Knowledge and Compliance of Ebonyi State University Undergraduates to Voluntary Counselling and Testing for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)
Chapter One
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.
CHAPTER TWO
LITERATURE REVIEW
This chapter reviewed literature on knowledge and compliance to voluntary counselling and testing (VCT) for HIV/AIDS under the following headings:-
Conceptual Review
Mode of transmission of HIV infection
Prevention of HIV infection
Concept of voluntary counselling and testing for HIV/AIDS
Knowledge of VCT for HIV/AIDS
Compliance to VCT for HIV/AIDS
Factors that affect VCT services for HIV/AIDS
Conditions under which clients use VCT services for HIV/AIDS
Theoretical framework
Health belief model
Theory of fear
Empirical Review
Conceptual framework of the Study
Summary of Reviewed Literature.
Mode of transmission of HIV
Human immunodeficiency virus can be transmitted through sexual contact (penis to anus, vagina, or mouth), blood-to-blood (through transfusion or needle sharing in drug users), and mother to child transmission (MTCT). Heterosexual transmission has been noted world wild as the most common way HIV spreads to people (Azuogu, Ogbonnaya & Alo, 2011). Other methods of spread are accidental needle injury, artificial insemination by donated semen and kidney transplant. There is a progressive knowledge of the mode of transmission of HIV as evidenced by several studies. MTCT and sexual intercourse was known by many but few are not aware of the association between breast milk and HIV transmission (Elkanem & Gbadegesin, 2004). Despite the knowledge by pregnant women in the same study almost all would still prefer to breast feed their babies if they were found to be HIV positive.
Methods of preventing HIV spread
Basically an individual has to adopt safe behaviours that will reduce the spread of HIV whether a carrier or not. An infected person should alter his or her sexual lifestyle and prevent possible ways of transmitting the virus to protect others. An uninfected person should also adopt safer sex procedure to avoid becoming infected.
UNAIDS in 2004 defined “ABC” as a preventive slogan, which stands for Abstinence (not engaging in sex and delaying first sex).
Being safer by being faithful to one’s partner or reducing the number of sexual partners.
Correct and consistent use of condom.
It is a combination approach that can be adopted in context, population and stage of the epidemic. Each approach may be relevant to different people at different stage of their life. Other measures to prevent the spread of HIV is by not sharing needles and other sharp objects, avoiding sex with drugs users, screening of blood donors before transfusion.
Concept of Voluntary Counselling and Testing for HIV/AIDS
The nature of man is such that does not need control or compulsion no matter the purpose, even when it is to the persons benefit. When people are forced to choose a particular option, total submission may not be guaranteed and some of the people will have grudges within. Peoples’ initiated choices are received in good faith and total co-operation anticipated.
VCT is a package aimed at duly reducing the incidence and prevalence of HIV in a given population. According to Boswell and Baggaley (2002), it comprises of pre and post test counselling which enables the counsellee give informed consent to do a HIV test having fully understood what the test involves and what the test means. VCT for HIV/AIDS is the process by which an individual undergoes pre-testing counselling to enable him/her make an informed choice before being voluntarily tested for HIV (Okojie & Omume , 2004 and FMOH ,2003). Counselling and testing for HIV/AIDS is voluntary when there is willingness on the part of the individual to go through the process (pre-test, test and post-test counselling) after being informed of such test. Okojie and Omume (2004) noted that knowledge of HIV status through VCT can be a motivating force for HIV positive or negative persons to adopt safer practices; while it enables sero-positive people to take measures of reducing the risk of their transmitting the infection to people not infected, those who are sero-negative will remain so.
Azuogu, Ogbonnaya & Alo (2011) affirms that VCT enables people to receive confidential counselling ahead of testing, if they then decide to test, post-test counselling and on-going psycho-social support can be provided to help individuals take preventive measures, whether their result is positive or negative. HIV counselling is a confidential dialogue between a person and a caregiver aimed at enabling the person cope with stress and make informed personal decisions relating to HIV/AIDS (Chukwu, 2009 and FMOH, 2006).
CHAPTER THREE
RESEARCH METHODS
This chapter deals with the method the researcher used in the study. It was discussed under research design, area of study, population for the study, sample size, sampling procedure, instrument for data collection, validation of the instrument, reliability of instrument, procedure of data collection and data analysis.
Research Design
Descriptive survey design was used for the study. Descriptive surveys are used when investigating a pre-existing phenomenon. According to Basavanthappa (2007), it is often used to determine the extent or direction of attitudes or behaviour.
Area of Study
The study was conducted in Ebonyi State University, Abakaliki (EBSU). Ebonyi State is located South-East of Nigeria with Abakaliki as the capital city. The state has boundaries in the North with Benue state, East with Cross River, South- Abia state and West – Enugu state. Ebonyi state University is the only state University and has a permanent site and four other campuses in and near the capital city. They include; permanent site, Ishieke campus, Presco campus, medical college campus and college of Agricultural Science campus. Three campuses namely Ishieke, Presco and College of Agricultural Sciences were used for the study. While Ishieke campus is outside the city, the other two are located in the capital city.
Population for the Study
All students from 200-500 level full time undergraduates were the population of study and they comprise 16,127 students. (Source: Academic Planning Unit, Ebonyi State University, 2011). 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.
CHAPTER FOUR
ANALYSIS AND PRESENTATION OF RESULT
This chapter deals with the presentation and analysis of data collected from the research questionnaires. Three hundred and eight-four (384) copies of questionnaire were distributed and three hundred and eighty one (381) was returned (99% return rate). The responses were tallied and presented in frequency tables and percentages according to research questions.
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 Immunedeficiency 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.
REFERENCES
- Academic Planning Unit, Ebonyi State University (2011)
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