Federal capital Territory was from 0.8% to 16.4%. 21 out of 85 sites were rural, where HIV prevalence ranged from 2.2% to 16%. The sites with the highest prevalence in the 2001 sentinel survey were rural (Utulu, 2006; UNAIDS, 2006).
In 2001, HIV prevalence among the 15 – 19 year old attendees tested was 5.9%, among the 20 -24 years olds the rate was 6.0% and among the 25-29 olds, 6.3%. In the major urban areas, HIV prevalence among clinic attendees has increased from 1% in 1991 to nearly 5% in 1999; in 1999 HIV prevalence ranged from 3% to 8% (Utulu, 2006). The most strategic form of care and support for people generally is counselling and testing as preventive measures of HIV/AIDS. This study is aimed at profiling knowledge of HIV/AIDS and psychosocial factors impeding positive attitudes to voluntary counselling and testing (VCT) of the most vulnerable group-young people in the fight against HIV and AIDS in Nigeria.
Statement of the problem
counselling and testing (VCT) services. It noted that participating nations commitment
“to ensure that a wide range of prevention programmes is available in all countries, including expanded access to voluntary and confidential counselling and testing by 2005”
Voluntary HIV counselling and testing is the process by which an individual undergoes counselling to enable him/her to make an informed choice about being tested for the human immunodeficiency virus (HIV). This decision must be entirely the choice of the individual and he or she must be assured that the process will be confidential.
VCT services are meant for all (literate and illiterate people). It is a key component of both HIV prevention and treatment programmes but in Nigeria, HIV/VCT is not taken seriously due to fear of stigmatization and discrimination (Myers, et al, 1993; Meiberg, et al, 2008; WHO, 1994; Boyd, et al, 1990; UNAIDS, 2004; Ewhrudjakpor, 2006d).
In recent years, voluntary HIV testing in combination with pre and post test counselling has become increasingly important in national and international prevention and care efforts. Knowledge of serostatus through VCT can be motivating force for HIV positive and negative people alike to adopt safer sexual behaviour, which enables seropositive people to prevent their sexual partners from getting infected and those who test seronegative to remain negative. This intervention also facilitates access to prevention services for seronegative people and is a key entry point to care and support services for those who are HIV infected. For instance, knowledge of seropositive of a pregnant mother will reduce mother to child transmission of HIV, secondly, interventions through VCT will prevent opportunistic infections such as tuberculosis, prophylaxis and others. This will help HIV positive people live longer, healthier and satisfied lives.This study is therefore designed to profile students knowledge of HIV/AIDS and their attitude towards voluntary counselling and testing (VCT) for HIV in Nigeria. This is against the backdrop of cultural, social, familial, bureaucratic and technological problems associated with counselling and testing for HIV as documented in earlier studies (Dorr, et. al; 1999; Flowers, et al, 2003; Fortenberry, et al 2002; Kalichman, et. al, 2003; Day, et al, 2003; and Peltzer, et. al, 2003;Popoola,2005).
Many studies (Kidanu, et al, 2001; Parker, et al, 2003; Crocker, et. al, 1998; Bos, et. al, 2001; Simbayi, et al, 2007; Malcolm, et.al, 1998; and Meiberg, et. al, 2008) have described the HIV/AIDs epidemic as an epidemic of ignorance, fear and denial leading to stigmatization of and discrimination against people living with HIV/AIDs and their family members.
Therefore, the objectives of this study are (i) to assess the present state of knowledge and (ii) attitude towards voluntary counselling and testing among undergraduates in Delta State tertiary educational institutions (iii) to determine the relationship between knowledge and attitude towards HIV VCT.
The Health Belief Model
The HBM is based on the fact that an adult will take a health – related action (that is go for HIV voluntary counselling and testing as in this study) if that person feels that a negative health condition HIV/AIDS can avoided or be known
and then manage it socio-psychologically and medically.
Sample size/ sampling technique
Validity and reliability of instrument
Procedure for data collection
knowledge is the independent variable (X) and attitudes, the dependent variable (Y). It was expected that, good knowledge of HIV VCT will encourage positive attitude towards testing.
Table 1: Summary of socio-demographics with corresponding knowledge and attitude scores of respondents (N.2815)
Source: Fieldwork 2009
Table 2: Summary of respondents knowledge factors and attitude scores towards HIV VCT (N= 2815)
*N.B: Respondents chose more than one item among the options of the variables.
Table 3: SPSS output summarizing the Pearson Product Moment Correlation analysis on the relationship between Respondents Knowledge of HIV and Attitudes towards VCT (N = 2815)
Source: Fieldwork, 2009
Table 4: Summary of Pearson Product – Moment Correlation Showing the relationship between Respondents Total Knowledge Factors of HIV and their Attitudes towards VCT (N= 2815)
(r= 0.123; d:f = 2813; p > .05)
Source: Fieldwork, 2009
* These findings were derived from statistical analysis contained in tables one to four and are discussed in the context of related studies retrieved and the health belief model.
The first objective of this study was fulfilled, that knowledge of HIV was good. In table one, knowledge scores relating to socio-demographics of respondents was tabulated. It shows unanimously that these students have good knowledge of HIV considering the huge score over the average knowledge score of 720 (that is 40 per person) as contained in the instrument scoring under methods in this study. Meanwhile in table one, knowledge scores ranged from 2684 from Male Law Students to 299562 from Ibo and Ukwuani female students. In addition, table two also summed the factors of knowledge on HIV, and it again supports the earlier results in table one. For instance, on the source of knowledge, the media had 57.16% as the commonest source of knowledge on HIV. On causes of HIV, unprotected sex had 93.96% positive responses, on consequence; social stigma had 100%, and others, this goes to further support knowledge scores derived in table one. This finding corroborates earlier studies (Myers, et al, 1993; Okonta, and Oseji, 2006; Akpede, et al; 2002; Utulu, 2006; Popoola, 2005; Boyd, et al, 1990; UNAIDs, 2006; Ewhrudjakpor, 2006d; kidanu, et. al. 2001; Parker, et. al, 2003).
This study’s second objective to assess the corresponding attitudes of students VCT to knowledge of HIV showed that it was negative. In other words, despite good knowledge of HIV, the respondents had low attitudinal scores portraying negative attitudes. This was based on the study’s ‘attitude scale’ scoring that had 55 per respondent as minimum positive score. The result (table 1) showed that attitude scores ranged from 106 among Male Law students to 14791 from Urhobo female students. This translated to an individual attitude score averages of; 2.30 to 24.61 as against the study’s positive attitude average of 55 per respondent. This shows a significantly negative attitude towards HIV VCT in Delta State of Nigeria. Table two which shows summarization of attitude scores according to knowledge factors confirmed results contained in table one. For instance, on knowledge factors having media as the commonest source of information with knowledge scores of 9663569 averaging per respondent 6005, had attitudinal score of 1,264, 410 average per respondent 785.835, against the expected positive attitude scores of 88495. Also, on consequences, the attitudinal score was 2639614 average per respondent 937.695 far less than 88495 (the minimum possible positive score). These shows clearly significant negative attitudes towards HIV VCT. These results support findings in past studies (Akpede, et al, 2002; Okpala, et. al, 2009; UNAIDS, 2004; Kalichman and Simbayi, 2003; Peltzer, et. al, 2003 and Ekanem, and
Gbadegesin, 2004; Crocker, et. al, 1998; Bos, et. al, 2001).
Furthermore, table three showed a re-confirmation of results contained in tables one and two using a computer application of the Statistical Package for Social Sciences (SPSS) version 14 Pearson product – moment correlation to analyze correspondences between each of the eight knowledge factors and attitudinal responses to HIV VCT. These results fulfil the third objective of this study, which is to determine the relationship between knowledge of HIV and attitudes towards HIV VCT. The inter – correlationship amongst these knowledge factors and attitude is unambiguously shown in table three.
In table three, there are three rows, the first row gives the coefficient of correlation of the eight elements (X1-X8) against attitude which is 1.00. The second row gives the significance level .000 which practically chosen as .05 alpha level of the test, and the third row gives the total number of observations (2815 respondents) considered in the analysis. It is the breakdown of how each knowledge item reached significance when subjected to the chosen .05 alpha level which is 0.195 in the statistical table that translates to positive or negative attitudes towards HIV VCT.
Therefore, from results shown in the second row of table three, all eight knowledge factors did not reach significance or alpha level of .195. This literally interpreted, means that each of the eight HIV knowledge factors did not relate positively with attitudes towards HIV VCT. Confirming result contained in tables one and two earlier discussed. In addition, table three was summarized in table four which expressly relates all knowledge factors summed and sum total of attitudinal scores. Again, here, the results (r=0.123; d.f=2813; p> .05) showed the unambiguity of respondents negative attitudes towards HIV VCT. This result and finding provides solution to objective three, that despite good knowledge of HIV, respondents attitudes towards HIV VCT is significantly negative. It however corroborates earlier researches (Meiberg, et. al, 2008; Fortenberry, et al, 2002; Day, et. al, 2003; Kamb, et. al, 1998; and De Zoysa, et al, 1995) in the literature.
Now in relating knowledge and attitude towards HIV VCT, there are barriers respondents face, which act significantly to block positive attitudes, in this study the most potent was traditional values and fear of social stigma with responses of 96.48% and 100% respectively. This finding situates in the Rosenstock (1974) model of health belief, that succinctly states, individuals act to avoid health problem based on perception of benefits and barriers to alternative (VCT) health behaviours. In this society, up until now, attitude towards people living with HIV/AIDS (PLWHA) is absolutely negative, hence fear to get VCT is real and alive as found in this study and supported by earlier researchers (WHO, 1994; Dorr, et. al, 1999; Flowers, et. al, 2003; and De Zoysa, et. al, 1995; Simbayi, et. al, 2007; Malcolm, et. al, 1998; Parker, et. al, 2003; and Kidanu, et. al, 2001) related to this subject matter in question.
These results were discussed in the light of past studies related to the subject matter of knowledge, attitude and HIV VCT. The findings were also explained situated in the Health Belief Model (HBM) of Rosenstock (1974). The author finally made recommendations in order to stem this negative trend and reverse negative attitudes.
aspect of General Studies in the schools curricula (ii) before any form of attention to students in the institutions health facilities. Result of this test must remain confidential.
Also, HIV VCT centres be made readily accessible in every primary, secondary and tertiary health institutions in the state. Presently only a few secondary and tertiary health institutions have facilities to run the HIV VCT. This is not proper considering the wealth of Delta State (Udonwa, et. al, 2004). In addition, the mass media should be encouraged to intensify campaigns on HIV VCT, which is presently in the state still campaigns on the abstinence, behaviour and condom use (A-B-C) Model of HIV/AIDS(Popoola,2005).
Bos, A.E.R; Kok, G; Dijker, A.J. (2001). Public reactions to people with HIV/AIDS in the Netherlands. AIDS Education and Prevention. 13:219 – 228.
Boyd, J.S; Kerr, S; Maw, R.D; Funnighan, E.A and Kilbane, P.K; (1990). Knowledge of HIV Infection and AIDs and attitudes to testing and counselling among general practitioners in Northern Ireland. British Journal of General Practice 40(333):156-160.
Crocker, J; Major, B; Steele, C (1998). In D.T. Gilbert, S.T. Fishe, G.Lindzey (Eds). The handbook of Social Psychology. New York: McGraw Hill. 504 – 553.
Day, J.H; Miyamura, K; Grant, A.D; Leeuw, A; Munsamy J., Baggaley, R; Churchyard, G.J. (2003). Attitudes to HIV voluntary counselling and testing among mineworkers in South Africa: will availability of antiretroviral therapy encourage testing? AIDS Care. 15:665-672.
De Zoysa, 1; Phillips, K.A; Kamengo, M.C; OReilly, K.R; Sweat, M.D; White, R.A; Grinstead, O.A; Coates, T.J (1995) Role of HIV counselling and testing in changing risk behaviour in developing countries. AIDS Care. 9:895-910.
Dorr, N; Kruecheberg, S; Strathman, A; Wood D.W; (1999). Psychosocial correlates of voluntary HIV antibody testing in college students. AIDS Educ Prevention 11; 14-27.
Ekanem, E.E and Gbadegesin, A (2004). Voluntary Counselling and testing (VCT) for human Immunodeficiency virus: a study on acceptability by Nigerian women attending antenatal clinics. African Journal of Reproductive Health. Vol 8(2): 91 – 100.
Ewhrudajakpor, C. (2006d). Nigerians orthodox sexual Behaviour and Paradox of HIV/AIDS campaign. International Journal of Social and Policy Issues: Vol. 4(1&2): 231-241
Federal Republic of Nigeria, official Gazette, Legal Notice on Publication of the 2006 census figures, 2007, 94 (4)B50 –B53.
Flowers, P; Knussen, C; Church, S (2003) Psychosocial factors associated with HIV testing amongst Scottish gay men. Psychological Health 18:739-752.
Fortenberry, J.D., Mcfarlane, M; Bleakley, A; Bull, S; Fishbein, M; Grimley, D,M; Malotte, C.K; Stoner, B.P; (2002) Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health 92:378-381.
Inside Delta State (2006). A Brief History of Delta State. Asaba. A publication of Delta State Ministry of Information.
Kalichman, S.C and Simbayi, L.C (2003). HIV testing attitudes AID stigma and
voluntary HIV counselling and testing in black township in cap town South African Sex Transmission Infection 76(6): 442-447.
Kamb, M.L; Fishbein, M; Douglas, J.M; Rhodes, F; Rogers, J; Bolan, G; Zenilman, J; Hoxworth, T; Malotte, C.K; Latesta, M; Kent, C; Lentz, A; Graziano, S., Byers, R.H; Peterman, T.A (1998). Efficacy of risk reduction counselling to prevent human immunodeficiency virus and sexuality transmitted diseases: a randomized controlled trail project. RESPECT study group. Journal of American Medical Association 280:1161 – 1167.
Kidanu, A, Mbwambo, J, Nyblade L, Bond, V (2001). A Multi-Country Study Understanding HIV related stigma and discrimination. Dar es Salaam: University of Dar es Salaam
Likert, R (1932).A Technique for the Measurement of Attitudes. Archives of Psychology.140:2-13.
Malcolm, A; Aggleton, P; Bronfman, M; Galvao, J; Mane, P, Verrall, J (1998). HIV-related Stigmatization and discrimination : its forms and contexts. Critical Public Health. 8:347-370.
Meiberg, A.E; Bos, A.E.R; Onya, H.E and Schaalma, H.P, (2008). Fear of Stigmatization as Barrier to Voluntary HIV Counselling and Testing in South Africa. East African Journal of Public Health Vol. 5 (2): 49 – 54.
Myers T, Orr, K.W; Locker, D, Jackson, E.A, (1993). Factors affecting and bisexual men’s decisions and intentions to seek HIV testing, American Journal of Public Health. 83:701 – 704.
Okonta, P.1. and Oseji, M.I. (2006). Relationship between knowledge of HIV/AIDs and Sexual behaviour among in – school adolescents in Delta State, Nigeria. Nigerian Journal of Clinical Practice Vol. 9 (1): 37 – 39.
Okpala, P.U., Ebenebe, U.E; Ibeh, C.C (2009) Voluntary Counselling and Testing Among African Women. http://www.valleyaids.org/presentations8/17/200911.04pm
Parker, R; Aggleton, P (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science and Medicine: 57:13-24.
Peltzer, K; Mpofu, E; Baguma, P; Lawal, B (2003). Attitudes toward HIV antibody testing among University Students in four African countries. International Journal of Advance Counselling. 24:193 – 203.
Popoola 1.5 (2005). The Role of Mass Media and the Family in curing the Spread of HIV/AIDS in Nigeria. International Journal of Communication. 2:105.
Rosenstock, L.M (1974). Historical Origins of the Health Belief Model Health Education Monograph No 1. 2:328 – 335.
Simbayi, L.C; Kalichman, S; Strebel, A, Cloete, A, Henda, N, Mqeketo, A (2007). Internalized Stigma discrimination and depression among men and women living with HIV/AIDs in Cap Town South Africa. Social Science and Medicine. 64:823-1831.
Udonwa, N.E; Ekpo, M; Ekanem, I.A; Inem, A.V; and Etokidem, A (2004). Oil doom and AIDs boom in the Niger Delta Region of Nigeria. The International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy. Vol. 6354: 1-7.
UNAIDS (2004). Stigmatization and Discrimination Against peoples living with HIV.AIDS. Geneva:UNAIDS
UNAIDS. (2006). Report on the global AIDs epidemic: A UNAIDS 10th anniversary special edition. General UNAIDS.
Utulu, S.N. (2006). The Epidemiology of HIV and AIDS in Africa. Ibadan. Ibadan University Press.
World Health Organization (1994). HIV/AIDS Fear, Stigma and Isolation. Fact Sheets, 6