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?