Knowledge And Compliance Of University Undergraduates To Voluntary Counselling And Testing For HIV & AIDS

Knowledge And Compliance Of University Undergraduates To Voluntary Counselling And Testing For HIV & AIDS
Abstract
Early detection and treatment of infected individuals is an important step in the control of HIV epidemic. Voluntary counselling and testing is a concept developed in this direction. The study was conducted to determine the knowledge and compliance of Ebonyi State University Undergraduates to VCT for HIV/AIDS using a descriptive survey design. The sample consists of 384 full-time undergraduates selected from 3 campuses by simple random sampling. Self structured questionnaire was used to collect data. Data generated were analyzed and presented in frequency tables and percentages, chi-square (X2) was used to test the four hypotheses formulated for the study. The findings showed a good level of knowledge of VCT for HIV/AIDS (69.9%) among EBSU students. More knowledge existed among females (36.7%) although not statistically significant. Presco campus students (40.2%) have more knowledge than the other two campuses.
All the students claimed to have done HIV test at one time or the other (i.e. did HIV test two times or more at three or six months interval voluntarily) but only 12.1% totally complied to HIV test voluntarily. Half of the respondents (73.4%) did HIV text “by own volition”. Confidentiality (78.7%) was the most important factor that would make EBSU undergraduates use VCT services for HIV test. The study noted that the number of students with good level of knowledge of VCT for HIV/AIDS did not reflect in the compliance level. It was recommended that awareness campaign on routine voluntary HIV test and safe behaviour practices to prevent HIV should be intensified to the public at large. Health care providers should ensure enabling environment that will make young people use VCT services for HIV test.
Chapter One
Introduction
Background to the Study
Globally about 70 million people have been infected with HIV virus while 35 million people have died of AIDS and 34million people were living with HIV by the end of 2011(WHO, 2014). An estimate of 0.8% of adults aged 15 – 49 years worldwide are living with HIV with variation in epidemics between countries and regions. Sub-Saharan Africa remains most affected with nearly 1 in every 20 adults living with HIV and accounting for 69% of people living with HIV worldwide (WHO, 2014). In Africa, an estimate of 1.7 million young people is infected annually (WHO /UN Joint Programme on HIV/AIDS, 2006).
Many youths engage in risky behaviours, with fewer than 10% of the sexually active adolescent females from countries in sub-Saharan Africa reporting condom use (Human Development Report, 2004). In Nigeria 3.4million people are living with HIV/AIDS (UNAIDS, 2013).Thus voluntary counselling and testing (VCT) for young people have been recognized as a major priority within the Nigerian HIV prevention programme.
Voluntary counselling and testing (VCT) for Human immunodeficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS) is the process whereby an individual or couple undergo counselling to enable him/her make an informed choice about being tested for HIV ( Federal Ministry of Health, 2003). VCT is a major strategy designed by programme planners to combat the pandemic of HIV/AIDS in Africa (Bruce and Stellenberg, 2007). It involves community mobilization, education, increase in VCT sites, reduction of stigma, policies that protect human rights, counselling, rapid tests and confidentiality. VCT activities are implemented with other measures like sexual abstinence, marital fidelity, condom use and anti-retroviral drugs. Voluntary HIV test is an active search for HIV among healthy people and is therefore a fundamental aspect of primary, secondary and tertiary prevention of HIV infection and AIDS (Park, 2007 and Ikechebelu, Udigwe, Ikechebelu & Imo, 2006). It offers holistic approach that can address HIV in the broader context of people’s lives. HIV screening is advocated for every individual from early teen years of life especially those who are sexually active or exhibit high risk behaviours ( injection – drug users and their sex partners, sex partners of HIV infected persons and heterosexual persons with more than one sex partners). The age group coverage for voluntary HIV test is as low as 15 years in developing world since there is evidence that 25% of them have initiated sex by then (HDR, 2004). Apart from early exposure, young people are at risk of HIV infection because of lack of skill to negotiate safe sex behaviour and vulnerability to sexual abuse. This has necessitated the campaign on youth friendly programmes to encourage youths know their HIV status. According to WHO (2003), regardless of test result after the first test, routine check continues regularly at least every 6 months, but every 3 months for those that are sexually active. Each HIV test follows the process of pretest counselling, test and post test counselling.
Voluntary counselling and testing is being advocated for because it has been shown to enable individuals, whether HIV positive or negative to change their behaviour appropriately (Okojie and Omume, 2004).Healthy lifestyle is achieved during interaction with service providers as the individual understands the need to maintain his or her HIV status. Although knowing HIV status is regarded as an important component of a healthier lifestyle, the decision to undergo VCT is entirely that of the individual being tested (FMOH, 2003). The willingness to do HIV test may be because of HIV services that are accessible, affordable and with observed confidentiality that will increase the clients trust or as routine during antenatal care, for premarital decision, or an institutional requirement. People’s willingness also depends on public awareness programmes that will give understanding of what VCT is.VCT education is one major component in the strategy of voluntary counselling and testing programme, which one is expected to acquire either from formal school or from other sources that include community, mass media and churches.
Compliance in VCT for HIV/AIDS is the willingness of an individual to undergo the process of knowing own HIV status correctly. It is influenced by knowledge of the procedure, benefit of the test, perception of the test, cost, and accessibility of the services and fear of positive result. Individual characteristics such as age, gender, social support, personality trait and personal beliefs about health are associated with people’s compliance to medical advice. Rejection of HIV screening has been linked to psychological trauma, infringement on fundamental human rights, fear of living with positive screening and stigmatization at place of work (Omoigberale, Abiodun and Famodu, 2006).
One hundred and nineteen countries reported a total of 95 million people that tested for HIV in 2010 (WHO, 2014). The compliance of Nigerians to voluntary counselling and testing for HIV/AIDS has improved with time although it is still on low side compared to its population of 150,000,000 (National Population Commission, 2009). A comparism of the 2003 and 2007 result of the proportion of Nigerians who took HIV test increased from 6.6% to14.4% for females and from 7.7% to14.17% in males (National Policy on AIDS, 2009). An estimate of 2.2 million people aged 15years and above received HIV testing and counselling in 2010, which amounts to only around 31 people per 100,000 of the total adult population (WHO/UNAIDS/UNICEF, 2011). In 2010 National Action Committee on AIDS (NACA) launched a comprehensive strategic framework with the aim to reach 80% of sexually active adults and 80% of most at risk population with HIV counselling and testing by 2015. This is to reinforce the existing guideline addressing the needs of young people. (National Strategic Framework 2010-2015, 2009). However, the success of VCT programme will depend to a large extent on the political will driving its implementation and client compliance to VCT.
There are many VCT centres in Ebonyi state that extends to the local government areas. This resulted from the effort of the government and interest of different non governmental organizations. Some of the VCT centres are located near these campuses: College of Agricultural Science (CAS), with its campus about 2 kilometres away from a VCT centres (St. Lukkes Laboratory); College of Health Sciences (Presco) campus which is about 100metres away from the State public VCT centre. Ishieke and Permanent site campuses are about 4 and 8 kilometres away from mile 4 VCT centre. Ebonyi state university has a permanent site and four other campuses that are within and outside the capital city. The university community amidst others have enjoyed so many preventive measures to HIV prevention to which VCT is one (Ebonyi State Action Committee on AIDS, 2009). The university government and non governmental organizations also organizes programmes to inform students on the need to live healthy life styles which usually end up with free HIV services. VCT services is therefore accessible to students, hence the need to explore their knowledge and compliance to the services.
Statement of the Problem
The burden of HIV/AIDS disease is felt in economically depressed countries like Nigeria (National Policy on AIDS, 2009 and UNAIDS, 2007). A lot of money has been spent by government of Nigeria and agencies concerned with HIV/AIDS in a bid to inform people of what voluntary HIV counselling and testing is and its importance in HIV control. This is evidenced in the strategies to improve access to VCT services through increase in sites, increase in awareness campaign, simple rapid test and test results, free test services, training of service providers and protection of rights of victims of AIDS diseases (National Policy on HIV/AIDS, 2009).
The social position of adolescents which is characterized by dependency, physical and emotional immaturity makes youths vulnerable to sexual and reproductive diseases. They lack skill to negotiate safe sexual behaviours, have poor access to contraceptives and are vulnerable to sexual abuse. Despite their high risk for HIV infection there is low National prevalence of VCT among youths (15-24 years) of 2.6% with regional variations (Nwachukwu & Odumegwu, 2011).
Ebonyi state government, university government and agencies concerned with HIV/AIDS have floated many programmes on awareness and prevention of HIV/AIDS in Ebonyi State University which usually end up with free HIV test services (EBOSACA, 2009).Aside such programmes are numerous VCT service centres that are in the state. These programmes and services are expected to yield positive results in order to meet
NACA target of 80% HIV counselling and testing among the sexually active and at risk group by 2015.
The researcher severally observed low turnout and participation of student during HIV preventive programmes in the University. Moreso, in one of the VCT centres of about 100metres from Presco Campus, only 0.8-12% of the total population that have HIV test between 2009 to 2011 are undergraduates of EBSU. (State public VCT Centre). This informed the research to know the knowledge EBSU undergraduates have about VCT for HIV and their level of compliance.
Purpose of the Study
The purpose of the study is to determine the knowledge about voluntary counselling and testing for HIV/AIDS among Ebonyi State University undergraduates and to asses their level of compliance to testing.
Specific objectives of the study includes to;
- Determine the knowledge that EBSU undergraduates have about VCT for HIV/AIDS.
- Determine the level of compliance with VCT for HIV among undergraduates.
- Explore what prompts undergraduate to engage in VCT for HIV/AIDS.
- Identify factors that would make EBSU undergraduates use VCT services for HIV test.
Significance of the Study
Findings from this study will provide the following:
- Show the level of knowledge about VCT among EBSU undergraduates and show their compliance level to the test. It will also show students condition for compliance and factors that will improve VCT compliance. The university by this discovery may plan and introduce programmes that will improve students knowledge and compliance to VCT for HIV/AIDS
- When the result of this study is utilized by Ebonyi State and agencies concerned with HIV/AIDS, other strategies to improve student’s knowledge and compliance to VCT services will be incorporated into their programme so as to increase the prevalence of VCT. This will in effect lead to early detection and treatment of HIV clients.
- This study will spur other researchers to carry out further studies on the topic.
Hypotheses
The following null hypotheses were tested at 0.05 level of significance:-
- There is no significant association between gender and knowledge of VCT for HIV/AIDS of EBSU students.
- There is no significant association between campus location and knowledge of VCT for HIV/AIDS of EBSU students.
- There is no significant association between campus location and compliance to VCT for HIV/AIDS among EBSU students.
- There is no significant association between gender and compliance to VCT for HIV/AIDS among EBSU students.
Scope of the Study
The study is delimited to 200-500 level undergraduates of Ebonyi State University. One hundred level students were excluded from the study because most of them do not have class rooms.
Some of them have not fully settled with school registration requirement. Three campuses were used and include Ishieke, Presco and College of Agricultural Sciences. It covers their knowledge of voluntary counselling and testing for HIV/AIDS, compliance to voluntary counselling and testing services, factor that made them comply/not comply and under what condition those who received testing were tested.
Operational Definition of Terms.
Knowledge of VCT for HIV/AIDS
For this study knowledge is graded in levels according to the number of question answered correctly (< 3 – 5 correct answers poor level of knowledge, 6 – 8 correct answers moderate level of knowledge, 9-12 correct answers good level of knowledge). It will be assessed by respondents’ ability to:
- Accurately state what VCT for HIV/AIDS means
- Accurately recall one importance of VCT.
- Identify a body fluid that can be used for HIV/AIDS test.
- Identify the type of test used during VCT for HIV/AIDS
- State correctly, what is done during pre-test and post-test counselling for HIV/AIDS.
- State the time interval between each VCT visit.
- State the implication of a positive test result.
Compliance to VCT for HIV/AIDS
Compliance is graded as
- Partial compliance: those that did HIV test once.
- Moderate compliance: those that did HIV test more than once but at intervals above 6 months.
- Total compliance:- those that voluntarily received VCT services for HIV/AIDS 2 times and more at 3 and 6 months interval.
Voluntary counselling and testing
A confidential client/provider interaction that results in a client willingly offering to do HIV test.
Chapter Five
Discussion of Findings
This study investigated the knowledge and compliance of Ebonyi State University (EBSU) undergraduates to voluntary counselling and testing (VCT) for Human Immunodeficiency Virus (HIV) and Acquired Immune deficiency Syndrome (AIDS). Findings from the data presented are discussed in this chapter.
Findings from the study show that 69.9% undergraduates of EBSU have good level of knowledge of VCT for HIV/AIDS. This is contrary to the findings in similar studies in South east, Nigeria. Contrary to the finding that students have good knowledge of VCT for HIV/AIDS, Salami and Adenole (2004) discovered that there was no knowledge of VCT although people heard and are educated about HIV/AIDS . Ikechebelu, Udigwe, Ikechebelu and Imo (2006) discovered a low knowledge of VCT among students in southeast. The time interval between these studies that were contrary to the findings of this present study have shown the positive effect of numerous and multidimensional approaches/campaigns that improved knowledge of VCT for HIV/AIDS among students. This may be as a result of advancement in information and computer technology where young people spend more time these days. The increase in knowledge is attributed to the awareness programmes by the government and non-governmental organizations. Mulugeta (2003) noted the significant positive association of younger age to better access to information through institutional media, clubs and organizations.
Presco students also have opportunity of seeing clients with HIV disease often during clinical postings This may be attributed to their course of study that is health related.
More female students have good knowledge of VCT for HIV/AIDS than males probably because females take care of themselves than males. There was no association between knowledge and gender at 0.05 level of significance. Both male and female students are exposed to knowledge of VCT alike and no peculiar gender factor affects their knowledge. The study noted that more students (73.4) received information about VCT from school. This indicates that awareness campaign has been going on in E BSU at one time or the other (EBOSACA, 2009). Government and service providers should look inwards on factors that would make people comply to HIV test.
Only12.1% of the respondents totally complied to VCT services for HIV\AIDS. The study is in contrast to studies by Okpala, Ebenebe and Ibe, 2009; Adeneye, Salami, Mafe, Adeneye and Adewole, 2004 where use of VCT services increased especially with level of education. This is an indication that more effort is needed to encourage young people to go for HIV test. The good level knowledge of VCT services by more than half of the respondents did not reflect on their compliance. It may be as a result of fear of unknown as stated by Rachman 1990 in theory of fear. Ikechebelu et al, (2006); and Omoigberale, (2006) noted that knowledge does not guarantee compliance.
Only 4.2% of Presco students totally complied to VCT services for HIV/AIDS despite their health related course of study and clinical exposure. This may be because they are in the same environment where HIV tests are done and feels confidentiality may not be guaranteed. There was no significant association between male (3.9%) and female (8.1%) students that totally complied to VCT.
More than half of the respondents 57.5% complied to VCT services moderately and partially 30.4%. This is in line with Ikechebelu, et al 2006 that people go for HIV test just to know their status. Emphasis is that compliance to VCT services for HIV/AIDS should fall within WHO standard range for the sexually active group for early detection and treatment of HIV disease. Considering the asymptomatic nature of HIV disease at the initial stage, test should be consciously done and repeated appropriately for early diagnosis and treatment.
When trying to establish the conditions under which students complied to VCT for HIV/AIDS, majority (73.4%) did the test by their own volition . This is in line with Ikechebelu, Udigwe, Ikechebelu and Imo (2006) that students have taken HIV test at one time or the other willingly just to know their HIV status. Those that did HIV test as university requirement (45.1%) showed that not all the students complied to the school instructions. This presupposes that Ebonyi State University is not strict about the policy of undertaking HIV test as admission requirement; for when made compulsory will infringe on students right.
Confidentiality 78.7% was the most important factor that would make undergraduates use VCT services while availability of HIV treatment 22.3% has the least frequency among factor to consider for using HIV services voluntarily. Iliyasu et al 2005 affirms that individuals seem to prefer a contest for testing in which the health personnel do not know them and where confidentiality is assured. This goes to strengthen the need for youth friendly services and training of providers for quality services. The stigma on AIDS disease makes people run away from being identified with the disease. Structural adjustment in service centres and training of service providers should be the area of emphasis by programme providers as against cost, distance and availability of HIV treatment.
Summary and Conclusion
At one time or the other students have done voluntarily HIV test which is not in line with WHO recommendation of testing every 6months or 3months for the sexually active group
.This has made the effort of the government, and the other bodies that render HIV services futile considering that youths are the most vulnerable group to HIV infection. More than half of the respondents have knowledge of VCT for HIV/AIDS but very few totally complied to HIV test. Students went for HIV test majorly by their own volition.
Confidentiality was a major factor that would make students use VCT services for HIV test. Hence, there is need for service providers to ensure enabling environment that will improve the use VCT services for HIV test. The number of student that did HIV test by own volition and as medical prescription was high. This has shown that consistent and vigorous awareness campaigns will yield good results.
Suggestion for Further Studies
- The present study has provided useful information on knowledge and compliance of Ebonyi State university undergraduates to voluntary counselling and testing for HIV/AIDS. It is however most inappropriate to make definite conclusion on this single study. There is need therefore for a repeat study using the entire students in order to support the findings of this study.
- Similar study should be done using secondary schools in Ebonyi State so as to know how HIV preventive services available are utilized
Limitations of the Study
- The absence of classes for all the different levels (200 500) in a department posed a limitation to the researcher. A single hall was used by so many classes and after a class, the next group will rush in making it difficult to collect the research instruments.
- Many students were not willing to participate in the study as they said it is a waste of time.
- The students of non health related courses were reluctant and unwilling to be part of the study as some of the terms in the instrument were unfamiliar to them.
- This study may not be generalized since year one were not included in the study.
Implication of the Study.
- Health workers and HIV/AIDS counsellors should provide enabling environment to ensure that confidentiality and privacy is promoted since the study found that it improves compliance to VCT. Good attitude in work place will also not scare clients away from using VCT services.
- Detailed information on the importance of voluntary HIV test is important so that clients will understand and avail themselves the opportunity for routine tests. It will also prevent waste of resources, ensure early detection of HIV disease and treatment with consequent reduction in death rate.
Recommendations
To increase the compliance to voluntary counselling and testing for HIV/AIDS, the following recommendations were made:
- Service centres should be provided in educational institutions.
- Confidentiality must be ensured by service providers.
- University should include programmes that will increase the awareness to voluntary HIV test.
- Emphasis should be on health educating the public on the prevention of HIV infection.
- There should be a shift from clinic based approach to wide spread public model.
- Stigmatization of HIV victims should be discouraged.
- Church should intensify programmes to create awareness on the available VCT services.
- Youth friendly programmes should be accessible to increase participation.


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