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ABSTRACT

This study was designed to determine the knowledge and attitude towards risk of acquiring HIV and use of voluntary counseling and testing in senior secondary schools Enugu. The study sought answers to five research objectives and tested five hypotheses. The population of the study consisted of one thousand, three hundred and fifty eight (1358) adolescent students. Sample size of four hundred and sixteen (416) senior secondary schools students in Enugu State were selected for the study; using stratified proportionate and simple random techniques. A validated researcher’s developed questionnaire consisting of Thirty seven (37) items questionnaire was the instrument used for the data collections. The instrument was validated by three experts and cronbach correlation reliability coefficient was used to determine the consistency of the instrument. The instrument yielded a reliability coefficient of 0.78. Frequency counts, percentages, mean statistics and standard deviation were used to answer research objectives while five hypotheses were tested using student t-test and chi-square at 0.05 level of significance. Findings revealed that a good number of the adolescents 359(66.1%), had poor knowledge of HIV/AIDS, the adolescents perceptions towards risks of acquiring HIV/AIDS was positive with frequency of 329(83.9%), attitude towards use of VCT was also positive with a means score > cut off point of 2.50, also the adolescent shows good use of VCT 208(53.1%).  Significant relationship existed between knowledge and utilization of VCT services among students (p<0.05),There was no significant difference (p>0.05) in the knowledge of HIV/AIDS between male and female students There was no significant relationship (P>0.05) between adolescent’s perceptions towards risk of acquiring HIV/AIDS and use of VCT services, There was no significant relationship (P>0.05) between adolescent’s attitude and use of VCT services. There was no significant (P>0.05) gender difference in the utilization of VCT services among adolescents in Senior Secondary Schools in Enugu. There was no significant relationship between knowledge and utilization of voluntary counseling and testing services among adolescents. The study concluded that Adolescents in senior secondary schools Enugu have poor knowledge of HIV/AID, showed high perception towards risks of acquiring HIV/AIDS, Showed good attitudes towards used of VCT services. The study recommended that HIV/AIDS should be taught in class for young people like every other general subject in order to improve the knowledge, Adolescents should be provided with a VCT service at their schools, with trained peer educators to increase access to the same service for the school age population and Adolescents and parental VCT information sharing should be encouraged and strengthened, so that adolescents can learn from their parents without fear.

CHAPTER ONE

INTRODUCTION

          Background to the Study

AIDS stand for Acquired Immune Deficiency Syndrome. AIDS is a pattern of devastating infections caused by the Human Immunodeficiency Virus (HIV), which attacks and destroys certain white blood cells that are essential to the body’s immune system.  It has been established that more than 70% of people who have contacted HIV live in sub-Saharan African (UNAIDS,2007).Nigeria has entered a stage where the epidemic could increase at an exponential rate unless adequate national and regional responses are mounted to stem the spread of HIV/AIDS. In an attempt to eradicate HIV, there is a need to educate people on risk behaviors, most especially the adolescents who are very sexually active. A study has it that adolescents  and young adults are in the Centre of the epidemic, because young  people ages 15-24 account for approximately half of new adult HIV/AIDS infections and 28% of the global total adults living with HIV/AIDS, (Kaiser Family Foundation, 2012).It was also confirmed that adolescents are at the Centre of the HIV/AIDS epidemic in terms of rates of infection, vulnerability and of the 1.5 billion young people worldwide, 11.8 million are estimated to be living with HIV. (United Nations Population Fund, 2013). Secondary schools students’ behavior towards HIV/AIDS has been found to been very poor. Cynthia (2013) in a study found out poor attitude of adolescents toward HIV/AID. It is also reported that every day between 5,000-6, 0000 young people (ages 15-24) contract   HIV and that many of them still lack comprehensive and correct knowledge about how to prevent the infection. In HIV, eradication, knowledge is very important. (WHO 2012) However, Diclement, et al (,2008), also reported a poor  correlation between knowledge and sexual behavior since knowledge have been clear enough to assess for HIV/AIDS, the study showed that people practice unsafe sex despite their knowledge of HIV/AIDS. Knowledge essentially is the recall recognition of specific and universal elements in a subject area. In the context of HIV/AIDS, having knowledge implies ability to recall facts concerning causes, transmission, prevention, concerning HIV/AIDS (Adegbola, et al, 2007). It is expected that when one has the knowledge of HIV/AIDS, the accompanying behavior would be logical. That is having the knowledge of prevention, transmission and other facts would motivate logical safe sex behavior.

In relation to HIV/AIDS the possibility that the possession of adequate and correct knowledge is highly correlated to preventive efforts is a strong motivating factor in most educational projects since it is assumed that knowledge will help to overcome fear, denial and also contribute to behavior modification. The power of increased knowledge to motivate logical sexual behavior to reduce HIV infection and modify sexual behavior change constitutes the crux of most HIV/AIDS education campaign. The ongoing and past HIV/AIDS programmes have provided information and education on radio and television while other primary prevention, intervention have continued all over the different South East States. The process of provision of information and education is based on assumption that youths would practice safe sex be (WHO, 2014). However it seems there is lack of balance between the knowledge of HIV/AIDS and the advancement in sexual behavior of many youths. According to National Aids Reproductive Health Survey NARHS, (2012), accurate knowledge on key basic information on HIV/AIDS which is the pre-requisite for taking preventive and care actions was generally low. There is a relatively low level awareness of HIV/AIDS as observed among the adolescent population in Nigeria, (Ogundana,2009).However Ogundana reported that a quarter of respondents acknowledged that they often had unsafe sex with high risk partners. The findings of Adedimeji, (2008), revealed that a 100% awareness rate was available among respondents. However Adedimeji reported that among those who are aware of the consequences of HIV infection, no serious preventive efforts are taken towards avoiding infection for instance, while almost all those interviewed acknowledged the efficacy of the Condom as a barrier method for infection, less than 20% of male and 5% of female mentioned, did not use condom in sexual encounter with someone they are meeting for the first time. Omorepie (2010) reported that majority of youths are aware that HIV/AIDS exist, there exists an underestimation of personal risk. Osho and Olayinka, (2009), knowledge of correct routes for HIV transmission appears to have played a role in condom use frequency. To some extent Osho and Olayinka, (2009) reported that knowledge of HIV/AIDS is being put into practice in south west Nigeria through condom use. Odu, (2006), found a high level of knowledge of risk reduction of HIV/AIDS and HIV testing in Nigeria. Olawale, (2011), opined that perception, thinking pattern, attitude and belief about an issue can have an impact on observable behavior. It could be seen therefore that knowledge and perception of individuals should be taken into consideration in determining the sexual behavior. Perception of being at risk for HIV/AIDS  and utilization of Voluntary counseling and testing is an effective and pivotal strategy for both HIV/AIDS prevention and care, and it is also a principal entry point to care and support for people living with HIV/AIDS. VCT help HIV negative people make informed Choices when engaging in sexual intercourse, such as having single partner or using a condom. There is strong evidence that voluntary HIV counseling and testing can affect sexual behaviors and a multi-country trial suggested that VCT is cost- effective and efficacious in promoting behavior change, particularly in high HIV prevalence setting and VCT can even lower HIV incidence rates (Allen, et al, 2007). Also adolescents view themselves as being unique and as such immune to disease and death, there thinking is that something bad will happen to someone else, not me, (WHO, 2013). In the case of HIV/AIDS, adolescents may view others as being vulnerable to the disease while they are invulnerable,this personal fable can lead the adolescent to engage in risky behaviors. Macphail,etal (2008) study HIV voluntary counseling and testing on adolescent in south Africa, the study showed that adolescents were afraid of knowing their HIV status and felt that testing was only for symptomatic individuals, the study also reported that youth avoids screening because they are afraid of stigma and discrimination that may emanate from the community, the study recommended that voluntary counseling and testing services should be youth friendly.   The use of VCT services by young people hasshowed also to be limited, and under-used primarily due to the issues such as lack of confidentiality, cost of services and unfriendly attitudes of clinical staff (UNFPA, 2013). This research therefore, aimed at assessing knowledge and attitude towards risk for acquiring HIV and utilization of VCT on the prevention of HIV/AIDS among adolescents in senior secondary school students in Enugu. 

 

          Statements of the Problem

Knowledge, positive or negative attitude towards risk for acquiring HIV/AIDS and utilization of Voluntary counseling and testing is an effective and pivotal strategy for both HIV/AIDS prevention and care, and it is also a principal entry point to care and support for people living with HIV/AIDS.   There is strong evidence that voluntary HIV counseling and testing can affect sexual behaviors and a multi-country trial suggested that VCT is cost- effective and efficacious in promoting behavioral change, particularly in high HIV prevalence setting and VCT can even lower HIV incidence rates (Allen, et al., 2007)

Knowledge, attitude towards risk of acquiring HIV and voluntary counseling and testing (VCT) has been identified as a critical   intervention tool in HIV prevention and care strategies. Voluntary Counseling and Testing (VCT) provides an opportunity for one to know his/her HIV status after receiving enough information to make the decision. A study by Allen, et al. (2007) had shown that VCT has been useful in facilitating and sustaining behavior change. Abraham, Gloria and Tshweneagae (2012) in a study, Adolescents’ knowledge and attitudes towards VCT services  revealed clearly indicated needs for a more accessible voluntary HIV counseling and testing services for adolescents.

According to the World Bank (2013), senior secondary students in Africa are at high risk of contracting HIV/AIDS because of high-risk activities such as “unprotected casual sexual practices with multiple partners. The use of VCT services by adolescents has also been limited, and under-used primarily due to the issues such as lack of confidentiality, cost of services and unfriendly attitudes of clinical staff (UNFPA, 2010). However, it has been observed that utilization of VCT services in conventional health care setting has been limited. This is especially in the case for hard to reach targets such as adolescent.The researcher observed the following problems; that the knowledge of HIV/AIDS and perceptions of risk of acquisition among adolescents has not been clearly established in this group. There is limited information about utilization of voluntary HIV/AIDS counseling and testing services among youths especially the adolescents. Therefor there is need to investigate the level of HIV/AIDS awareness as well as the attitudes towards use of VCT services among the adolescents in this area. It is against this background that the researcher intends to conduct a study on knowledge and attitude towards risk for acquiring HIV and voluntary counseling and testing among adolescents in senior secondary schools students Enugu. There is no such study in nursing literature in Nigeria. The present study will therefore provide baseline data for any intervention program me and for further studies.

 

Purpose of the Study

The purpose of the study is to investigate knowledge and attitude towards risk for acquiring HIV/AIDS, and utilization of voluntary counseling and testing (VCT) services among adolescents in senior secondary schools, in Enugu North Local Government Area.

 

Objectives

The specific objectives for the research are to:

1. Assess the knowledge of HIV/AIDS among adolescent.
2. Determine adolescent perception towards risk of acquiring HIV/AIDS.
3. Determine adolescents’ attitude towards use of VCT services.
4. Determine adolescent’s use of voluntary counseling and testing services.
5. Establish the relationship between knowledge and utilizations of voluntary counseling and testing services among adolescents.

 

Research Questions

1. What is the level of knowledge of HIV/AIDS services among adolescents?
2. What are the adolescent perceptions towards risk of acquiring HIV/AID?
3. What is the attitude of adolescents towards use of VCT services?
4. What is the level of use of VCT services among adolescents?
5. What is the relationship between knowledge and use of VCT services on the prevention of

HIV/AIDS among adolescents in senior secondary schools Enugu?

 

Hypothesis

1. There is no significant difference in the knowledge of HIV/AIDS between male and female students.
2. There is no relationship between adolescent’s perceptions towards risk of acquiring HIV/AID and use of VCT services.
3. There is no relationship between adolescent’s attitude and use of VCT.
4. There is no significant gender difference in the utilization of VCT services among adolescents in senior secondary schools Enugu.
5. There is no significant relationship between knowledge and use of VCT services in the prevention of HIV/AIDs among adolescents in senior secondary schools Enugu state.

 

Significance of the Study

The findings from the present study will provide information about the adolescent knowledge level; this will help the community health nurses to design health promotion interventions on increased risk of acquiring HIV/AIDS, if the knowledge is poor. This will help in bringing a desired behavioral change in the adolescent risk sexual behaviors, Assessing the knowledge and attitude towards risk of acquiring HIV/AIDS is important as perceptions of being at risk will help to increase the use of voluntary counseling and testing services of the adolescent.

The findings from this study if published, and made available will also provide information which will be of immense benefit to the community health nurses and public health nurses to improve the level of awareness and preventive measures through school health programs, community mobilization and public health education, it will also provide information for future research and education in adolescents sexual health behaviors.

 

Non-governmental organization would also find this study useful in designing health education campaign on the benefits of VCT services utilization to individuals at risk particularly, adolescents.

 

 

Scope of the Study

The study was delimited to senior secondary schools students in SS1, SS2, and SS3 students in Enugu North Local Government Area where the study was executed. It was also delimited to knowledge and attitude towards risk for acquiring HIV and voluntary counseling and testing among adolescents in senior secondary schools students Enugu.

 

 

Operational Definition of Terms

Adolescents: means senior secondary schools students in SS1, SS2, SS3 aged 15-24 years in Enugu, Nigeria.

Perception towards risk of acquiring HIV: Students’ attitude towards perceiving themselves as susceptible to HIV infection. Students were considered to have information about risk if they had been exposed to at least one of the conditions like having sex without condom, having sex with prostitute, having sex with HIV infected person and having injury with HIV infected sharp materials susceptible to HIV infection.

Attitude towards HIV: adolescent feeling towards HIV/AIDS. It is an internal condition which is influenced by importance attitude to its human behavior. It varies according to the importance people attach to issues. Consequently, adolescent’s attitude towards HIV/AIDS prevention may be guided by the importance attached to it.

Voluntary counseling and testing (VCT): is a process by which an individual undergoes counseling to enable him/her to make informed choices about being tested for HIV.

Attitude towards voluntary counseling and testing: Adolescents behavior, feelings towards use of VCT.

Utilizations of voluntary counseling and testing: is a process by which the adolescents uses HIV/AID counseling and screening services to know there status.