Male Adolescents’ Knowledge, Perceptions And Attitudes Towards HIV / AIDS Prevention
Knowledge, attitudes and sexual behavior change towards HIV/AIDS remains a primary goal of HIV prevention efforts.HIV and AIDS is one of the leading health problems in Nigeria where nearly 7.1% of the population had been infected by the disease in 2012. Thus, the purpose of this study was to evaluate the male adolescents’ knowledge, perceptions and attitudes towards HIV/AIDS preventionin Ikot Ekpene LGA of Akwa Ibom. The objective of the study was to ascertain knowledge of HIV prevention, the sexual behavior, the beliefs and practices linked with sexual promiscuity,to assess how the knowledge on HIV/ AIDS, social conditions, attitudes and the sexual behaviors of youths influence their spread of HIV/ AIDS. The study used a descriptive research design. The target population was youths in Ikot Ekpene LGA. The data was collected from a sample of 371 youths who were selected through a stratified sampling technique. The data was collected using questionnaires with structured and unstructured questions. Data analysis was conducted through descriptive statistics.
The study found that 100% of the males had heard about HIV and AIDS. At least 80% of the males were aware of the major modes of HIV transmission, which include unprotected sex, sharing sharp objects, and blood transfusion. The study found that 44.7% of the males strongly agreed that if a member of their family was HIV positive, the information should remain secret. Moreover, 63.1% of the males strongly agreed that condom use education should be introduced in their schools and locale. The study found that 63.1% of the males had had sex at least once in their lifetime and 56% of them used a condom in their last sexual intercourse. Moreover, 81.1% of the males had gone for HIV tests. 53.8% of the males stated that having unprotected sex was the main adverse social condition that exposed them to the risk of acquiring HIV.
In addition, 27.1% were likely to acquire HIV/AIDS because of risky leisure activities such as drinking alcohol. The study concluded that the males lack accurate information/ knowledge on HIV/ AIDS. The quality of information about the disease among youths should be improved to prevent the spread of the disease. Youths’ sexual behaviors and social conditions also expose them to the risk of acquiring HIV/ AIDS. Thus, youths should be encouraged to use condoms and refrain from risky leisure activities such as drug abuse. The government in collaboration with the community should address the stigma associated with HIV and AIDS to enhance its prevention.
Table Of Contents
- Title page
- Certification page
- Table of content
- 1.1 Background of the Study
- 1.2 Statement of the Problem
- 1.3 Objectives of the Study
- 1.4 Research Questions
- 1.5 Significance of the Study
- 1.6 Limitations of the study
- 1.7 Scope of the Study
- 1.8 Definitions of Significant Terms
- 2.1 Introduction
- Conceptual Review
- 2.2 Knowledge of Youth about HIV/ AIDS and Prevention of the Disease
- 2.2.1 Knowledge, information Sources of Youth and Prevention of HIV and AIDS
- 2.3 Attitudes of Youth and Prevention of HIV and AIDS
- 2.3.1 Attitudes of the male towards Condom Use
- 2.3.2 Attitudes of the male towards VCT Services
- 2.4 The Sexual Behavior of the male and Prevention of HIV/AIDS
- 2.4.1 Condom Use and Prevention of HIV/AIDS
- 2.4.2 Uptake of VCT Services and the Prevention of HIV/AIDS
- 2.5 The Social Conditions of Youth and Prevention of HIV and AIDS
- 2.6 Theoretical Framework
- 3.1 Introduction
- 3.2 Research Design
- 3.3 Target Population
- 3.4 Sample size and Sampling Procedures
- 3.5 Research Instruments
- 3.5.1 Validity of the Instrument
- 3.5.2 Pilot Testing
- 3.5.3 Reliability of the Instrument
- 3.6 Data Collection Procedure
- 3.7 Data Analysis Techniques
- 3.8 Ethical Considerations
Data Analysis, Presentation, Interpretations, And Discussion
- 4.1 Introduction
- 4.2 Background Information of the Respondents
- 4.3 Knowledge of Youth about HIV/ AIDS and Prevention of the Disease
- 4.4 Attitudes of the male and their Participation in HIV Prevention
- 4.5 Sexual Behavior and HIV/ AIDS Prevention
- 4.6 Social Conditions of the male and HIV/ AIDS Prevention among the male
Summary Of Findings, Conclusions, And Recommendations
- 5.1 Introduction
- 5.2 Summary of Findings
- 5.3 Conclusions
- 5.4 Recommendations
1.1 Background of the Study
Since the first reported case of HIV/AIDS in 1981, the disease has had a devastating effect on all components of our society and has become the most deadly infectious disease epidemic in recent times. The disease is seen as a threat to the stability of entire nations and regions affecting the most productive members of the society. HIV/AIDS has become a global phenomenon, however the disease is most pronounced in developing countries particularly Sub-Saharan Africa. The spread of the disease has reached pandemic proportions in most parts of the African continent (Agyei-Mensah 2001).
The numbers of people infected with HIV keeps on increasing particularly among the young people. The estimated number of persons living with HIV worldwide in 2007 was 33.3 million. African continent alone had 22.5 million of the world’s estimated 33.3 million people living with HIV/AIDS (UNSAID/WHO 2007). UNAIDS estimates showed that young people under 25 accounted for about 45% of all new HIV cases (over 6800 people become infected with HIV everyday) in adults in 2007. The disease continues to ravage Sub-Saharan Africa and it remains the most serious of infectious disease challenges in Africa. The leading cause of death in Sub-Saharan Africa is HIV/AIDS (Tanaka, Kunii, Hatano&Wakai 2007).
HIV/AIDS has in the past decades had devastating effects on the maleful population, especially, youths by causing deaths and stigmatization. Prevention of HIV/ AIDS is critical for creating a healthy and productive population. According to WHO , 95% of the world population should have accurate knowledge about HIV and AIDS to prevent new infections. However, in low and middle-income countries only 24% and 36% of young women and men respectively have accurate knowledge about the disease. Lack of adequate knowledge prevents individuals from taking preventive measures such as using condoms to avoid acquiring HIV and AIDS.
A positive attitude towards HIV/ AIDS and the people living with it is required to enhance prevention. A positive attitude eliminates stigma and discrimination, thereby allowing individuals to go for HIV tests and seek medication. In the contrary, the negative attitude associated with the disease when it emerged in early 1980s still exists today. This is reflected in the stigma, fear, and discrimination that HIV/ AIDS patients face today. Individuals believe that HIV/ AIDS is a life threatening condition associated with death. They also associate the disease with behaviors that people disapprove such as homosexuality, drug use, sex work, and infidelity. The resulting increase in fear, discrimination, and stigmatization prevent individuals from going for HIV tests, disclosing their HIV status, and taking antiretroviral drugs . Reluctance to go for HIV test means that individuals are diagnosed late, making treatment less effective and increasing the likelihood of transmitting the disease.
According to , safe sexual behaviors should be adopted to prevent the spread of HIV/ AIDS. This includes avoiding unprotected sex, anal sex, and having multiple sexual partners. Risky sexual behavior is still an obstacle to prevention of HIV/ AIDS since only 51% of individuals aged 15-49 years use condoms in Sub-Sahara Africa, Middle East, and Latin America . Globally, risky behaviors such as anal sex, oral sex, and having multiple sex partners are still common in most countries. CDC 2012 notes that poverty is one of the major social conditions that promote the spread of HIV and AIDS in urban and rural communities. Poor people might not be able to access condoms, information about HIV/ AIDS, and antiretroviral drugs due to limited financial resources. HIV patients who are not able to meet basic housing needs often find difficulties in maintaining regular care and adherence to medication. This increases their viral load and chances of transmitting the disease to others. Family rejection is another social condition that prevents the spread of HIV/ AIDS.
According to UNAIDS , lesbians, gays, and bisexuals who are rejected by their families or caregivers are 3.4 times more likely to engage in risky sexual behaviors. Also, globally 34 million people were living with HIV at the end of 2011. An estimated 0.8% of adults aged 15-49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults (4.9%) living with HIV and accounting for 69% of the people living with HIV worldwide . The number of people infected by HIV and AIDS in Sub-Sahara Africa is five times higher than in South, Southeast, and East Asia. According to UNAIDS worldwide number of people newly infected by the disease continues to fall. However, the rate of decline varies across regions and countries with the Caribbean and Sub-Saharan Africa having recorded the highest decline rates of 42% and 25% between 2001 and 2011 (UNAIDS 2012). However, the number of new infections in the Middle East and North Africa has increased by over 35% between 2001 and 2011. Similarly, the infection rate has been increasing steadily in Eastern Europe and Central Asia since 2007(UNAIDS 2012). Overall, developed countries such as the US and Japan have the least prevalence of HIV and AIDS, whereas developing countries in Africa and the Middle East are the most affected. Developed countries have low prevalence rates because of access to advance and affordable health care services that have helpedto control the spread of the virus. In most African countries, the prevalence is high due to poor health care systems and lack of access to medication such as ARVs and services such as HIV testing and counseling. Cultural practices such as wife in heritance have also increased the rate of infection in Africa.
In the African region, the prevalence of HIV/ AIDS has either decreased or remained stable in most countries in the last five years. In Nigeria, the national infection rate has declined from 10% in the late 1990s to approximately 5% in 2011 , . The decline is attributed in part to the increase in the use of condoms among the sexually active youths and adults . In Uganda, the national HIV prevalence declined from 18.5% in 1992 to 5% in 2000 . The remarkable decline was achieved through a strong political leadership that encouraged sexual behavior change among the male to control the spread of the virus. Other causes of the decline included open discussions to share knowledge about HIV/ AIDS, as well as, a strong decentralized multi-sectoral and community response to the epidemic. By 2005, the prevalence rate had stabilized at around 6.4%. However, it rose to 6.7% in 2012 partly because of the government’s decision to promote abstinence only rather than safe sex as a prevention measure.
In Tanzania, the prevalence is high among the old age groups and women who have limited access to medication and information about the disease. Overall, Tanzania’s national prevalence rate is nearly 6.5% as at 2011 . Rwanda has a low prevalence of only 3%, with women having a higher infection rate than men as at 2010. Over 60% of the adult population has satisfactory knowledge about HIV transmission and prevention in Rwanda . In addition, the number of people going for HIV tests increased by 38% in 2010, thereby allowing the infected persons to seek medication in time. Somalia has the lowest prevalence rate of nearly 2%. However, knowledge of HIV transmission is poor and condom use is uncommon. The males (18years and above) are among the most vulnerable groups because of their risky sexual behaviors, attitudes towards prevention of HIV/ AIDS, and inadequate knowledge about the disease . Among the 15-19 years old, 70 percent are sexually active and the first sexual intercourse occurs before the age of 15 years among the girls. HIV/AIDS is mainly transmitted through sexual intercourse in the area . Thus, urgent intervention is needed to reduce the infection rate among youthful population.
1.2 Statement of the Problem
HIV/ AIDS remain one of the major health challenges that Nigeria is trying to deal with. The infection rate in the southern region is 26.3%, which is almost double the prevalence level. About 70% of 18-30 years olds are sexually active and the first sexual intercourse occurs before the age of 15 years among the girls . The fact that HIV and AIDs is mainly transmitted through sexual intercourse is well documented. In this regard, majority of the male in schools are at risk of being infected with HIV/ AIDS since they are sexually active. At least 95% of the male should have accurate knowledge about HIV and AIDS to prevent the spread of the disease. In Nigeria, the government has embarked on improving the knowledge of the male by introducing HIV/ AIDS education programmes in schools. This has increased the general awareness about HIV and AIDS among the male. However, the information that the male have is not accurate since they still hold myths and misconceptions about the disease. Lack of adequate and accurate knowledge prevents the male from taking preventive measures such as using condoms to avoid acquiring or spreading HIV/ AIDS.
The community is expected to develop a positive attitude towards the male living with HIV/ AIDS to prevent the spread of the disease. Accepting HIV positive youth is expected to eliminate stigma and discrimination, thereby allowing the male to seek HIV tests and medication. However, stigma, fear, and discrimination continue to limit the participation of the male in the prevention of HIV/ AIDS in Nigeria. Negative attitudes towards the male living with HIV/ AIDS increase fear, discrimination, and stigmatization, which in turn prevent the male from going for HIV tests, disclosing their HIV status, and taking antiretroviral drugs. This promotes the spread of the disease.
The males are expected to adopt safe sexual behavior to reduce their vulnerability to HIV/ AIDS. The government through its HIV/ AIDS awareness campaign programmes continues to sensitize the public including the male to avoid risky behaviors such as having unprotected sex. Nonetheless, the male still engage in risky sexual behaviors due to social and economic conditions such as poverty.
Social conditions such as poverty, gender inequality, and sexual violence should be addressed to prevent the spread of the disease. Gender inequality limits women’s ability to negotiate for safe sax with their partners. Pending the discovery of an effective vaccine, therapy, or curative treatment, reduction of risk-taking behavior is the only way through which the spread of HIV/AIDS pandemic can be arrested. In particular, the spread of the disease among the male in school can be prevented if they avoid risky behaviors such as having unprotected sex. Access to adequate and accurate knowledge about HIV/ AIDS can also enhance prevention. The males are likely to participate in the prevention of HIV/ AIDS if they have a positive attitude towards the disease. It is against this background that this study sought to evaluate the male adolescents’ knowledge, perceptions and attitudes towards HIV/AIDS prevention in Ikot Ekpene LGA of Akwa Ibom.
1.3 Objectives of the Study
The purpose of this study is to assess the male adolescents’ knowledge, perceptions and attitudes towards HIV/AIDS prevention in Ikot Ekpene LGA of Akwa Ibom State.Specifically, the study was guided by the following objectives
- To ascertain the knowledge level of youth on HIV/ AIDS in the prevention of HIV/AIDS in Ikot Ekpene LGA of Akwa Ibom State.
- To establish the extent to which the attitudes of youth determine their participation in the prevention of HIV and AIDS inIkot Ekpene LGA.
- To examine how the sexual behavior of youth determine their participation in the prevention of HIV and AIDS in Ikot Ekpene LGA of Akwa Ibom State.
- To ascertain the beliefs and practices linked with sexual promiscuity among youths in Ikot Ekpene LGA of Akwa Ibom State.
- To examine the extent to which the social conditions of youths determine their participation in the prevention of HIV and AIDS in Ikot Ekpene LGA of Akwa Ibom State.
1.4 Research Questions
The research answered the following questions:
- What is the level of knowledge of youths on HIV/ AIDS in the prevention of HIV and AIDS in Ikot Ekpene LGA of Akwa Ibom State?
- To what extent does the attitude of the male determine their participation in the prevention of HIV and AIDS in Ikot Ekpene LGA, Ikot Ekpene LGA?
- How does the sexual behavior of the male determine their participation in the prevention of HIV and AIDS in Ikot Ekpene LGA?
- What are the beliefs and practices linked with sexual promiscuity among youths in Ikot Ekpene LGA of Akwa Ibom State?
1.5 Significance of the Study
The high prevalence of HIV and AIDS estimated at 26.3%, creates a need for intense prevention efforts in the Nigeria and other regions with comparable infection rates . National surveys are usually very expensive to carry out. This study would provide valuable insights that may guide the target population in the process of preventing HIV/AIDS. Abstinence is the only prevention measure that can be taught in schools and institutions of learning, despite the fact that majority of the population becomes sexually active by the age of 18 years. Thus, the findings of this study would help the government through the ministry of education to adjust its policy concerning HIV/AIDS education in schools. Finally, studies that target the male population are scanty, and the existing ones are inconclusive. Thus, this study will contribute to the process of designing policies and programs that are geared towards the prevention and control of HIV/AIDS.
1.6 Limitations of the study
The main limitation of the study was that some respondents were reluctant to provide information about their sexual behavior. In this regard, the study used anonymous questionnaires to encourage the respondents to provide all the required information.
1.7 Scope of the Study
The study focused on the male adolescents’ knowledge, perceptions and attitudes towards HIV/AIDS preventionin Ikot Ekpene LGA of Akwa Ibom State. It was conducted using a survey research design and a sample of 371 participants selected from the study area. In this case, it was necessary to pay special attention to Ikot Ekpene LGA to understand the determinants of HIV/AIDS spread among youths (18-26), and youth participation in the prevention of the disease.
1.8 Definitions of Significant Terms
Knowledge of youth:
Is defined as a justified true belief. For one to have knowledge, three conditions must be fulfilled namely, the belief condition, the truth condition and the grounds/ justification condition.
Attitude of youth:
Can be defined as learned, relatively enduring dispositions to respond in a consistently favorable or unfavorable ways to certain people, groups, ideas, or situations. They may change and predict behavior. Therefore, attitude includes the affect (psychological arousal), behavior, and cognition (thoughts).
Individuals aged between 18 and 26 years for the purpose of this study
Prevention of HIV:
Refers to ensuring that there is controlled HIV incidence among the secondary school youth
Summary Of Findings, Conclusions, And Recommendations
This chapter will present a summary of the major findings of the study. The conclusions of the study will also be presented in this chapter. In addition, recommendations for improving the participation ofyouths in prevention of HIV will be made. The chapter will also highlight the study’s contribution to the body of knowledge and the areas for further research.
5.2 Summary of Findings
The study found that 100% of the males had heard about HIV and AIDS. The main sources of information about the disease included schools, youth clubs, health centers, and the mass media. These sources of information were used by at least 60% of the 371 youths who participated in the study. At least 80% of the males were aware of the major modes of HIV transmission, which include unprotected sex, sharing sharp objects, and blood transfusion. In addition, 91.9% of the males were aware that abstinence helps in preventing HIV infection. However, less than 20% of the males were aware that blood screening before transfusion, avoiding sharing toothbrushes, and instilling moral values could prevent HIV/ AIDS. Condom use was identified by 88.9% of the males as a means of preventing the spread of HIV/ AIDS. Other prevention measures that were identified by at least 50% of the males included being faithful to one uninfected sexual partner and not sharing sharp objects. However, only 43.7% of the males knew that wife inheritance could lead to HIV infection. Moreover, only 14.3% of the males were aware that female genital mutilation (FGM) can lead to HIV infection.
The study found that 44.7% of the males strongly agreed that if a member of their family was HIV positive, the information should remain secret. Similarly, 34.5% of the males agreed that the information should be treated as a secret. According to the findings of the study, 51.4% of the males strongly agreed that they were willing to share a desk with a classmate who is infected with HIV/ AIDS. In addition, 58.5% of the males strongly agreed that they would buy vegetables from an HIV/ AIDS infected vendor. Similarly, 20.8% of the males agreed that they would buy vegetables from an infected vendor. Majority of the males (63.1%) strongly agreed that condom use education should be introduced in their schools. However, 20.5% of the males strongly disagreed that the use of condom should not be taught in schools.
The study found that 63.1% of the males had had sex at least once in their lifetime. Majority of the sexually active youths (63.3%) had sex with their friends/ lovers in their last sexual intercourse. Although majority of the males were sexually active, only 6.7% of them had been infected with a sexually transmitted infection (STI). 96% of the males who had encountered STIs had been infected with gonorrhea, whereas 92% of them had been infected with syphilis. Furthermore, 12% of the males had been infected with HIV/ AIDS. Only 24% of the males who were infected with STIs sought medical treatment from health facilities. However, 12% of the infected youths bought drugs from chemists, whereas another 20% bought drugs from shops/ kiosks to treat themselves.
The study found that 67.9% of the males had ever used a condom. Moreover, 56% of the males used a condom in their last sexual intercourse. The main reason for using a condom (cited by 52.4% of youths) was to prevent unwanted pregnancies. Using condoms as a means of preventing HIV/ STIs was cited by only 41.9% of the males. The main reason for not using a condom was that the males had faithful sexual partners. This reason was given by 76.4% of the males who did not use condoms. Another important reason given by 47.3% of the males was unavailability of condoms. However, 20% of the males did not use condoms because they believed that condoms do not prevent HIV/ AIDS. The males obtained condoms from multiple sources. However, the leading sources were shops/ kiosks and government health facilities, which were used by 27.5% and 23.7% of the males respectively.
The study revealed that 81.15% of the males had gone for HIV tests. 73.8% of the males who had gone for HIV tests went for the tests because they wanted to know their HIV status. In addition, 67.1% of the males who had been tested went for the tests in VCT centers, whereas 35.5% of them went for the tests in government health facilities. Among the males who had not gone for HIV tests, 25% stated that they avoided the test because of the fear of the stigma associated with HIV. Another 25% of the males avoided the test because they assumed to be HIV negative, whereas 22.9% avoided the test because of the fear of knowing their status. Overall, 73.9% of the males had visited a VCT. The main things that youths liked in VCTs included good counseling services and ease of understanding the information given.
The study revealed that 66.6% of the males had encountered a social condition that exposed them to the risk of acquiring HIV. 53.8% of the males stated that having unprotected sex was the main adverse social condition that exposed them to the risk of acquiring HIV. In addition, 29.1% of the males were likely to acquire HIV because of lack of post exposure prophylaxis. Risky leisure activities such as drinking alcohol and smoking had been encountered by 27.1% of the males. However, poverty and peer pressure were considered adverse social conditions by only 10.5% and 15.4% of the males respectively.
The study shows that there is high awareness about HIV/ AIDs in general. However, the quality of knowledge that youths have about the disease is not perfect. Majority of the males have basic knowledge about the major modes of HIV transmission, as well as, the main methods of preventing the disease. However, majority of the males have inadequate knowledge about the cultural practices that can lead to HIV infection. In addition, they lack knowledge of important measures for preventing HIV/ AIDS such as blood screening before transfusion. In this respect, the quality of knowledge that youths have is not adequate to enable them to participate effectively in prevention of HIV/ AIDS.
The males have a positive attitude towards their colleagues and members of the society who are infected with HIV and AIDS. Moreover, majority of them believe that the use of condom should be taught in schools. Majority of the males are not willing to share information about their relatives who are HIV positive. This implies that fear, stigma, and discrimination against HIV patients in the community are barriers that prevent youths from participating in prevention of HIV/ AIDS.
The study shows that majority of the males are sexually active and most of them are using condoms. However, the main reason for using condoms was to prevent unwanted pregnancies rather than HIV/ STIs. Therefore, the males are at risk of being infected with HIV since they are likely to abandon using condoms if they find alternative contraceptives. The prevalence of STIs including HIV among the males is low. However, STIs are still a threat to youths’ participation in prevention of HIV because they increase the likelihood of acquiring the disease and most of those who are already infected hardly seek medical treatment. Although the uptake of HIV test is high, stigma and the fear of knowing one’s status still prevent some youths from going for the tests as a way of participating in the prevention of HIV/ AIDS.
Adverse social conditions also prevent secondary school youths from participating in the prevention of HIV/ AIDS. The social conditions that expose the males to the risk of acquiring the disease include having unprotected sex, lack of access to treatment after potential exposure to HIV, and having unprotected sex.
The following policy recommendations should be considered by the school administrators and the government to enhance prevention of HIV/AIDS among school going youth. First, the study revealed that youths did not have perfect or accurate information or knowledge about HIV/ AIDS. This problem should be solved by improving the quality of information about HIV and AIDS. This should involve consolidating accurate information about the disease and disseminating it through appropriate means such as formal class lessons, youth clubs, and health centers. This will help in eliminating the myths and use of incorrect information that is likely to expose youths to higher risk of infection.
Second, the study found that risky sexual behavior such as having unprotected sex is a problem that limits youths’ participation in prevention of HIV/ AIDS. In order to solve this problem, school administrators, parents, and the government should promote responsible behaviors among youths. Since majority of the males are already sexually active, the use of condoms should be promoted. In this respect, the use of condoms should be encouraged as a means of preventing HIV/AIDS rather than just avoiding unwanted pregnancies. Additionally, abstinence should be promoted among the male.
Third, riskyleisure activities such as drug abuse are also challenges that prevent the male from participating in the fight against HIV/ AIDS. Risky leisure activities should be discouraged since they expose the male to the risk of contracting HIV/ AIDS. In this case, counseling services should be provided to the male to discourage them from participating in risky activities such as having unprotected sex due to peer pressure or drug abuse.
Fourth, fear and stigma prevent the male from participating in the fight against HIV/ AIDS. Health policy makers/ the government should collaborate with the community to address the fear and stigma associated with HIV/ AIDS. This will improve the participation of secondary school youths in prevention of HIV/ AIDS through going for voluntary counseling and testing, seeking medication, and living positively in the event that one is infected with the disease. In addition, access to medication for STIs should be improved to enable the infected youth to avoid spreading or acquiring HIV. Similarly, access to post exposure prophylaxis should be improved to enable youths avoid acquiring the disease.
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