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PSYCHO-CULTURAL VARIABLES PREDICTING ATTITUDE OF STUDENTS’ TOWARDS HIV COUNSELLING AND TESTING IN SELECTED TERTIARY INSTITUTIONS IN LAGOS STATE, NIGERIA. Olujide Adekeye, Augustine Ebiai and Sussan Olufunmilola Adeusi Department of Psychology, Covenant University, Ota, Nigeria E-mail: oadekeye@covenantuniversity.com, aebiai@yahoo.com, funmiswayas@yahoo.com

Abstract The aim of the present study was to assess attitude of young people (n=287, mean=20.5 years) towards testing for HIV/AIDS. The participants completed a standard socio-demographic questionnaire, indicating sexual behaviour, cultural beliefs and practices, attitude to HCT, and knowledge of HIV/AIDS. Descriptive and inferential statistics at 0.05 alpha level were used to analyze the data. The study indicates that most participants have poor knowledge of HCT centres in their communities, but had a fairly high knowledge level of HIV. The findings of this study include that there is a significant difference in the disposition to HCT between respondents who have experienced sexual intercourse and those who have not (t = 3.866, df = 285: p<0.05) and between male and female respondents (t = 4.775, df = 285; p< 0.05). The study also shows that knowledge of HIV/AIDS was the strongest predictor of attitude of young people towards HCT ( = 0.547; t = 3.458 p<0.05), closely followed by cultural practices ( = 0.324; t = 2.740 p<0.05) while sexual behaviour was not a strong predictor ( = 0.041; t = 0.543 p>0.05). The present study challenged the adequacy of reproductive health knowledge available to Nigerian students and based on the findings in this study, it was recommended that young people should be sufficiently enlightened and counselled on the imperative of HIV counselling and testing. Keywords: HIV counselling and testing (HCT), young people, attitude, knowledge of HIV/AIDS Introduction Infection with human immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) remains a major global threat to good health. HIV/AIDS cases have been reported in all regions of the world, it is become a major health issue in Nigeria (HDR, 2004; Adekeye, 2005). Most people living with HIV/AIDS (95%) reside in the low- and middle-income countries, where most new HIV infections and AIDS-related deaths occur (UNAIDS, 2006). Young people between ages 15 and 24 years are at risk on an unparalleled scale (UNESCO, 2006; UNICEF, UNAIDS, WHO, 2002). It is estimated that about 3.8 million people are living with HIV in Nigeria, which implies that one out of every seven Africans living with HIV is a Nigerian. According to a recent estimate, almost 16,000 new infections occur everyday in the world, 90 percent of which occurs in Africa (UNAIDS 2007). Young people constitute an important segment of the world’s total population and 5060% of new cases of HIV are among this group. Although issues surrounding young people are multifaceted, the study focused on some psycho-cultural variables such as knowledge of HIV/AIDS, cultural influence and sexual behavioural disposition of young people to predicting their attitude to HIV counselling and testing (HCT). The terms young people and adolescents are used synonymously in this study to refer to people between 15 and 24 years. The World Health 431

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Organization (WHO, 2002) defined adolescents as those between one year and 19 years and youths as persons between 19 and 24 years. For the purpose of this study, adolescents refer to those between ages 15 and 24 years. Therefore, the terms adolescents, youths and young people are be used interchangeably. Statement of Problem Due to their vulnerability, young people encounter numerous psychological, social and economic obstacles, and because of the inability of government, parents and other significant persons to monitor the population under consideration in this study, some resort to prostitution, armed robbery, thuggery, bullying and engaging in careless and risky sexual behaviours. HCT is therefore indispensable in the fight against HIV/AIDS as a first step in reducing the incidence of HIV/AIDS in Nigeria. It is widely recognized by policy makers, health practitioners and human rights advocates alike that the low uptake of HIV testing and counselling is a major challenge in the response to the epidemic that needs to be urgently addressed (UNAIDS 2007). Although studies have shown that young people are especially vulnerable to HIV (Adekeye, 2009; HRD, 2004 and UNAIDS, 2006), some other studies (Abogunrin, 2004; UNAIDS, 2006 and WHO, 2006) equally point out that they have enormous potential for changing the course of the epidemic. Young people are particularly at risk of HIV infection because they are in the transition phase of their life, coupled with their feeling of invincibility while experimenting with sexual experiences (Adekeye, 2005; Adegoke, 2004; Tavoosi, Zaferani, Enzevaei, Tajik & Ahmadinezhad, 2004). Studies conducted on young people in Nigeria shows that sexual experimentation and increase in sexual activities are at the maximum during this period (Adekeye, 2009; Adegoke, 2003; Olatunji 2000; Araoye and Fakeye, 1998; Oladele, 1994). The combination of adolescent risky sexual

behaviour with often a lack of both information and access to services makes young peoples’ attitude to HCT a research priority. The present study in Lagos, Nigeria covered young people between 15 and 24 years. This study aims to explore the uptake of HCT, knowledge of HIV/AIDS, influence of culture and sexual behaviour of this group and how these variables predict their attitude towards HCT. Literature Review Based on available literature (Adekeye, 2009; HDR, 2004; Simbayi, Shisana, Chauveau & Ramlagan, 2003; UNICEF, 2006, 2007 and WHO, 2007) there is no gainsaying the fact that HIV is a generalized epidemic affecting all segments of the society especially young people. It has been documented that HIV is ravaging the lives of the younger population due to features such as sexual experimentation and the general belief of invincibility (Adekeye, 2005; Adegoke, 2004). Also, Akinboye (1985), Noel (1988) and WHO (2003) reported that since adolescence is a period of intense sexual drive and experimentation, they constitute a vulnerable group at great risk of contracting HIV. Araoye & Fakeye (1998) reported on the prevalence of STI among young people, especially university students in Nigeria. UNDP (1997) reports that among all age groups in the United States of America for example, girls aged 15-19 years have the highest incidence of gonorrhea among females and boys aged 15-19 years with the second highest incidence among males. All these point to the fact that young people are the most vulnerable group to sexually transmitted infections including HIV/AIDS. Young people are perhaps the most important group in a given society and going by their features and population; they are a country’s most valuable future assets (UNFPA, 2003). Grubman and Oleske (1996) noted that in subSaharan Africa, 75% of all new cases of HIV infection occur in individuals below 20 years of

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age. They compare this with data from the United States and reported that relatively in the US, an analysis of the age of acquisition of HIV fell from over 30 years in 1980 to 25 years during the period between 1987 and 1991 and that during that time, 25% of newly infected people were under the age of 22 years. Papalia, Olds & Feldman (2001), Rwenge (2000) and Toroitich-Ruto (2000) all agree that the rate of adolescent sexual behaviour, especially risky sexual behaviour, was fast becoming a public health concern. Culturally, information about sexuality more often than not is unavailable to young people. It is traditional to protect young people from receiving education on sexual matters in the false belief that ignorance will encourage chastity (Ransome-Kuti, 1996). Many parents prefer to remain silent on issues relating to sexual behaviour, dating, sexual intercourse and contraception. They tend to ignore the fact that young people, due to their inquisitive minds, will get answers from other sources such as peers, the media, older adolescents, and magazines among others (Adekeye, 2005). Amazigo, Silva, Kaufman & Obikeze (1997) note that reproductive health information is not always readily available to adolescents in Nigeria while Hottois, (1972), Bamigboye, (1987), Amazigo et al., (1997) and UNAIDS, (1998) advocate the need for information to be made available to this category of people. Vulnerability to HIV/AIDS is systematically patterned to render some young people more likely to be infected than 1. others. Gender, socio-economic and cultural status, sexuality and age are important factors structuring such vulnerability, and the perception of risk and high knowledge about HIV/AIDS do not necessarily translate to behaviour change (Toroitich- Ruto, 2000).

million people in the world who are infected with HIV were infected between the ages of 15 and 24 (UNAIDS, 2009). Persons in this category are young people and they constitute an important segment of the world’s total population. Among the new cases of HIV, 5060% are young people. This establishes the fact that young people are in the centre spread of the HIV/AIDS epidemic. A total of 287 respondents were included in the study: 166 (58%) males and 121 (42%) females. The mean age was 21years. Research design The survey method was employed as the research design for this study. According to McQueen & Knussen (2006), the survey method helps to collect data from large numbers of participants on a particular topic and may involve self-report questionnaires or highly structured interviews. To achieve the objectives of this study, three research questions and three hypotheses were raised. The research questions are: 1. Do young people understand what HIV connotes, means of transmission, prevention and the sources of HIV information? 2. Are the participants sexually active? 3. Do young people possess adequate knowledge of HCT centres in their communities? Hypotheses there will be a significant difference in the disposition to HCT between respondents who have engaged in sex in the last six months and those who have not there will be a significant difference in the disposition to HCT between male and female respondents there will be a significant combined contribution of knowledge of HIV/AIDS, sex and age in the prediction of attitude of young people towards HIV counseling and testing (HCT).

Method Population The target population for the study is all young persons in tertiary institutions in Lagos State, Instrument Nigeria. It is estimated that half of the 33.2 433

JORIND (9)1 June, 2011. ISSN 1596-8303. www.transcampus.org/journals. www.ajol.info/journals/jorind

The instrument titled Questionnaire on HIV Counselling and Testing (QHCT) was adapted from Questionnaire on HIV VCT (QHVCT) by Adekeye (2009). A split half reliability was conducted and the correlation coefficient yielded between .78 to .86. the QHCT has two sections- A and B. Section A deals with the demographic details of the respondents such as sex, age and sexual activity, while Section B contains the four research trajectories that make up the Questionnaire on HIV CT (QHCT). The four trajectories are: 1. 2. 3. 4. Youths’ Sexual Behaviour Scale Cultural Practices and Beliefs Scale Attitude towards HIV/AIDS Scale Knowledge of HIV/AIDS Scale

statistic and regression analysis and a P-value of 0.05 was considered as significant. Results Table 1 shows the general knowledge of HIV/AIDS measured on four levels viz knowledge, routes of transmission, how to prevent the transmission of HIV/AIDS and respondents’ sources of HIV information. Data indicates a fairly high knowledge level of HIV (HIV causes AIDS, 93% and HIV is presently incurable 77%). Ninety-eight percent (94%) correctly identified sexual intercourse without condoms as one of the routes of transmitting HIV, while the response to HIV prevention shows that young people have the capacity to stay away from HIV infection. Ninety-two percent (92%) correctly identified using condom during sex to prevent HIV while 72% and 86% identified being faithful to ones partner and abstaining from sex to prevent HIV respectively. Five hundred and fifty seven (255 or 89%) indicated radio as their source of HIV information while 218 (76%) indicated television. Seventy seven percent (64%) got their HIV information from family members. Others are posters/billboards (34%), nurses (41%) and doctors (57%).

Data collection The questionnaire forms were administered to the respondents with the aid of trained research assistants. The questionnaires were collected immediately the respondents were through with them. Data analysis The data were analysed using SPSS, version 17. The data were expressed as both descriptive and inferential statistical methods, such as frequency counts and percentages, t-test

Table 1: General knowledge of HIV of young people and sexual experimentation Knowledge of HIV Frequency Percentage HIV causes AIDS 267 93 HIV is a contagious disease 213 74 HIV is presently incurable 223 77 Transmission of HIV HIV/AIDS is transmitted through Sexual intercourse without condoms 271 94 Blood from an HIV infected person 211 74 Sharing of needles among drug users 176 61 Prevention of HIV Abstaining from sex 247 86 Being faithful to ones partner 206 72 Using condom during sex 265 92 Sources of HIV information 434

JORIND (9)1 June, 2011. ISSN 1596-8303. www.transcampus.org/journals. www.ajol.info/journals/jorind

Sources Television Church/Mosque Doctors Family members

% 76 28 57 64

Sources Radio Parents Nurses Posters/Billboard

% Sources 89 Newspaper 53 Friends 41 Other Sources 34 Teachers

% 43 27 15 58

Table 2 shows that 192 or 67% of respondents have engaged in some form of sexual relationship while 95 or 33% have not had sexual intercourse in the last six months. Of the 287 respondents, only 33.4% have tested for HIV while 179 (62.4%)have not, 12 respondents did not respond to the question. Table 2: Sexual Experimentation Level of Sexual Experimentation Have had sexual intercourse No sexual intercourse Ever Screened for HIV Yes No No Response

N 192 95

% 67 33

96 (33.4%) 179 (62.4%) 12 (4.2%)

Table 3: Knowledge of HCT Centres in Communities/States HIV Counselling &Testing Centres Frequency % Government Hospitals 121 42 Private Hospitals 109 38 Clinics 69 24 Counselling centres 32 11 Drug shop/Pharmacy 23 8 Table 3 indicates poor knowledge of HCT centres, 42 and 38% of respondents are aware that government and private hospitals provide HCT services respectively. Nineteen percent (24%) indicated clinics and 11% counselling centres. Twenty three respondents (8%) reported that drug shop/pharmacy provides HCT services. Table 4: Means, Std Deviations and t value by Gender Gender N= cases Mean Std. Dev. Male 166 17.2107 2.784 Female 121 16.2110 2.232 df 285 t-value 4.775 Sig. .014

Table 4 reveals there was a significant difference in the attitude of male and female respondents towards HCT (t = 4.775, df = 285; p< 0.05). Hypothesis 1 was therefore sustained. Table 5: Means, Std Deviations and t value by Sexual Experience Sexual Experience N= cases Mean Std. Dev. Have had Sex 192 20.5521 3.724 435 df 285 t-value 3.866 Sig. .000

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Not Sexually Active

95

18.1020

3.120

Table 5 shows that there is a significant difference in the disposition to HCT between respondents who have experienced sexual intercourse and those who have not (t = 3.866, df = 285: p<0.05). Hypothesis 2 was therefore sustained. Table 6: Model Summary of Multiple Regressions Predictors R Knowledge of HIV/AIDS, Youths .453a Sexual Behaviour, Cultural Practices R2 .205 R2 Adjusted .186 Std. Error 2.33631

a.Predictors: Knowledge of HIV/AIDS, Youths Sexual Behaviour, Cultural Practices Table 7: Regression Analysis on Attitude towards HCT Sources SS df MS F Sig. Regression 151.670 3 50.557 9.248 .000a Residual 595.888 283 5.467 Total 747.558 286 a. Predictors: (Constant), Attitude towards HCT, Youths Sexual Behaviour, Cultural Practices b. Dependent Variable: Attitude towards HCT Table 8: Relative Contribution of the Independent Variables to the Prediction of Attitude of Young People towards HIV Counselling and Testing (HCT). Model Predictors Unstandardized Coeff Standardized Coeff t Sig. B Std Error Beta 1 (Constant) 10.776 1.753 6.207 .000 Knowledge .431 .067 .547 3.458 .001 Sexual Beh. .088 .043 .041 0.543 .543 Culture .268 .058 .324 2.740 .005 Dependent Variable: HIV Counselling and Testing Data in Table 6 and 7 reveals that knowledge of HIV/AIDS, youths sexual behaviour and cultural practices would significantly predict attitude of young people towards HCT (R= 0.453; R2= 0.205; F (3, 283) = 9.248; p< 0.05). When combined, the three predictor variables predicted about 21% of the variation in attitude towards HCT. Table 8 reveals the relative contributions of knowledge of HIV/AIDS, youth’s sexual behaviour and cultural practices to predicting attitude towards HIV VCT. The summary table revealed that of all the three predictor variables, youth’s sexual behaviour was not a strong predictor of attitude of young people towards HCT. With youths sexual behaviour ( = 0.041; t = 0.543 p>0.05), Knowledge of HIV/AIDS ( = 0.547; t = 3.458 p<0.05) and cultural beliefs and practices ( = 0.324; t = 2.740 p<0.05). In effect, knowledge of HIV/AIDS is the best predictor of attitude towards HIV counselling and testing (HCT). The hypothesis which stated that there is a significant combined contribution of knowledge of HIV/AIDS, youth’s sexual behaviour and cultural beliefs and practices in the prediction of attitude of young people towards HIV counselling and testing was accepted for knowledge of HIV/AIDS and

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cultural beliefs and practices but rejected for (2008) notes that sexually active people avoid youths sexual behaviour. testing because of anxiety about the possibility of a positive test result while Brian, Ostermann, Whetten & Kumar (2007) found that high-risk Discussion In this study, it was found that young people groups want to get tested – but their actions do have good knowledge of HIV/AIDS and not match up with their intentions. The result of majority of them receive HIV information from the third hypothesis show that knowledge of radio programmes. Various studies report HIV/AIDS and cultural beliefs and practices differing findings about the youth’s knowledge produced some effect in the prediction of with regard to the existence of HIV/AIDS. attitude of young people towards HCT, with According to the Behavioural Surveillance knowledge of HIV/AIDS being the best Survey 2006 (NACO, 2007), as many as 86% predictor. Sexual behaviour was however not a of youth surveyed had heard about either HIV good predictor though Papalia, Olds & or AIDS or both. Studies indicate that for Feldman (2001); Rwenge (2000) & ToroitichNigerian and Indian youths, the mass media, Ruto (2000) all agreed that the rate of especially radio and television, constitutes a adolescent sexual behaviour especially risky major source of information about HIV/AIDS sexual behaviour is fast becoming a public (Adekeye, 2009; Banerji & Mattle, 2005). The health concern. respondents however displayed poor knowledge of HCT sites in their communities, Conclusion 42 and 38 percent of the respondents This study explored the psycho-cultural mentioned government and private clinics variables predicting attitude of young people respectively. The result of the first hypothesis towards HIV counselling and testing (HCT) in shows that there was a significant difference in selected tertiary institutions in Lagos state, the attitude of male and female respondents Nigeria. HIV counselling and testing allows towards HCT, with the males showing more individuals to determine their HIV status and disposition towards HCT. This finding is in serve as a gateway for both HIV prevention tandem with some earlier studies (Adekeye, and early access to treatment, care and support. 2009; Bond, Lauby & Batson, 2005; Ayiga, While much effort has been made towards James, Ntozi, Ahimbisibwe, Odwee & Okurut, improving knowledge about HIV/AIDS among 2000; Otwombe, Ndindi, Ajema & Wanyungu, students in higher institutions in Nigeria, it is 2007). In a study by Ayiga et al., (2000), male also important to understand the extent to respondents were more willing than females to which young people are willing to test for HIV, present for HIV testing. Otwombe et al.,(2007) and the factors associated with such reported that there were more males than willingness. In a study by UNAIDS (2007), females presenting for HIV test. only 18 percent of women and 21 percent of men between the ages of 15 and 24 could The second result shows that young people correctly identify ways to prevent HIV, this who have engaged in sexual activities are more indicates that there is still a strong reluctance to disposed to HIV counselling and testing while access testing amongst much of the population those who have not engaged in sexual activities under review. In most developing economies, are less disposed to HCT. This suggests that the priority now is to scale up access to HIV young people who engage in sexual intercourse Counselling and Testing especially for young are aware that it is risky, hence, their readiness people. More avenues and outlets to increase to go for HIV testing regardless of whether it is general knowledge of HIV need be explored, free or not. In contrast to this finding, Bartlett because knowledge of HIV and one’s HIV 437

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