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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 10  |  Page : 52-56

Knowledge and uptake of HIV counseling and testing in faith-based school: Case study of REMI School, Gwagwalada, Abuja, Nigeria


Department of Community Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria

Date of Web Publication13-Feb-2018

Correspondence Address:
Mustapha Abubakar Jamda
Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_50_16

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  Abstract 


Introduction: HIV counseling and testing (HCT) is the entry point to HIV prevention, care, and support services, especially among the adolescent group who are very vulnerable. This study is to assess the knowledge and uptake of HIV counseling and testing (HCT) services among secondary school students in Gwagwalada, Abuja. Methods: A cross-sectional descriptive study was conducted using eligibility criteria in selecting the 89 students in the study. Information was obtained through the use of pretested self-administered questionnaires. Data were analyzed using SPSS software and presented in frequency and proportions. Results: Out of the 89 students surveyed, 45 (50.6%) were aware of HCT. Electronic media and friends/relations representing 33.3% each were the major sources of HCT information. Respondents had little knowledge of the purpose of HCT. A total of 78 (87.6%) were willing to be tested; the uptake of free HCT services offered was 5 (5.6%). Of the 11 (12.4%) not willing to be tested, 7 (63.6%) were afraid of positive result and 4 (36.4%) because of associated stigma. Conclusion: Despite 50.6% of respondents been aware of HCT and majority willing to have HCT, uptake of free HCT offered was 5.6%. HCT services should be extended to secondary schools as a matter of urgency to “catch them young.” Intensive awareness targeted at this group of youths should be carried out in environments they would be comfortable and free to accept the knowledge and services provided in adolescent-friendly manner to enhance uptake.

Keywords: HIV counseling and testing, knowledge, Nigeria, secondary school students, uptake


How to cite this article:
Adelaiye RS, Jamda MA. Knowledge and uptake of HIV counseling and testing in faith-based school: Case study of REMI School, Gwagwalada, Abuja, Nigeria. N Niger J Clin Res 2017;6:52-6

How to cite this URL:
Adelaiye RS, Jamda MA. Knowledge and uptake of HIV counseling and testing in faith-based school: Case study of REMI School, Gwagwalada, Abuja, Nigeria. N Niger J Clin Res [serial online] 2017 [cited 2020 Nov 26];6:52-6. Available from: https://www.mdcan-uath.org/text.asp?2017/6/10/52/225336




  Introduction Top


Since HIV/AIDS was first discovered in 1981, it has remained one of the most destructive epidemics recorded in history.[1] The disease affects people of all ages, depleting the gains made both in human and capital resources, especially in Sub-Saharan Africa. Africa remains the region mostly affected by the epidemic, with over two-third (67%) of all people living with HIV globally and for nearly three quarters (72%) of AIDS-related deaths.[2] Over 50% of all HIV cases globally are young people aged 10–24 years. Despite high vulnerability to HIV infection, HIV counseling and testing (HCT) uptake by young people is significantly lower than other age groups.[2],[3],[4],[5]

According to World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS, young people are much more prone to HIV infection as a result of lack of correct information, lack/reduced access to adequate reproductive health services, and indulging in risky behaviors. They tend to face greater challenges including economic exploitation, changing lifestyles, and the spread of sexually transmitted infections (STIs) and HIV/AIDS, unintended pregnancy, sexual abuse, and other preventable sexual health problems. About two billion people are between 10 and 24 years of age in the world, and about 85% of them live in developing countries.[6] The youths in Nigeria account for 32% of Nigeria's 160 million people and about 48.6% of adolescents aged 15–19 are sexually active. About 1 in 5 of sexually active females and 1 in 12 sexually active males in Nigeria had directly engaged in sexual intercourse by the age of 15.[7],[8],[9],[10],[11] The Joint United Nations program on AIDS reported that the rate of newly acquired HIV infections are the highest in the 15–25 years age group and that this group accounts for about 60% of the global total HIV infected persons.[12] Furthermore, the highest zero-prevalence rate of HIV in Nigeria is in this age group.[13]

The term adolescents, according to the National Youth Policy of Nigeria [14] and National Population Commission [15] documents in the country, are defined as persons between the ages of 12–18 years. According to Dr. Gottfried Himschall, director of WHO HIV/AIDS department, “adolescents face difficult and often confusing emotional and social pressures as they grow from children into adults and they need health services and support, tailored to their needs. They are less likely than adults to be tested for HIV and often need more support than adults to help them maintain care and to stick to treatment”. Adolescence is the period of transition from childhood to adulthood and this period lays a foundation for important aspect of life which includes establishing behavioral patterns and attitudes such as sexual behavior and health-seeking behavior. Early adolescence provides an opportunity for intervention in the sexual behavior of young adults before they become sexually active.[13]

Adolescents are an important risk group for HIV infection in Nigeria, as they constitute a large proportion of the population, therefore, the need for HCT. This group is particularly at risk of HIV infection because they experience early unprotected sexual debut, high frequency of sex usually with multiple sexual partners, high risk of sexual coercion and abuse, large age differences in relationship, peer pressure, and need to belong.[14] It is found that teenagers in the secondary schools are sexually active with many girls starting sexual intercourses soon after the onset of puberty. According to the National HIV/AIDS and Reproductive Health Survey conducted in 2007, 11.9% of young women and men in Nigeria have had sexual intercourse at <15 years of age.[16] Another researcher also examined sexual health decisions among students of some tertiary institutions in Lagos state, Nigeria, and the study showed that the age of sexual debut among the students was as low as 12 years. About 50% of those who had their sexual debut before age 16 years had it before 12 years, and 38% of this group has had STIs.[17]

Personal knowledge about HCT is very crucial to the perception of its importance and benefits. The main motivation for HIV testing is recent knowledge about HIV while poor knowledge about HCT serves as barrier to the uptake of HCT.[18],[19] This is supported by a study conducted among undergraduates in a polytechnic in the South eastern part of Nigeria, where inadequate knowledge of HCT was revealed to have a significant impact on how people access HCT services.[20]

HIV counseling and testing is one of the strategies used to control HIV/AIDS. It links clients to HIV/AIDS care and support and serves as a vital tool for HIV prevention. HCT is said to be the confidential dialogue between a person and a care provider aimed at enabling the individual to make a decision to have HIV test or not.[21],[15] It is known for its potential in empowering people through health promotion as well as a way to prevent secondary transmission; the knowledge of HIV status of an individual allows behavior adjustment with respect to the result.[22] Globally, the coverage of HCT programs remains low especially in countries with the highest HIV/AIDS burden.[16] Fewer than one in 10 people know their HIV status in most part of Sub-Saharan Africa.[23]

Very few Nigerians know their HIV status. This can place people at risk of becoming ill as they do not access timely HIV treatment and care. It also increases the risk of onward transmission to the sexual partners.[22] Many young people do not know their status. For example, in Sub-Saharan Africa, it is estimated that only 10% of young men and 15% of young women (15–24 years) know their HIV status, and in other regions, although data are scarce, access to HIV testing and counseling by vulnerable adolescents is consistently reported as being very low.[22] The HCT services targeted at adolescents may provide them the opportunity to access counseling, disclosure, negotiating safety, care, and support.[14]

This study was designed to find the level of knowledge of HIV counseling and testing (HCT) services and the uptake among students so as to improve the knowledge of the students on HCT services and utilization.


  Methods Top


The study used a descriptive cross-sectional design to explore the knowledge and uptake of HCT among secondary school students in Rural Evangelism Ministry International (REMI) College Gwagwalada, Abuja, Nigeria. The school is a faith-based coeducational boarding school with a population of 100 students, situated in Gwagwalada, which is about 60 km from Abuja, the capital city of Nigeria.

The school has a population of 100 students. Eighty-nine students that fulfilled the eligibility criteria were enrolled for the study. The quantitative method of data collection was adopted using a self-administered questionnaire. The questionnaires were administered to the pupils in October 2014. All questionnaires were retrieved immediately, checked for completeness and errors, and a coding guide was developed to facilitate data entry. The data were analyzed using IBM Statistical Package for Social Sciences for Windows, version 20, Chicago, Illinois, USA. The major variables analyzed are the background characteristics, knowledge of HCT services, and uptake of HCT.

Ethical consideration

Approval was sought from the school and other necessary authorities. The nature, purpose, and processes of the study were explained to the respondents and their guardians. Thereafter, written consent was obtained from respondents or guardians, where applicable. Assent was then obtained from respondents whose consent was given by their guardians (due to age). Respondents were assured of confidentiality, privacy, and anonymity of information. The names of the respondents were not recorded in the questionnaire. They were provided and given the choice not to partake in the study if they so desired and as many that agreed were recruited for the study.


  Results Top


Response rate was 100% as all of the 89 students aged between 12 and 20 years recruited responded. There were 49 (55%) males and 40 (45%) females. Most of the respondents were aged between 12 and 14 years, i.e., 42 (47.2%), followed by 15–17 years that were 39 (43.8%). The lowest proportion age group was 18 years and above that were 8 (9%). The mean age of the respondents was 14.67 years (1.99 years). Forty-seven (52.8%) were in junior secondary section, and the rest were in senior secondary section 42 (47.2%).

Knowledge and purpose of HIV counseling and testing services among respondents

Forty-five (50.6%) were aware of HCT while the remaining 44 (49.4%) were not. The main sources of information about HCT were radio/television and friends/relations each of which accounted for 33.3% of the respondents. The knowledge of pre- and post-test counseling, HCT confidentiality, and HCT services were 6 (6.7%), 10 (11.2%), and 12 (14%). Twenty-five (55.6%) respondents were aware that the main purpose of HCT was to determine HIV status as a gateway to access care. Other participants reported the following reasons: 18 (40%), to know about HIV test and confidentiality; 16 (35.6%), to counsel on risk of infection; 12 (25.6%), to know about the benefits of HIV test, and 13 (27.8%), to know the implications of the results.

Attitude toward HIV counseling and testing

Seventy-eight (87.6%) were willing to have HCT while the remaining 11 (12.4%) were unwilling as at the time of the survey. The preferred persons to whom client were willing to disclose their HIV test results, were parents 43 (65%) or relatives 12 (18.2%).

Uptake of HIV counseling and testing

The uptake of HCT services was found to be 5 (5.6%). Displays some of the reasons participants did not want to be tested as: fear of knowing they are HIV positive, 7 (63.6%); fear of other people knowing their HIV status, 5 (48%); sure of self's (negative) HIV status, 4 (36.4%), and lack of interest to know the status, 1 (9.1%). Sixty-six (74.5%) were willing to share their HCT results even if it test turns out to be positive; preferring to share with parents, 43 (65%); relations, 12 (18.2%); friends, 5 (8%); and 6 (9.5%) with others.


  Discussion Top


Adolescents are at high risk of contracting HIV infection because of their youthful exuberance, risky lifestyle, and the increased rate of new infections among their age group.[3] This study sets to determine the knowledge and uptake of HCT services among adolescents in a faith-based secondary school. Only about half of students are aware of HCT, which is lower than the two-thirds or more reported in other studies [24],[25],[26],[27] in similar settings. Gwagwalada is a semi-urban area, and probably awareness about HCT has not reached the majority of adolescents in the area, due to low coverage of sexuality education in our schools, poor communication with parents, and young age of the participants. This is re-enforced by the report that the major sources of information about HCT were electronic media and friends/relations, each reported by one-third of the participants, which is very low compared to other studies.[19],[28] It is interesting that friends/relations had the same level of contribution with electronic media. Unlike in most of the studies carried out, where electronic media plays a major role as source of information about HIV/AIDS and sexuality in general.[3],[27],[29] This may indicate that more communications about sexuality including HIV/AIDS take place between peers with attendant exchange of ideas. Knowing that peers are not desired source of information on sexuality for young people, because they may not have the correct information, there is need to increase education through parents/guardian, school system, and electronic media that have been documented to give a holistic information to young people.

Knowledge of HIV and HCT has been demonstrated to be important predictor of HCT uptake as shown by nationwide studies conducted in Nigeria.[29],[30] More than half of the participants having reported good knowledge of HCT indicate likelihood of acceptance and/or uptake of HCT if the test is made available. This could explain the high proportion of participants that reported willingness to be tested for HIV/AIDS.

Therefore, there is a need to design a method of HCT delivery appropriate for the young people of this particular age group, who hardly visit the hospital, to understand and access HCT services. These could be provided through the youth-friendly health services in their schools or recreation centers. Mobile HCT services could also be useful to encourage HCT uptake, as it has been demonstrated to be effective among the hard to reach populations including young people.[31]

About attitudes of respondents toward HCT, more than two-thirds willing to undergo HCT and is similar to studies reported in other studies around the country [25],[27] and outside the country.[25] However, lower results are also reported by some authors in Nigeria and Ethiopia.[27],[28] This may indicate possibility of high uptake of HCT services, if made available. Thus, poor uptake may not be entirely related to unavailability as recorded in some communities, where the main barrier was their negative beliefs or attitudes to HCT.

Another factor that might have contributed to nonwillingness to have HCT among some respondents is not knowing the location of HCT centers, most of which were located in hospital that offers provider-initiated against the client-initiated HCT services that are encouraged among young people who have rare attendance at hospitals.

The fear of positive HIV result reported as barriers to HCT in this study has also been reported elsewhere but at a lower proportion [2],[19],[28] or high as reported among adolescents in Ethiopia.[26] Stigmatization is known to fuel the fear of been HIV positive. However, despite the high proportion that reported fear of knowing their HIV status, fear of stigma or other people knowing the HIV status accounted for a very small proportion in this study. This implies that there may be other factors contributing to fear of knowing one's HIV status.[32]

The willingness to disclose HIV test results, even where positive was very high compared to what was reported in other studies.[26],[32] Similarly, preference to disclose HIV test results with parents rather than friends is higher than reported elsewhere and could be due to the young age of the respondents who are more likely to be dependent on their parents than adults, as reported in the other studies.[26]

The uptake of HCT services was only 5.6%. Similar findings kept recurring in earlier studies in Nigeria with 2% in a study in Northern Nigeria [19] and 33% in Southern Nigeria.[28] The difference in the HCT levels uptake between the regions may be related to the difference in educational, health, and socioeconomic developments of the two regions. The update has been demonstrated to be positively related to knowledge of HIV/AIDS and HCT, which is in turn related to educational and socioeconomic achievements that are reported to be higher in the southern part of Nigeria. The relatively low uptake of HCT among youths is also seen in Ethiopia with an uptake of 18.5%.[26] However, South Africa, another African country where acceptability was reported among over two-thirds, more half have been tested. This is probably due to the multitudes of HIV/AIDs campaign that has taken place in that country over the years and high number of HIV/AIDs patients in the community (affecting almost every household) leading to reduction in stigmatization and normalization of the epidemic.[25]


  Conclusion and Recommendation Top


Although about half of the adolescents were aware of HCT and majority were willing to be tested, only 5.6% have ever had HCT. Respondents' major sources of information on HCT were nonschool sources. This may imply that there is little HCT education been carried out by the school, probably due to religious preference for sexual abstinence.

As a matter of urgency, HCT education and services should be made available to the students, in the spirit of “catch them young”. These services should be specifically tailored at them to enhance acceptability.

Acknowledgments

We acknowledge the support of the clients that cooperated with the researchers during the survey and the management of REMI that gave the permission and supported us during the survey.

Financial support and sponsorship

Researcher's personal funds were used.

Conflicts of interest

There are no conflicts of interest.



 
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