ABSTRACT
The
prevalence rate of HIV infection has been onthe increase in Nigeria and half of
all new infectionsoccur among adolescent between the ages of 15-24 years old,
who mostly are in tertiary institution. Voluntary Counseling and Testing is a
strategy towards prevention and control of HIV. Despite findings high level of
awareness of the availability of VCT by adolescents and of willingness to
utilize VCT, utilization of this service is still low. In light of this, the
study aimed at assessing the relationship between sexual behaviour and
utilization of VCT.
This research
was a cross-sectional survey which was carried out among 357students of the
Port-Harcourt Polytechnic, Rivers state, Nigeria. A semi-structured instrument
(questionnaire) was used for data collection. Data collected were analyzed
using Statistical Package for Social Science (SPSS) version 21 with levels of significance
set at 0.05.
There were 125 males (35%) and 212
females (59.4%) respondents with a mean age of 16.96 ± 9.145. It was found that
respondents’ attitudinal disposition was below average (49.44%), this was
however determined to predict willingness of respondents to undergo VCT [df =
1; R2 = 0.024; P < 0.05].
The result revealed that despite willingness to undergo VCT by respondents was
high (81%) only 42% of the respondents voluntarily got tested for HIV. Sexual
behaviour of respondents was good (55.7%) however, data showed that only 43% of
respondents used condoms during sexual intercourse and also 62% practice sexual
relation with multiple partners. Major finding of the study found that sexual
behaviour of respondents had a 7.8% influence on their utilization of VCT [df =
1; R2 = 0.078; P < 0.05].
Further findings indicated that opinions of respondents significant others,
family and close friends in encouraging them to undergo VCT had an influence of
6.2% on utilization of VCT [df = 1; R2 = 0.062; P < 0.05] likewise was their control beliefs, which had a 1.7%
influence on their utilization of VCT [df = 1;R2 = 0.017; P < 0.05].
This study
concluded that adolescents’ sexual behaviour plays a pivotal role in
determining utilization of VCT among adolescents. This is inferred that
adolescents who are not sexually active despite having a high willingness to
undergo VCT may not see it deem fit to undergo VCT as such individual doesn’t
feel susceptible to infection of HIV, sexually active individuals however are
likely to undergo VCT with the perception of increased susceptibility to
infection. It was recommended that health intervention be aimed at improving
healthy sexual behaviour among students and also focused should be placed on
sexually active students on the importance of regularly seeking VCT. The
findings of this study will improve health promotion in identifying an
important factor to improving utilization of VCT.
CHAPTER ONE
INTRODUCTION
1.1 Background
to the Study
Since
the Human Immunodeficiency Virus (HIV) was first discovered three decades ago,
it is estimated that globally approximately 1.8 million adults and children had
died of Acquired Immune Deficiency Syndrome (AIDS)-related illnesses by the end
of 2010 (UNAIDS, 2010). In the same year 2010, it was estimated that there were
34 million people living with HIV globally, with the bulk, 22.9 million,
residing in Sub-Saharan Africa. Globally, adolescents bear the brunt of the
epidemic as they account for one third of currently HIV and AIDS infected
individuals and half of new infections of HIV globally (Dehne & Riedner,
2005; UNAIDS, 2011).
According
to the United Nations Joint Programme on HIV and AIDS (UNAIDS), 2.1 million
people were newly infected with HIV in 2013, and an estimated 35 million people
were living with the virus (UNAIDS, 2015; Wilson, Wright, Safrit & Ruby,
2011). It has since been dubbed as one of the greatest humanitarian and
development challenges facing the global community in recent times (Adekeye,
2010). Globally, there is an estimated 1.2 billion adolescents, constituting
18% of the world’s population (UNICEF, 2012). Available evidence shows that
about 2.2 million of these (60% of them, females) are living with HIV, and many
are unaware of their infection (WHO, 2016).
The
first case of AIDS was reported in Nigeria in 1986 in a sexually active
13-year-old girl as recorded by the Federal ministry of Health and Human
Services (1992). Since this first report, the prevalence rate of HIV infection
has been on the increase in Nigeria; from 1.9% in 1993 to 5.8% in 2001 and with
a decline to 4.6% in 2010 (NACA, 2011). In adolescents, 15-24 years rates
declined from 6.0% in 2001 to 4.1% in 2010. One third of currently infected
individuals are adolescents aged 15 to 24 years, and half of all new infections
occur in this same age (Dehne & Riedner, 2005). It was also estimated that
Nigeria accounted for the highest AIDS-related deaths in Sub-Saharan African
(Global Burden of Disease: Nigeria, 2010; UNAIDS, 2013).
One
reason for high prevalence rates is that most people are unaware of their HIV
status, Sekatawa (2000) revealed that75% - 80% of new infections came about as
a result of unprotected sexual contact with an infected person, attributable to
the low level of HIV testing among adolescents (Idele, Gillespie, Porth,
Suzuki, Mahy, Kasadde et al., 2014;
John, Okolo & Isichei, 2014; UNAIDS, 2013). It was estimated that less than 40% of the people in Sub-Sahara Africa
know their HIV status despite the fact that the present HIV intervention
packages depend on the knowledge of individual’s HIV status (Mbamara, Obiechina
& Akabuike, 2013).
The
rate of HIV and AIDS increase is very alarming amongst adolescents who are found within
the age brackets of 15 and 24 years especially among students of higher
institutions of learning who do not have knowledge of their HIV status (Kennedy
& Ibinabo, 2013; Schantz, 2012). Risky sexual behavior and alcohol
consumption has been regarded as the major health risk behavior engaged by
adolescents that predisposes them to infection of HIV (Elkington, Bauermeister
& Zimmerman, 2010; Nkansah-Amankra, Diedhiou, Agbanu, Harrod & Dhawan,
2011). Early initiation of sexual intercourse, sexual intercourse under the
influence of alcohol, unprotected sexual intercourse and multiple sexual partners
constitute sexual risky behavior exposing adolescents to several health
problems especially HIV infection (Baltazar, Conopio, Moreno, Ulery & Hopkins, 2013).
Knowing
HIV status of individual has been established to be the entry point to other
HIV services and an opportunity for individuals to learn not only their HIV
status but correct knowledge and also gain accurate risk perceptions, thereby
encouraging safer behavior, it helps the individual to make informed decision,
assess personal risk for HIV and further develop risk reduction strategy (WHO,
2010) however, barriers to HIV Voluntary Counseling and Testing (VCT) has been
revealed to include lack of awareness of available services, low perception of
personal risk, fear of negative consequences associated with a positive test
result (including stigma), concerns about confidentiality, financial burden of
testing, and lack of HIV and AIDS knowledge and this has immensely contributed
to willingness and utilization of VCT by adolescents (Idele, Gillespie, Porth,
Suzuki, Mahy, Kasedde et al., 2014;
Musheke, Ntalasha, Gari, Mckenzie, Bond, Martin-HIber et al., 2013; Oginni, Obianwu & Adebajo, 2014).
Studies
have revealed considerable reduction in risky sexual behaviors after
utilization of VCT (Arthur, Nduba, Forsythe, Mutemi, Odhiambo & Gilks,
2007; FHI, 2006; Kirakoya-Samadoulougou, Yaro, Deccache, Defer, Meda, Robert
& Nagot, 2013; Sherr, Lopman, Kakowa, Dube, Chawira, Nyamukapa et al., 2007; Wusu & Okoukoni,
2011), as suggested by Jansen, Holtgrave, Valdiserri, Shepherd, Gayle and De
(2001) that knowing individual’s HIV status can influence one to be more
carefully and adapt HIV preventive behaviors, such as faithfulness or
abstinence. Individuals with increased sexual behaviour perceived themselves at
high risk of infection (Singh, Lall, Gupta, Bose & Singh, 2014) and
according to Kitali, Mahande, Mosha, Kessy, Njau and Mushi (2013) it was gathered
that most participants who utilized VCT were sexually active and practice
multiple sexual partnership. However, it has not been established if an
individual’s sexual behavior predicts their utilization of VCT.
1.2 Statement
of the Problem
The National Department
of Health (NDOH, 2010) guideline explained that adolescent is particularly at
risk of HIV infection in
comparison to the adults. Studies have shown that half of all new HIV
infections are found more within adolescents aged between 15 and 24 years (Wusu
& Okoukoni, 2011) and that approximately 50% of HIV related
deaths reported among adolescents between year 2005 and 2012 were influenced by
inadequate friendly VCT services, poor prioritization of adolescent issues,
inadequate treatment and lack of support to the adolescents (Hopkins, 2012).
Africa’s young people aged 15–24 are disproportionately
infected and affected by HIV/AIDS. Nearly 4 million (UNICEF, 2011) Sub-Saharan
African youth currently live with the virus, and 20 countries in Sub-Saharan Africa
accounted for about 69% (UNAIDS, 2011) of all new HIV infections globally among
young people in 2009. HIV prevalence is more than twice as high among young
girls (3.4%) than among their male counterparts (1.4%) (UNAIDS, 2009)Across the
continent, HIV prevalence among young people varies considerably from less than
0.1% in Egypt (with its highly concentrated epidemic among injecting drug users
[IDUs] and Men who have sex with men (MSM) (Parker, 2007) to more than 25% in
Zimbabwe.
Nigeria and South Africa have the highest number of adolescents living with
HIV/AIDS, as many as 1.3 million in Nigeria and 1.9 million in South Africa
(UNAIDS, 2009). African youth have suffered disproportionately from the effects
of the epidemic. Millions have lost at least one parent to AIDS, eight out of
ten individuals orphaned by AIDS live in Africa, and an estimated 55% of all
AIDS orphans in the region are adolescents. (Biddlecom, 2007)
Over
the years, there have been unavailable
VCT clinics and especially in Nigeria,
there were no record of any VCT centers as far back as 2005 (WHO, 2005),
however, with the introduction of VCT clinics, Voluntary Counseling and Testing
became crucial for HIV prevention and considered a priority intervention for the
provision of comprehensive HIV and AIDS care, management, and treatment
.The
introduction, establishment, and
utilization of VCT services have since been reported to be low which might be
as a result of adolescents feeling less susceptible to HIV infections and other
factors that has been established to be associated with the spread of HIV (Gatta &
Thupayagale-Tshweneagae, 2012; Mwangi, Ngure, Thiga & Ngure, 2014).
Despite
findings from studies revealing high level of awareness of the availability of
VCT by adolescents and also the high level of willingness to utilize VCT,
utilization of this service is still low in Nigeria (Ikechebelu, Udigwe, Ikechebule & Imoh,
2006; Iliyasu Abubakar, Kabir & Aliyu, 2006; Onyeonoro, Emelumadu, Chuku,
Kanu, Ebenebe, Onwukwe et al., 2014).With
adolescents being at a stage of their greatest risk taking behavior, sexual
risky behavior is prevalent among them, predisposing them to infection of HIV
(Baltazar, Conopio, Moreno, Ulery & Hopkins, 2013. This has brought to
light the need for an exploration of individual’s sexual behavior as a factor
that influences the utilization of VCT which has been overlooked in recent
studies.
1.3 Objective of the Study
The
main objective of the study is to assess sexual behavior as a correlates of VCT
utilization for HIV among students of Port-Harcourt Polytechnic, in Rivers
State, using the components of the Theory of Planned Behavior. The specific
objectives are to:
- identify
the sexual behavior pattern of respondents;
- determine
the level of willingness of respondents to utilize VCT;
- assess
the attitudinal disposition of respondents towards VCT for HIV;
- identify
the effect of attitudinal disposition of respondents on their willingness
to utilize VCT for HIV;
- assess
the level sexual behaviour of respondents influences utilization of VCT by
respondents and
- find
the level of utilization of VCT by respondents.
1.4 Research Questions
- What
is the sexual behavior pattern of respondents?
- At
what level is the willingness of respondents to utilize VCT?
- To
what extent is the attitudinal disposition of respondents to VCT for HIV?
- How
does the attitudinal disposition of respondents affect their willingness
to utilize VCT for HIV?
- At
what level does sexual behaviour of respondents influence utilization of VCT
by respondents?
- What
is the level of utilization of VCT by respondents?
1.5 Hypotheses
Ho1: There
is significant difference in the sexual behavior of respondents across their
demographic characteristics.
Ho2: There
is significant difference in the level of willingness of respondents to utilize
VCT across demographic characteristics of respondents.
Ho3: There
is significant difference in the attitudinal disposition of respondents towards
VCT across demographic characteristics of respondents.
Ho4: There
is significant association between attitudinal disposition of respondents and
willingness to utilize VCT.
Ho5: There
is significant association between subjective norm of respondents and their
willingness to utilize VCT.
Ho6: There
is significant association between control beliefs of respondents and their
willingness to utilize VCT
Ho7: There
is significant difference in the level of utilization of VCT across demographic
characteristics of respondents.
Ho8: There
is significant relationship between respondents’ willingness and their behavior
in practicing VCT.
Ho9: There
is significant association between respondents’ sexual behavior and utilization
of VCT.
1.6 Scope of the Study
This
study focused on the sexual behavior of students as a correlate of Voluntary
Counseling and Testing Utilization for HIV and AIDS in Rivers-State; the
researcher has limited the research to the students of Port Harcourt
Polytechnic, Rumuola, Rivers state who falls between the ages of 15-24 years.
This was done because the institution provides the researcher with the
characteristics needed for the study in large number expected of the study.
A
cross-sectional design was used in this study, where a total of 370 students
participated in this study. Data was collected using a self-developed
questionnaire which was administered randomly among students of the
institution.
1.7 Justification for the Study
The importance
of VCT in the prevention and control of HIV and AIDS infection cannot be
overemphasized as it is an important strategy towards achieving the goal (Abebe
& Mitikie, 2009; Sebudde & Nangendo, 2009). An increase in the level of
utilization of VCT where adolescents can get tested and get ample information
on HIV prevention will help the reduction in new infections of HIV among
adolescents as they will be aware of their HIV status and inevitably engage in
healthy behaviors and take steps towards prevention of transmission. Also the relatively high levels
of sexual activity among adolescents demonstrate the need for educating young
people regarding safer sexual practices. This young population should have
access to Sexual Reproductive Health (SRH) services and youth-focused sexuality
education that goes beyond abstinence-only messages. (Population council, 2014)
Studies
have revealed a low level of utilization of VCT for HIV across the Sub-Saharan
African (Gatta et al., 2012; Mwangi, et al., 2014; Okiriamu, Onyango,
Odiwuor & Simatwa, 2013; Ramirez-Avila, Nixon, Noubary, Giddy, Losina,
Walensky et al., 2012) this has been
attributed to so many factors however, there is need to understand adolescents’
willingness to utilize VCT services using the Theory of Planned Behavior
(TPB) construct, exploring the
interpersonal and intrapersonal factors influencing the behaviour.
This study aims at
identifying the areas of adolescents component where focus need to be placed in
improving the utilizations of VCT services by developing an intervention guided
by the model employed from this study. This research will be of importance in
improving health and quality of life of adolescents and overall reduce
incidence rate of HIV in the country.================================================================
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