AWARENESS AND ACCEPTABILITY OF VOLUNTARY HIV COUNSELLING AND TESTING AMONG SELECTED COLLEGE STUDENTS IN

OYO METROPOLIS

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

According to United Nations Joint Programme on AIDS (UNAIDS, 2004), the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic remains a major public health problem worldwide, more so in sub-Saharan Africa where more than 70 percent of all People Living With HIV and AIDS (PLWHA) resides. Evidence shows that out of the 4.2 million people infected, 700,000 were children (UNAIDS, 2004).  In Nigeria, AIDS has left a staggering 1.2 million orphans, the largest in the world and 200,000 deaths occurred in 2005 (Federal Ministry of Health, 2006)

Federal Ministry of Health (2006) reported that the first case of HIV/AIDS was identified in Nigeria in 1986. Since then the HIV prevalence has grown exponentially from 1.8 percent in 1991 to 3.4 percent in 1993 to 5.4 percent in 1999 and 5.8 percent in 2001.  In 2003, the national adult prevalence was 5.0 percent. By the end of 2003, Nigeria was said to have the third highest number of people infected with HIV in the world after South Africa and India (Federal Ministry of Health, 2006).

Family Health International (2006) shows that results from the 2005 survey revealed the overall national HIV prevalence for adults is 4.4 percent. This figure however conceals significant difference between states from 1.6 percent in Ekiti and 1.8 percent in Jigawa to 8.0 percent in Akwa Ibom and 10.0 percent in Benue state.  This divergence and irregular patterns of HIV prevalence rates and trends across states demonstrate that dynamics of the epidemic are different in each state.  The 2005 HIV Counselling and Testing (HCT) survey revealed that all states of Nigeria have a prevalence of greater than 5 percent. Young women in the 20-29 years age bracket, have the highest prevalence rates (4.7 percent for the 20-24 age group and 4.9 percent for the 25-29 age group) and urban populations generally have a higher prevalence than rural areas (Family Health International, 2006). More than 90 percent of PLWHA were in the developing world and about 70 percent of cases were in sub-Saharan Africa (Family Health International,2006).

Internationally, since the AIDS epidemic began, more than 20 million deaths have been attributed to AIDS.  The current estimate of the disease worldwide indicates a   prevalence of   more than 33 million HIV infections; nearly two-thirds of these cases are in developing countries, generally in sub-Saharan Africa and Southeast Asia (Kassler, Alwano-Edyegu, Marum, Biryahwabo, Kataaha and Dillon, 2001).  The result from the study conducted by Oniyangi (2005) supported that 72 percent of respondents agreed that HIV/AIDS was common among the youths.

As of December 31,2000, a total of 774,467 persons were reported with AIDS and 448,000 of these persons had died, the number of people living with HIV/AIDS 322,865 was the highest reported.  Like in the United States, approximately 275,000 of these persons might not know they are infected (Centres for Disease Control, 2001).

According to Centres for Disease Control and Prevention (2006), globally, HIV counselling and testing is recognized as a priority in the national HIV programme because it forms the gateway to HIV/AIDS prevention, care, treatment, support interventions, and a vital component for the expansion of access to comprehensive care for PLWHA. The utilization of HIV counselling and testing services is disappointingly low because of psychological and social barriers; and   people fear learning that they are infected with a disease that is fatal and stigmatizing (Nicole, Agatha, Lauren, Eitan, Rebecca and Sarah, 2009).

       The government of Nigeria has demonstrated a high level of commitment to fight the HIV and AIDS epidemic.  In response to the epidemic, the federal government launched the multi-sectoral approaches to HIV/AIDS prevention and control. In 2001, the National Action Committee on AIDS (NACA) was constituted to coordinate all HIV/AIDS responses of the various sector of the country (Federal Ministry of Health, 2006).  His Excellency, Chief Olusegun Obasanjo launched the National HIV and AIDS policy, providing guidance for HIV and AIDS intervention and prevention strategies. The strategies include HIV Counselling and Testing , which aim at enabling people to know their HIV status and reducing high-risk behaviour (Family Health International, 2006; Federal Ministry of Health, 2006).

Tao, Irwin and Kassler (2001) asserted that despite several advances in HIV prevention and care, a substantial number of opportunities for HIV prevention through Voluntary Counselling and Testing (VCT) are missing. At a publicly funded site, approximately 70 percent of persons tested received their result and information regarding the test, but fewer person likely received HIV prevention counselling and referrals (UNAIDS, 2005). In private settings, a lower proportion of all clients are tested and few receive prevention counselling and referral.

British Infection Society (2008) opined that with the continued growing numbers of HIV infected individuals, physicians need to recognize acute HIV infection as well as screen for asymptomatic infections.  Early diagnosis of acute HIV infection can help identify clients who may be eligible for anti retroviral  treatment, which has been shown to delay the progression to AIDS and death.  Rapid HIV testing may also be useful to quickly confirm HIV status in a person not known to be HIV positive who presents with AIDS-defining illness (British Infection Society,2008).

There are increasing efforts to encourage young people in utilizing voluntary counseling testing services. However, few programmes are currently providing counselling and testing   as well as post-test services that are tailored to the special needs of young people.  Many adolescents in sub-Sahara Africa are sexually experienced and when entering into sexual relationship for the first time, do not use any form of contraception (Federal Ministry of Health, 2005). This leave them vulnerable to HIV infection, sexually transmitted infections (STIs), and unplanned parenthood. Access by young people (particularly girls) to sexual and reproductive health services in developing countries remain a major challenge (Akinso, 2003). 

Akinso (2003) further expressed that the usual display of HIV and AIDS people on the media is capable of creating fear in the minds of the members of the public.  In many cultures in Nigeria, HIV/AIDS is perceived as an evil disease and no one would want to be identified with such an evil disease that discourages many people from taking advantage of screening to know their status.  Even those that know their status shy away from counselling because they do not want to be identified with such an evil disease.

Above all, this study shall deal extensively into examination of college students’ level of awareness and acceptability of voluntary HIV counselling and testing.

1.2   Statement of the Problem

Despite series of jingles, public enlightenment campaigns and health talk on availability of voluntary HIV counselling and testing in all public health institutions in Nigeria, patronage level of students to VCT centres is still low.

In Nigeria, Federal Ministry of Health (2006) reported that young people aged 15-24 years are among the people who are  likely to be infected with HIV.  For example, UNAIDS (2005) reported that all states of Nigeria have a prevalence rate of over 1 percent, Federal Capital Territory and 10 states have a prevalence rate greater than 5 percent.  Young women in the 20-29years age bracket, have the higher prevalence rate, 4.7 percent for the 20-24 years age group and 4.9 percent for the 25-29 years age group.  Young people are at the centre of the global HIV/AIDS epidemic. An estimated 11.8 million young people aged 15-24 years are living with HIV/AIDS, yet only a fraction of them know they are infected (UNAIDS,2005)

        Oyo State Ministry of Health (2003) reported   the result of the national sero-surveillance prevalence study which shows the following for Oyo State; 1992 (0.1 percent), 1994 (0.2 percent), 1996 (0.2 percent), 1999 (3.5 percent) and 2001 (4.2 percent). In addition, the figures from Oyo State central blood screening have shown an average sero-prevalence rate of 2 to 3 percent among blood donors.

Nkoli, Benjamin and Obinna (2005) in their recent study on VCT for HIV/AIDS among students in tertiary institutions, Nigeria revealed that the awareness of voluntary HIV counselling and testing is quite high among students but this does not reflect on the attendance at VCT clinics which is quite low compared to the awareness.

Therefore, considering the victim age of HIV/AIDS and other scholarly reports, the researcher deem it fit to investigate the level of awareness and acceptability of voluntary HIV counselling and testing among selected college students in Oyo metropolis

1.3   Research Questions

1.   Will gender influence acceptability of HIV testing among college students?

2.   Will age influence knowledge of   importance and acceptability of HIV testing among college students?

3.   Will socio – economic background influence accessibility to sources and acceptability of HIV testing among college students?

4.   Will religion influence willingness and acceptability of HIV  testing among college students?

5.   Will parental educational background influence awareness of rapid HIV test and acceptability of HIV testing among college students?

1.4   Research Hypotheses

1.   Gender will not significantly influence acceptability of HIV testing among college students.

2.   Knowledge of   importance of voluntary HIV counselling and testing will not significantly influence acceptability of HIV testing among college students on the basis of age.

3.   Accessibility to sources of voluntary HIV counselling and testing will not significantly influence acceptability of HIV testing among college students on the basis of socio – economic background.

4.   Willingness to know HIV status will not significantly influence acceptability of HIV testing among college students on the basis of religion.

5.   Awareness of HIV rapid test will not significantly influence acceptability of HIV testing among college students on the basis of parental educational background.

1.5   Purpose of the Study

    1. To ascertain the influence of gender on acceptability of HIV testing among college students.

    2.  To find out the influence of age on knowledge of   importance of voluntary HIV counselling and testing and acceptability of HIV testing among college students.

     3.  To investigate the influence of socio economic background on accessibility to sources of voluntary HIV counselling and testing and acceptability of HIV testing among college students.

     4.  To examine the influence of religion on willingness to know HIV status and acceptability of HIV testing among college students.

      5. To determine the influence of parental educational background on awareness of rapid HIV test and acceptability of HIV testing among college students.

1.6   Significance of the Study

          The rationale for this study is to have the proper understanding of the awareness level and to ascertain if the college students are accepting Voluntary HIV Counselling and Testing (VHCT) free of coercion and made available within their environment. The study will benefit the national, state and local education sectors to see at a glance whether college students in Oyo metropolis are accepting HIV voluntary counselling and testing. The Non-Governmental Organizations (NGOs) will equally assist the education sector in scaling up measures to adopt for better participation of those students if their participation level in HIV testing is low.

          In addition, the study is significant because it will put hands of government at all levels (federal, state and local) on desk majorly on strategies to employ in raising awareness level of students on HIV/AIDS and making them actively involved in HIV testing session.  Religious leaders as one of the beneficiaries will be able to preach more on morals and encourage their members who are students to embrace VHCT for their health benefit. Also, the study will help the community members to be fully aware of the importance of VHCT and thereby make them have positive attitude towards its acceptability.

1.7   Scope and Delimitation of the Study                   

          This study is delimited to students of two colleges of education in Oyo metropolis

i.         Emmanuel Alayande College of Education (EACOED) which comprises of two campuses – Erelu and Isokun. Erelu campus is located in Atiba local government while Isokun campus is located in Oyo West local government area of Oyo town.

ii.       Federal College of Education (Special) (FCE(sp)) is located in Afijio local government.

Questionnaire will be mainly used to elicit information on the research topic and variables like influence of gender, age, socio-economic background, religion and parental educational background on knowledge of importance, accessibility to sources of VHCT, willingness to know HIV status and awareness of rapid HIV test, will be dealt with. A well structured questionnaire validated and tested for reliability shall be research instrument for this study. However, data to be collected will be analysed using frequency counts and percentages; and inferential statistics of chi-square analysis.

1.8   Operational Definition of Terms

i.        HIV – Human Immunodeficiency Virus is a germ causing Acquired Immune Deficiency Syndrome (AIDS).

ii.       AIDS – Acquired Immune Deficiency Syndrome is referred to the most advanced stage of HIV infection.

iii.      Positive test – A blood sample that is reactive after a repeated test.

iv.      HIV test – A laboratory procedure that detects antibodies to HIV.

v.       Pandemic – Worldwide occurrence of a disease.

vi.      Rapid HIV test – A test to detect antibodies to HIV that can be collected and processed within a short interval of time.

vii.     Antiretroviral – Drugs prepared to prevent HIV from replicating in HIV – infected person(s).

viii.    Prevalence – The number or percentage of persons in a given population with a disease or condition at a given point in time.

List of Abbreviations

i.             HIV – Human Immunodeficiency Virus

ii.           AIDS – Acquired Immune Deficiency Syndrome

iii.          HCT – HIV Counselling and Testing

iv.          PLWHA – People Living With HIV/AIDS

v.            ARV – Anti Retro Viral

vi.          VCT – Voluntary Counselling and Testing

vii.        NACA – National Action Committee on AIDS

viii.       CT – Counselling and Testing

ix.          STIs – Sexually Transmitted Infections

x.           VHCT –Voluntary HIV Counselling and Testing

CHAPTER TWO

REVIEW OF RELATED LITERATURES

2.0   Introduction

          The main focus of this study is to look into the level of awareness and acceptability of voluntary HIV counselling and testing among selected college students in Oyo metropolis. Therefore, based on the above research study, related literatures in the following areas shall be critically examined viz:

·                    Gender and acceptability of HIV test

·                    Age and importance of voluntary HIV test

·                    Socio –economic background and acceptability of  HIV test

·                    Barriers to HIV testing

·                    Awareness and types of HIV test  

·                    Concept of HIV/AIDS

·                    World Health Organization (WHO) staging system for HIV infection and disease in adults

·                    Overview of HIV/AIDS in Oyo state

·                    Transmission of HIV/AIDS 

·                    Prevention of HIV/ AIDS transmission 

·                    Concept of HIV counselling

·                    HIV  testing

·                    Model of HIV counselling and testing service delivery in Nigeria

·                    Appraisal of review of related literatures

2.1   Gender and Acceptability of HIV Test

          The current strategy to prevent mother-to-child-transmission of HIV depends on females’ readiness to know and accept their HIV status.

          In the recent study of Oboh, Ekpebu and Odeh (2010), it was reported that the high probability of male to accept volountary HIV counselling and testing services than female counterpart was because female were more vulnerable to HIV infection and are therefore less willing to know their HIV status. The findings of Iliyasu, Abubakar, Kabir and Aliyu (2006), however contrasted with an earlier survey among adults in Kano State, Northern Nigeria where more female adults were willing to accept volountary HIV counselling and testing than male counterparts because of their frequent patronage in hospitals. Omary (2006) in his study also observed that voluntary counselling and testing services were accepted among female than male students.

          However, studies from Tanzania and Kenya have shown that women who share HIV test results with their partners experienced a range of reactions from support and understanding to denial, accusations, discrimination, physical violence and abandonment  (De-Paoli, Manongi and Klepp, 2004). Notwithstanding, most female gender were willing to accept volountary HIV counselling and testing because of their pregnancy status and attendance at sexually transmitted infection clinics (De-Paoli, Manongi and Klepp, 2004). This will reduce the risk of infecting the unborn child and provision of benefits such as free antiretroviral drugs infant feeding counselling.

          Pignatelli, Simpore, Pietra, Ouodraogo, Conombo and Saeri (2006) investigated the factors predicting uptake of VHCT and it was independently associated with age, the number of previous pregnancies and the number of previous miscarriage.

2.2   Age and Importance of Voluntary HIV Test

          The youth is characterized by strength and vitality which predispose the young to a high level of involvement in sexual activities and the attendant risk such as unwanted pregnancy, abortion and infection with Sexually Transmitted Diseases (STDs) (Yahaya, Jimoh and Balogun, 2010). Young people are highly vulnerable to HIV and other STDs. He asserted that in many countries, 60 percent of all new HIV infections are among the age group 15 – 24 years and stressed that the highest rates of STDs are usually found among the youths of ages 20 – 24 years followed by 15 – 19 years (Mishra, 2005).

          A large number of students knew that VCT use is necessary and the acceptance of VHCT among the students is influenced by age where younger students were more willing to accept VCT than their older students (Omary, 2006). The willingness to use VCT sevices decreased with the increase in age due to the fact that as the age increases the students becomes more sexually active and so less willing to test for HIV (Omary, 2006). Peltzer, Nzewi and Mohan (2005) opined that among both secondary and tertiary institutions in Bostwana, younger students were more likely to test than older students. Testing rates decreased by 2.5 percent with each yearly increase in age suggesting that as young people in school grow older and reach higher levels of education, they are more willing to test for HIV (Peltzer, Nzewi and Mohan, 2005)

          Among the students who use VCT services, they were interested in knowing their HIV status and to get HIV education like knowledge of risk reduction, support services for infected person, knowledge of the outcome and positive living (Oshi, Ezugwu, Oshi, Dimkpa, Korie and Okperi, 2007)

          Stella (2007) revealed that promotion of HCT services will foster HIV prevalence, early and prompt access to antiretroviral therapy   and increase the use of appropriate health services for the treatment of opportunistic diseases associated with AIDS and other HIV-related illnesses. Also, it serves as a strong weapon against stigma and discrimination, offers psycho-social support for the infected and affected, and links the infected to other care and support services, prepares potential HIV positive clients for the consequences of positive test result and the several opportunities and options available to him or her (Hope, 2002).

          To the clients, Federal Ministry of Health (2006) stated that HCT empowers them to make informed decision to know their HIV status; empowers the uninfected person to protect himself or herself from becoming infected with HIV; assists infected persons to protect others and to live positively and seek other support services; and offers the opportunity for treatment of HIV and associated illnesses.

          HIV counselling and testing further helps the community members because it facilitates modification of community norms; provides opportunity for community members to know their status and take necessary action; reduces stigma, serves as a catalyst for the implementation of care and support services; and reduces transmissions and changes the tide of the epidemic (UNAIDS, 2004).

          Couples were of the opinion that it supports safer relationship, enhances faithfulness, encourages family planning and treatment, to help prevent mother-to-child HIV transmission; allows the couple or family to plan for the future and promotes trust among couples (Federal Ministry of Health, 2006).

2.3   Socio-economic Background and Acceptability of HIV Test

          Low socio-economic family status, living in a remote environment was positively associated with sexual activity which leads to the spread of HIV/AIDS and low HIV/AIDS education (Thabo, 2010). Other socio-economic factors that adequately discriminated between students with adequate knowledge about HIV/AIDS testing sites and those without adequate knowledge were type of family, level of education, residence of parents, discussion of sexual issues with family members (Thabo, 2010).

          In addition, students from poor backgrounds were less willing to test for HIV infection than those from privileged backgrounds, who attended private schools, lived in high cost housing areas, had parents who lived in urban areas because many of them did not have enough information about where to be tested for HIV (Thabo, 2010). Omary (2006) opined that location of VCT was among the factors that cause low turn out for VCT among youths.

Centres for Disease Control and Prevention (2005) outlined settings that provide voluntary HIV counselling and testing where people can access their HIV status and these include: adolescent health clinics, school based health centres, AIDS services organizations, community health centres, drug or alcohol prevention and treatment programmes, family planning clinics, free standing HIV test sites, hospital emergency departments, occupational/employee health clinic, outreach programmes, prenatal clinics, private sector service providers, publicly funded counselling and testing sites, sexual transmitted disease sites, tuberculosis clinic and women and men’s health clinics.

          Family Health International (2009) categorically stated more than two thousand HCT centres across ten (10) states namely, Oyo, Osun, Ekiti, Kwara, Ogun, Lagos, FCT, Edo, Delta and Kogi. This data include non-governmental organizations, community based organizations, professional associations and religious organizations whose works are extensive on HIV/AIDS and they have been operating to compliment the efforts of the government across states in the nation.

          In Oyo metropolis where this study is being carried out, personal investigation of the researcher revealed the following public and private centres where people can assess their HIV status: State hospitals (Oyo, Ilora and Fiditi), Baptist hospital, Momoh memorial hospital, Oba Adeyemi Primary Health Care (PHC), Atiba PHC, Iseke PHC, Federal School of Surveying health centre, Ajayi Crowther University health centre, Federal College of Education (special) health centre, Emmanuel Alayande College of Education health centre, Oba Adeyemi Tuberculosis and Leprosy (TBL) clinic, Atiba TBL clinic, Iseke TBL clinic, Ilora TBL Clinic, Peamark hospital, Bisol medical centre, EMMA laboratory, Ayo diagnostic centre, Zion medical laboratory and Alaafia medical laboratory.

As asserted by Family Health International (2004), students obtained information on VHCT through pamphlets, bronchure and video.  The researcher through oral interview discovered that people got information on VHCT through health workers, mass media, friends, churches, mosques, health campaign, posters, handbills, fliers and textbooks. According to Nkolika (2007) in a recent research conducted among students shows that they obtained information on VHCT from families and private hospitals.  Also, information should be provided in a manner appropriate to the clients’ culture, language, sex, sexual orientation, age and developmental level.

2.4       Barriers to HIV Testing

Yahaya, Jimoh and Balogun (2010) identified religious factor as a barrier to HIV test despite programmes put up in Nigeria by religious organizations on HIV/AIDS awareness and the usefulness of voluntary HIV counselling and testing.

The study of Omry (2006) shows larger proportion of his respondents that said voluntary HIV counselling and testing was not necessary because it is against religious teaching and even misleads the society. De – Paoli, Manongi and Klepp (2004) opined that religion among other factors was an important factor influencing the acceptance of voluntary counselling and testing. It was further said that for Muslim women, polygamy increases the complexity of disclosing the results and may increase the risk of dismissal, and that they therefore are less willing to accept voluntary counselling and testing.

        De-Paoli, Manongi and Klepp (2004) reported that perceived high personal susceptibility to HIV/AIDS, barriers related to confidentiality and partner involvement were associated with willingness to accept voluntary counselling and testing.

          Further reasons for not willing to seek voluntary HIV counselling and testing includes: the issue of suspicion and its social consequences if the intention to seek testing is made known among relations; fear and misconceptions regarding voluntary counselling and testing; concern about confidentiality of test result if tested positive which they feared may predispose them to stigmatization, discrimination and rejection (Suzanne, Heidi, Barbara and Jane, 2005).

          Many studies in developing countries described barriers to access VCT as distance, cost of the service in some places, fear of knowing one’s status, self-efficacy expectation, no present cure for the disease, shock from disclosure of result if positive and stigma (Nuwaha, Katabesi, Muganwa and Whalen, 2002).

          A study in a Prevention of Mother-To-Child Transmission (PMTCT) clinic in Uganda shows higher acceptability rate among those at perceived high risk of HIV infection (Mpairwe, Muhangi, Namujju, Kintu, Tumusiime, Muwanga, Whitworth, Onyago, Biryahwaho and Elliot, 2005). Also, in Zambia, young people with felt high risk of HIV infection were more likely to be willing to be tested (Matovu, Gray, Makumbi, Wawer, Serwadda, Kigozi, Sewan-Kambo and Nalugoda, 2005). The long process of counselling and testing is a likely cause for the low acceptability despite high initial willingness.

          Federal Ministry of Health (2006) identified the following four prominent barriers.

i         Limited access which may be due to; not seen as a priority by policy makers, ignorance about the services and its benefits by the populace; apparent lack of evidence of reducing HIV transmission; limited technical and financial capacity to provide HCT; born out (emotional exhaustion) due to non-availability of support systems for counsellors.

 ii       Stigma. HIV is highly stigmatized in most countries (visiting an HCT site is inferred as being HIV positive); social reflections (issues of confidentiality; providers not trusted); reflection by families or communities.

iii       Gender inequalities. Violence against women who access HCT without consent of their spouse, discrimination against HIV positive women who are often wrongly accused of bringing infection into the home; women being abused, abandoned and divorced by husbands or disowned by family members if their HIV status becomes known (Family Health International, 2004).

iv       Discrimination. HIV positive people are subjected to discrimination in the work place, educational institutions and places of worship.

2.5   Awareness and Types of HIV Test

It was discovered that students whose parents had professional or managerial level and grew up with both parents were accepting HIV test than other students. They have been earlier educated by their parents about HIV test (Thabo, 2010)

There are four common types of HIV test viz:

i.      Rapid Test

          Rapid test is recommended for HCT services in all settings (Family Health International, 2004).  The rapid tests that are recommended by World Health Organization have been evaluated at various WHO collaborating centres, and have been found to have levels of sensitivity and specificity comparable to Enzyme–linked Immunosorbent Assay (ELISA) test.  Association for Public Health Laboratories (2003) reported that rapid HIV testing provides the result during the single counselling session.

          Kenya Ministry of Health (2005) outlined advantages of rapid test which make people embrace it thus: easy and quick to perform, use of a very small amount of blood from the person’s finger tip, efficient for screening single or small number of tests, can be done in clinics without laboratories, requires minimum materials and skills, does not require highly trained staff, and allows for same day result collection.

          Afolabi, Fatusi, Abioye – Kuteyi, Bello and Fakande (2006) opined that availability of affordable, accurate, reliable, simple and rapid HIV test provide results within the time frame of a single visit thereby reducing traveling time and expenses.  The sensitivity and specificity of these tests are greater than or equal to ninety-nine percent and similar to those of ELISA (Centres for Disease Control and Prevention, 2006).

ii.     Polymerase Chain Reaction (PCR) Test

          The HIV PCR test is one of the most accurate diagnostic tool in use to detect the presence of the HIV virus in the blood (Federal Ministry of Health, 2006).  Aside from being considered more reliable in terms of accuracy than most other tests, the HIV PCR test is also one of the few screening procedures that can be used for early detection. In fact, it can successfully detect the virus in as little as three weeks after infection has occurred (Federal Ministry of Health, 2006).

          According to Family Health International (2006), false or negative reading may be returned if the test is performed less than five days after infection is suspected.  Unlike other tests, such as the Antigen test, the HIV PCR test does not rely on the presence of antigens or antibodies in the blood for diagnosis.  Instead, it endeavour to identify certain genetic materials by highlighting sequences for the virus within the subject’s DeoxyriboNucleic Acid (DNA).  This is achieved via nucleic-acid amplification testing to observe the resulting polymerase chain reaction, hence the acronym PCR.

iii.    Enzyme-linked Immunosorbent Assay (ELISA)

          ELISA is a biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample (Leng, McElhaney, Walston, Xie, Fedarko and Kuchel, 2008).  The ELISA was the first screening test widely used for HIV because of its high sensitivity.  ELISA test is available in some health facilities but the results of such tests usually take longer to obtain.  Only trained medical laboratory scientist(s) can perform this type of test (Lequin, 2005).

iv.    Antigen Test (P24 test)

        Family Health International (2006) affirmed that P24 antigen assays are used for routine screening in blood and plasma centres. Routine use for diagnosing HIV infection has been discouraged because the estimated average time from detection of P24 antigen to detection of HIV antibody by standard Enzyme Immuno Assay (EIA) is six days, and not all recently infected persons have detectable level of p24 antigen.

2.6   Concept of HIV and AIDS

          HIV means Human Immunodeficiency Virus, the virus that causes AIDS.  HIV breaks down the body’s immune system (the body’s defence against infection and disease) by infecting white blood cells, leading to a weakened immune system (Walker, 2004; Kenya Ministry of Health, 2005). When the immune system becomes weak or compromised, the body loses its protection against illnesses and as time passes, the immune system is unable to fight the HIV infection and the person may develop serious and deadly disease including other infections (Suzanne, Heidi, Barbara and Jane, 2005).

          AIDS is an acronym for Acquired Immune Deficiency syndrome and refers to the most advanced stage of HIV infection (Centres for Disease Control and Prevention, 2006). AIDS is interpreted thus:

A:      Acquired, (not inherited) to differentiate from a genetic or inherited condition that causes immune dysfunction.

I:       Immune, because it attacks the immune system and increases susceptibility to infection.

D:      Deficiency of certain white blood cells in the immune system.

S:      Syndrome, meaning a group of symptoms or illnesses that result from the HIV infection (Federal Ministry of Health, 2006).

2.7   WHO Staging System for HIV Infection and Disease in Adult

          World Health Organization (2004) identified four (4) clinical stages of HIV in adult

Clinical stage I

i.        Asymptomatic

ii.       Generalized lymphadenopathy

Clinical stage II  

i.                 Weight loss of less than 10% of body weight

ii.               Minor mucocutaneous manifestations

iii.              Herpes zoster within the last 5 years

iv.              Recurrent upper respiratory tract infections

Clinical stage III

i.             Weight loss of more than 10% of body weight

ii.           Unexplained chronic diarrhoea lasting for more than 1 month

iii.          Unexplained prolonged fever (intermittent or constant) lasting for more than 1 month

iv.          Oral candidiasis (thrush)

v.            Oral hairy leukoplakia

vi.          Pulmonary tuberculosis

vii.        Severe bacterial infections

Clinical stage IV

i.             HIV wasting syndrome

ii.           Pneumocystis jeroveci pneumonia

iii.          Toxoplasmosis of the brain

iv.          Cryptosporidiosis with diarrhoea lasting more than 1 month

v.            Cryptococcosis, extrapulmonary

vi.          Cytomegalovirus (CMV) disease of an organ other than liver, spleen or lymph node

vii.        Herpes Simplex Virus (HSV) infection

viii.       Progressive Multifocal Leukoencephalopathy (PML)

ix.              Any disseminated endemic mycosis

x.               Candidiasis of the oesophagus, trachea and bronchi

xi.              Atypical mycobacteriosis, disseminated or pulmonary

xii.            Non-typhoid salmonella septicaemia

xiii.          Lymphoma

xiv.           Kaposis Sarcoma (KS)

xv.            HIV encephalopathy

Source: World Health Organization (2004)

2.8   Overview of HIV/AIDS in Oyo State

          The first formal report of AIDS case in Nigeria was in a 13 – years old colanut seller in Lagos in 1986.  In 1987, another case (the first case seen in Oyo State) was reported from Saki in Oke-Ogun area of Oyo State, but nothing drastic was done to curtail the HIV/AIDS scourge, both in the state and the nation at large (Oyo State Ministry of Health, 2003).

          The result of the national sero-surveillance prevalence study showed the following for Oyo State: 1992 (0.1%), 1994 (0.2%), 1996(0.2%), 1999 (3.5%), 2001 (4.2%) and the result of 2001 HIV survey showed a prevalence of 9.5% among Sexually Transmitted Diseases (STDs) victims and 4.2% among Pulmonary Tuberculosis (PTB) in Oyo State (Oyo State Ministry of Health, 2003).

          Heterosexual intercourse takes about 85% of how HIV is contracted in this state whilst the rest is through mother-to-child transmission, and blood transfusion. This result can be compared with other states in Nigeria and other developing countries as asserted by Federal Ministry of Health (2006) that heterosexual transmission is the primary mode of acquiring HIV in Nigeria as in other developing countries. Those at risk include: Commercial Sex Workers (CSWs), children born to HIV infected mothers, long distance lorry drivers, migrant workers, the youth, especially between the ages of 15 and 24 years, the uniformed men and the un-informed (Oyo State Ministry of Health, 2003; Akinso, 2003).

          Among the activities of Oyo State government to address the menace of HIV/AIDS transmission are; provision of safe blood through central blood screening centre (a strategy that has been adopted since 1991); education of the general populace to avoid reuse of needle and syringes and other sharp objects; training of counsellors; establishment of sexually transmitted disease clinics, training of laboratory scientists in HIV screening, World AIDS day rallies, jingles and inauguration of State Action Committee on AIDS (SACA) (Oyo State Ministry of Health, 2003).

2.9   Transmission of HIV/AIDS

          HIV/AIDS transmission can occur through the following ways:

I.            Vertical Transmission. According to Oyo State Ministry of Health (2003), mother-to-child transmission (vertical transmission) is an overwhelming source of HIV infection in young children contributing about 90% of the total disease burden.  Most studies estimate the probability that an HIV positive woman’s baby will have the virus as ranging from 15% to 40% (in the absence of antiretroviral drugs) in the developing country where breast feeding is exclusively practiced (Family Health International, 2005; Oyo State Ministry of Health, 2003). In many of the developing countries of which Nigeria is one, HIV infection is fast becoming the most important complication of pregnancy, while AIDS is now the biggest single cause of child death.

       World Health Organization (2004) established that Mother-to-        Child Transmission (MTCT) accounts for the majority of HIV infections in children in developing countries. The rate of transmission from an untreated HIV positive pregnant woman to her newborn is high (Adjorlolo-Johnson, DeCock, Ekpini, Vetter, Sibailly, Brattergaard, Yavo, Doorly, Whitaker and Kestens, 1994).

O’Donovan, Ariyoshi, Milligan, Ota, Yamuah, Sarge-Njie and Whittle (2002) was of the opinion that all women should be screened for HIV before delivery, during an initial prenatal care visit so that potent combination antiretroviral treatment can be given to women who are HIV-infected.  However, approximately 40 percent of the mothers of the estimated HIV infected infants born in the year 2000 were not screened for HIV infection before delivery (Oyo State Ministry of Health, 2003).

II.            Sexual Contact. Unprotected sexual intercourse with a partner who is HIV positive (through anal, vaginal and direct contact with HIV-infected body fluids such as semen and vaginal secretion) is a potential source of HIV/AIDS transmission (Federal Ministry of Health, 2006).  Heterosexual transmission is the primary mode of acquiring HIV in Nigeria as in other developing countries (Walker, 2004). Women especially young girls, are more likely than men to become infected following heterosexual intercourse due to biological, socio-economic and cultural reasons (Federal Ministry of Health, 2006).

III.            Blood-to-Blood Transmission. Blood-to-blood transmission of HIV/AIDS can occur through the following means; transfusion with HIV-infected blood, direct contact with HIV-infected blood, re-use and sharing of unsterilized skin piercing objects and sharps (for example, needles, razor blades, surgical blades and lancets) and needle-stick injury (Federal Ministry of  Health, 2005).

2.10  Prevention of HIV/AIDS Transmission

There are many ways people can avoid getting HIV infection and it can be prevented in the following ways:

1.      Prevention of Mother-to-child Transmission (PMTCT). Voluntary HIV counselling and testing plays a vital role in reducing mother-to-child transmission by helping to identify mothers who are HIV positive for treatment, care and support (Afolabi, Fatusi, Abioye-Kuteyi, Bello and Fakande, 2007).      

 The following PMTCT options are available:

(a)          Short – course antiretroviral treatment to the mother during pregnancy and labour and sometimes also the baby and mother afterwards (Family Health International, 2005).

(b)         Highly Active Antiretroviral Therapy (HAART) involves the use of full course ART for a positive pregnant woman and can also be used in place of short-course antiretroviral drugs (Federal Ministry of Health, 2006).

(c)          Planned caesarean section reduces the risk of transmission during birth, but it is not an option to use widely because of the high cost and possible risks to the mother.

(d)         Changed breast feeding practice involves total replacement of feeding from birth, or exclusive breast feeding followed by abrupt weaning at 3-6 months, or heat-treating expressed breast milk has been demonstrated to reduce mother to child transmission (Family Health International, 2004).

2.      Prevention of Sexual Transmission

(a)      Abstinence. Abstaining from sex will help people not to be infected with HIV/AIDS. This needs a lot of targeted messages for behavioural change (Salkeld and McGreehan, 2010).  According to Centres for Disease Control and Prevention (2006), youths require education on relevant life skills that will help them not to indulge in sex before marriage and remain faithful in marriage.  The more likely you are to meet someone with HIV and become infected yourself.

(b)     Faithfulness. Being faithful in this context refers to an individual having sexual relationship with one partner and vice versa.  If such faithful partners have tested HIV negative, they do not have to use condom unless otherwise advised by experts (Family Health International, 2004).

(c)      Condom use or safer sex: Safer sex is any sexual practice that prevents exchanges of semen, vaginal fluids or blood between partners.  Correct use of condom will prevent HIV transmission from one partner to another during sexual intercourse.  Research has shown that HIV cannot pass through latex rubber (Federal Ministry of Health, 2005). 

 3.     Prevention of Blood Transmission.                                    

          Federal Ministry of Health (2006) recommends that to prevent blood transmission, the following precautions need to be taken; transfuse only fully screened blood and blood products, avoid sharing skin piercing objects or sharps; avoid unnecessary blood transfusion; avoid touching all body fluids with bare hands; always use gloves when handling blood and blood fluids; and if skin-piercing instrument must be re-used, disinfect in bleach.

2.11  Concept of HIV Counselling

          According to Kenya Ministry of Health (2005), HIV counselling is an intervention which gives the client an opportunity to confidentially discuss his or her HIV risks and be assisted to learn his or her HIV status for   the purpose of prevention, treatment, care and support. The counselling process includes an evaluation of personal risk of HIV transmission and facilitation of preventive behaviour.  Voluntary counselling and testing is a cornerstone for successful implementation of prevention care and support services among HIV negative and positive individuals.  It is also perceived to be an effective strategy on risk reduction among sexually young people (Zimbabwe Ministry of Health, 2005).

          Mpairwe et al (2005) were of the opinion that all clients who are recommended or who request HIV testing should receive the following information during counselling session: information regarding the HIV test and its benefits and consequences, risks for transmission and how HIV can be prevented; the importance of obtaining test results in explicit, understandable language; where to obtain further information or if applicable, HIV prevention counselling and where to obtain other services.

          In some setting where HIV testing is offered, other useful information include, description of demonstration of how to use condoms correctly; information regarding risk free and safer sex options; information regarding other sexually transmitted and blood borne diseases; descriptions regarding the effectiveness of using clean needles, syringes and other drug paraphernalia; and information regarding drug treatment (Kermode, Jolley, Langkham, Thomas and Crofts, 2005).

There are two stages in the counselling process prior to conducting blood tests for HIV antibodies (Family Health International, 2004). Reasons for pre-test counselling includes, to review the client’s risk of infection, to explain the test and clarify its meaning, to explain the limitations of the test results, to caution the clients about possible reactions to the test and who should be informed; to help the client understand why the test is required and to make a decision about the test (Matovu et al, 2005).

          Core components of the pre-test counselling session as highlighted by Federal Ministry of Health (2006) are, basic facts on HIV/AIDS, (understanding of HIV/AIDS, modes of transmission and ways in which HIV is not transmitted, myths about HIV transmission, prevention including PMTCT and opportunistic infections), discussion of benefits and potential difficulties; explanation of HIV rapid test process and meaning of HIV test results; exploration of personal HIV risk behaviour and options for reducing risk including dual protection; assessment of clients’ readiness for HIV testing, exploration of support systems and discussion of disclosure mechanism; and obtaining consent for HIV testing (Akinso, 2003).

Post test counselling is a counselling provided for both HIV positive and negative clients who have undergone HIV testing (Federal Ministry of Health, 2004). Major components of post test counselling session are, provision of HIV test results highlighting window period for HIV negative clients; review of risk reduction plan including condom use skills building; discussion of positive living, ongoing support and referral for such services as family planning, tuberculosis and STIs screening and management; discussion of disclosure of test result; partner referral for HIV testing; and provision of information on family planning (Zimbabwe Ministry of Health, 2005; Kenya Ministry of Health, 2005 and Federal Ministry of Health, 2005).

2.12  HIV Testing

          There are numbers of test that are used to find out whether a person is infected with HIV, the virus that causes AIDS (British Infection Society, 2008).  Identification of individuals infected with HIV can only be achieved through laboratory investigations. It involves the use of blood and blood products, saliva, semen and various other body secretions. However, the best way to tell whether someone is infected with HIV is to test blood for the presence of the virus or its genetic material that is viral load count or polymerase chain reaction (Family Health International, 2006).  The alternative option, which is more widely used, is to look for the indirect evidence of infection that a person’s immune system provides, which are HIV antibodies (Centres for Disease Control and Prevention, 2006).

          Kipp, Kabagambe and Konde –Lule (2002) asserted that when a person is infected with HIV, their body responds by producing special proteins that fight infection, called antibodies.  An HIV antibody test looks for these antibodies in the blood.  If antibodies to HIV are detected, it means a person has been infected with HIV.  There is only one exception to this rule; babies born to HIV infected mothers retain their mothers antibodies for up to eighteen months, which means they may test positive on an HIV antibody test, even if they are actually HIV negative (Asamoah –Odei, Garcia and Boerma, 2004).

          Current study revealed that a number of rapid assays are based on one of four immunodiagnostic principles; particle agglutination, immunodot (dipstick), immunofiltration or immune chromatography. They have been developed for ease of performance and quick results.  These assays generally require less than 30 minutes to perform and do not require special equipment.  In addition, whole blood, capillary blood, serum or plasma can be used for some of the assays (Federal Ministry of Health, 2006).

2.13  Model of HCT Service Delivery in Nigeria                                        

          The most commonest service delivery on HCT are, integrated, stand –alone and mobile/outreach models.

i.         Integrated model. According to Federal Ministry of Health (2005), integrated service are provided in hospital setting, with such programmes as those for tuberculosis, sexually transmitted infection, PMTCT, and management of opportunistic infections and antiretroviral.  In Nigeria, HCT usually recommended and provided whenever a client shows signs and symptoms of HIV disease; this is to aid clinical diagnosis and management (Federal Ministry of Health, 2006). Informed consent usually obtained during the normal process of consultation between the health care provider and the client.

ii.       Stand-along model. Stand-alone HCT services are provided in sites that are situated outside the health facilities. Available stand-alone services are often run by non-governmental, faith-based and Community Based Organizations (CBOs) and should be linked to other care and support services (Federal Ministry of Health, 2005).

According to Family Health International (2009), in Nigeria, examples of CBOs and Non-Governmental Organizations (NGOs) mentioned include, National Youth Network on HIV/AIDS (NYNETHA), GEDE foundations, Centre for the Right to Health, United Visionary Youth of Nigeria, Hope World Wide, Community Life Advancement Project (CLAP), African Health Project, Society for Youth Education on HIV/AIDS (SOYEHA), Vision Integrated in Development Approach, Life Link Organization (LLO), Development Option for Humanity (DOH), The Salvation Army, Society for Women and AIDS in Africa, Nigeria (SWAAN), Africare Technical Response to AIDS Affected Population, Family Health and Population Action Committee (FAHPAC) and Association for Reproductive and Family Health (ARFH).         

iii.          Mobile/Outreach Model. Outreach HCT services are usually set up to meet the needs of special populations such as people living in remote areas (villages), refugee camps, nomads, physically challenged and prisoners (Federal Ministry of Health, 2006).  The outreach service can be integrated within existing primary health care services in rural communities.  Outreach services may be provided using mobile vans, ambulance equipped for testing within premises such as community and church halls, mosques and youth facilities where space for counselling is available to ensure confidentiality and privacy (Federal Ministry of Health, 2005).

Appraisal of Reviewed Related Literatures

This chapter summarily reviewed relevant literatures on gender and acceptability of HIV test in which   male was reported accepting VHCT than female counterparts (Oboh, Ekpebu and Odeh, 2010.)  In contrary, De-Paoli, Manongi and Klepp (2004) revealed that most female genders were willing to accept VHCT because of their pregnancy status and attendance at sexually transmitted infection clinics.

Age was identified as a factor that influenced acceptance of VHCT. Omary (2006) asserted that the willingness to use VCT services decreased with the increase in age due to the fact that as the age increases the students become more sexually active and  so less willing to test for HIV.

        Also, among   the students who use VHCT services, they were interested in knowing their HIV status and get HIV education (Oshi, Ezugwu, Oshi, Dimkpa, Korie and Okperi, 2007). Furthermore, among the outlined benefits of voluntary HIV counselling and testing are; early and prompts access to ART, empowers the uninfected person to protect himself from becoming infected with HIV and provides opportunity for community members to know their HIV status (Stella, 2007; UNAIDS, 2004). 

Sources of voluntary HIV counselling and testing revealed that people accessed their HIV status in different places like, government health institutions, private owned places, Faith Based Organizations (FBOs), community based organizations, non-governmental organizations and in religious centres.  Students from poor backgrounds were less willing to test for HIV infection because many of them did not have enough information about where to be tested for HIV (Thabo,2010).

Equally, information on HIV/AIDS reached people through health workers, mass media, friends, churches, mosques, health campaigns, posters, handbills, fliers and textbooks (Centre for Disease Control and Prevention, 2005; Family Health International, 2009; Nkolika, 2007).

          Identified barriers to HIV testing include, religion, lack of confidentiality, suspicion, fear, misconception, cost of the services and distance (De-Paoli, Manongi and Klepp, 2004; Nuwaha, Katabesi, Muganwa and Whalem, 2002; Omary, 2006; Yahaya, Jimoh and Balogun, 2010)

          It was discovered that most students whose parents worked in high status position have been earlier educated about available HIV test (Thabo,2010). Also, rapid test, polymerase chain reaction and enzyme-linked immunosorbent assay were identified by Family Health International (2004); Federal Ministry of Health (2005) and Leng, McElhaney, Walston, Xie, Fedarko and Kuchel (2008) as types of HIV test.

The study also reviewed the concept of HIV AIDS in which HIV means Human Immunodeficiency Virus and AIDS stands for Acquired Immune Deficiency Syndrome (Walker, 2004; Kenya Ministry of Health, 2005; Centres for Disease Control and Prevention, 2006).  Then, according to WHO (2004), WHO staging system for HIV infection and disease in adult was classified into clinical stage I, II III and IV with their related signs and symptoms.

          Overview of HIV/AIDS in Oyo State shows sero-surveillance prevalence level of 0.1% in 1992, 0.2% in 1994, 0.2% in 1996, 3.5% in 1999 and 4.2% in 2001.  Those at risk in Oyo State include, commercial sex workers, long distance lorry drivers, migrant workers, children born to HIV infected mothers and the youths, especially between the ages of 15 and 24years (Oyo State Ministry of Health, 2003; Akinso, 2003).

          Walker (2004) revealed that transmission of HIV/AIDS occurred vertically, sexually and through blood-to-blood contact.  All these can be prevented by helping identify members who are HIV positive through screening, abstinence, safer sex with the use of condom, careful handling of sharps and taking universal precautions (Afolabi, Fatusi, Abioye –Kuteyi, Bello and Fakande, 2007; Salkeld and McGreehan,2010 and Centres for Disease Control and Prevention, 2006).           

Lastly, HIV counselling was described as an intervention that gives the client an opportunity to confidentially discuss his or her HIV risks and be assisted to learn his or her HIV status while the testing section helps in finding out whether a person is infected with HIV (Kenya Ministry of Health, 2005; British Infection Society, 2008). Integrated, stand-alone and mobile or outreach models are the three major models of HCT services delivery in Nigeria as stated by Federal Ministry of Health (2006).
                                   CHAPTER THREE

RESEARCH METHODOLOGY

3.0   Introduction

          This chapter focuses on the step by step procedural activities to be taken by the researcher in the conduct of this study.  This include the research design, population of the study, sample and sampling technique, instrument for data collection, validity and reliability of the instrument, procedure for data collection and method of data analysis.

3.1   Research Design

          Descriptive research design of the survey type is adopted for this study. Abiola (2007) opined that this type of research design involves a clear definition of the problem, collection of relevant and adequate data, careful and interpretation of the data and skillful reporting of the findings.  Therefore, this design is appropriate for this study because it requires representatives (samples) of the population.

3.2   Population of the Study

          The population for this study consists of all students of colleges of education in Oyo metropolis (Emmanuel Alayande College of Education and Federal College of Education(special), Oyo) which are 8,743 and 6,350 respectively. The target respondents for the study consist of all 300 level registered students of the two institutions for the 2010/2011 academic session in eight(8) departments. Medical staffs of the two (2) colleges of education (10 and 13 for Emmanuel Alayande College of Education and Federal College of Education(special) respectively), who are actually involved in counselling and testing of clients/patients for HIV/AIDS will also form part of the population for the study.

3.3   Sample and Sampling Technique

              A total of four hundred and sixty-four (464) respondents (representing 20 percent of registered 300 level students in both institutions) comprise of 232 males and 232 females from eight (8) departments; Physical and Health Education, Computer Science, Yoruba, Biology, Chemistry, Home Economics, Social Studies and Fine Art in both colleges would be sampled for this study with the use of a stratified random sampling technique.  This will help in sub-dividing the population of the study into different levels (homogenous sub-groups). Then, fifty-eight (58) respondents from each department listed above would be randomly selected with the equal ratio of male and female to solicit for the required respondents of the study.

A Table Showing Registered Part 3 Students of Emmanuel Alayande College of Education and FCE(special) for 2010/2011 Academic Session

Dept	PHE	Comp Sci	Yoruba	Biology	Chemistry	Home Econs	Soc Std	F/Art	Row Total
EACOED	55	184	300	350	160	120	417	55	1641
FCE (SPECIAL)	30	84	135	106	22	37	250	15	679
Column Total	85	268	435	456	182	157	667	70	2320

Source: Departmental Continuous Assessment (C.A) format for 2010/2011 Academic session.

3.4   Instrument for Data Collection

          The main instrument for data collection will be a self-structured questionnaire titled Awareness and Acceptability of Voluntary HIV Counselling and Testing (AAVHCT). The questionnaire shall be divided into sections A and B; section A deals with demographic data of respondents such as: name of institution, department, level of study, gender, age, religion, parental occupation and parental education while section B will elicit information on influence gender, age, socio-economic background, religion and parental educational background on acceptability of HIV testing among the respondents. 

          The questionnaire contains thirty items that is six items per variable and items shall be based on a 4-point likert-scale of strongly agree, agree, disagree and strongly disagree.

3.5   Validity of Instrument

        According to Abiola (2007), validity is the extent to which an instrument or test measures what it purports to measure.  The questionnaire was  given to three (3) chosen jurors, who are experts in the fields of public health, medical science and health education for validation.  Their comments and suggestions were used to improve the face and content validity of the questionnaire.

3.6   Reliability of Instrument

          Reliability refers to the consistency with which the instrument measures what it purports to measure (Kolawole, 2002; Adewuyi and Oluokun, 2001).  The reliability of this instrument was carried out using test re-test technique. The instrument was first administered on the selected sample used for the pilot study, again the instrument was further administered on the samples after a period of two (2) weeks interval.  This result of the first administration was compared with this result of the second administration using Spearman rank order statistical analysis. A reliability result of 0.82 was obtained. This was considered reliable enough for use.

3.7   Procedure for Data Collection

          The researcher will visit the two colleges and administer the instrument. The consent of each departmental Heads and the participants will be sought before the administration of the instrument.  The researcher, in company of two research Assistants will administer the questionnaire and make on the spot collection to maintain a high retrieval rate.

3.8   Method of Data Analysis

          Descriptive statistics of frequency count and percentage will be used to analyse the demographic characteristics of respondents, while the non-parametric statistics of chi-square will be used to test the five postulated hypotheses. The decision criteria for the hypotheses to be tested will be set at 0.05 alpha level of significance.

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United Nations Joint Programme on AIDS (2004). HIV voluntary counselling and testing: a gateway to prevention and care. NAIDS Best Practice Collection. Geneva: UNAIDS

United Nations Joint Programme on AIDS (2005). AIDS epidemic. http://unaids.org/worldaidsday/2005/press/update2005-en.doc.                            

Walker, N. (2004).  Estimating the global burden of HIV/AIDS. What do we really know about the HIV pandemic? Lancet. 363: 2180-2185.

World Health Organization (2004).  Scaling up antiretroviral therapy in resource limited setting: treatment guidelines for a public health approach.  WHO Publication.

Yahaya, L.A., Jimoh, A.A.G & Balogun, O.R. (2010). Factors hindering the acceptance of HIV/AIDS Voluntary Counselling and Testing (VCT) among youths in Kwara State, Nigeria. Journal of AIDS and HIV Research. Vol 2 (7): 138 – 143

Zimbabwe Ministry of Health (2005).  Zimbabwe national guidelines on HIV testing and counselling. Zimbabwe. ZMOH Publication.  

APPENDIX 1

FACULTY OF EDUCATION,

DEPARTMENT OF HUMAN KINETICS AND HEALTH EDUCATION

QUESTIONNAIRE ON: AWARENESS AND ACCEPTABILITY OF VOLUNTARY HIV COUNSELLING AND TESTING

Dear Respondent,

          This questionnaire is designed to elicit information on the level of awareness and acceptability of voluntary HIV counselling and testing among college students in Oyo metropolis. All information provided shall be kept confidential because it is purely for academic purpose only.

       Yours faithfully,

Consent:

(  ) I am willing to take part in this study.

(  ) I am not interested in this study.

SECTION A – DEMOGRAPHIC INFORMATION

Instruction: Please fill in the gaps and tick (Ö ) the correct option(s) as appropriate.

1.      Name of your Institution ____________________________________

2.      Name of your Department __________________________________

3.      Level of study ______________________________________________

4.      Gender:  (a) Male    (  );  (b) Female (   )

5.      Age range: (a) 16-20years (   ); (b) 21-25years (   );  

(c) 26years and above

6.      Religion (a) Christian (  ): (b) Muslim

7.      Parental occupation (a) Government employee (  );

(b) Self-employed (c) Others (  )

8.      Parental education (a) HND and above (  ) (b) TC II/NCE/OND (  );  (c) Primary/Secondary (  )  (d) None (  )

SECTION B: General Information on AAVHCT

Instruction: Kindly tick (Ö ) the correct option as appropriate to you below

Key

SA     -        Strongly Agree

A       -        Agree

D       -        Disagree

SD     -        Strongly Disagree

S/N	ITEMS	SA	A	D	SD
	GENDER AND ACCEPTABILITY OF HIV TESTING
1.	Males are accepting HIV test compared to females.
2.	Females accept HIV test than males because of their pregnancy status.
3.	Frequent patronage of women in hospitals affords them opportunities of having HIV test done.
4.	Male students attach less importance to their health compared to female students.
5.	Most women prefer knowing their HIV status before entering into marriage compared to men.
6.	Females attend sexually transmitted infections’ clinics more than males and this afford them opportunity of assessing their HIV status.
	SA     A      D     SD   AGE AND ACCEPTABILITY OF HIV TESTING
7.	Youths are vulnerable to STDs due to their high level involvement in sexual activities and this make them accept voluntary HIV counselling and testing
8.	Younger students more willing to accept voluntary HIV counselling and testing than older students.
9.	Willingness to use voluntary counselling and testing services decreased with the increase in students’ age.
10.	Younger students are more inquisitive to get HIV/AIDS education and know their HIV status.
11.	Awareness about increased number of HIV/AIDS victims among youths motivates them patronize voluntary counselling and testing sites.
12.	One of the factors predicting uptake of voluntary HIV counselling and testing is age.
	SOCIO-ECONOMIC BACKGROUND AND ACCEPTABILITY OF HIV TESTING
13	I am aware of HIV counselling sites through relations and friends
14.	Where I live facilitates my positive attitude towards HIV and exposes me to counselling SA     A      D     SD   and HIV sites.
15.	Awareness of my parents about HIV/AIDS affects my acceptability of HIV testing
16.	Open discussion of sexual issues with family members influence my acceptability of HIV testing
17.	Social consequences of positive test result serves as barrier to HIV testing
18.	Social reflection like lack of confidentiality by the service provider barricades people from assessing HIV test
	RELIGION AND ACCEPTABILTY OF HIV TESTING
19.	My religion forbids HIV/AIDS education and testing
20.	I refuse voluntary HIV counselling and testing because of my religion.
21.	Discrimination against HIV positive clients in the place of worship discourage people from getting tested for HIV.
22.	My religion supports polygamy and this suggests need for HIV testing.
23.	I go for HIV testing because my religious leaders mandate it for marriage.
24.	Christians are likely to accept voluntary HIV counselling and testing compared to Muslims.
	SA     A      D     SD   EDUCATIONAL BACKGROUND AND AWARENESS OF HIV TESTING
25.	Students whose parents are knowledgeable about HIV/AIDS might have been earlier educated on HIV test compared to others.
26.	Parental level of education can influence students’ acceptability OF HIV testing.
27.	Students having parents who are well exposed (working in high status position) are likely to accept HIV testing than others.
28.	Students who grew up with both parents have high tendency to accept HIV testing than others.
29.	Students from low parental educational background are less aware of HIV testing.
30.	Students from low parental educational background are less willing to be tested for HIV

APPENDIX II

Spearman rank order for data collected during pilot study.

X	Y	RX	RY	D	D2
104	107	1	1	0	0
93	91	5.5	5.5	0	0
103	105	2	2	0	0
77	71	20	20	0	0
88	83	12.5	11.5	1	1
90	82	9.5	13.5	-4	16
78	73	18.5	19	-0.5	0.25
89	81	11	15	-4	16
87	83	14	11.5	2.5	6.25
90	88	9.5	8	1.5	2.25
78	75	18.5	18	0.5	0.25
92	89	7	7	0	0
86	82	15	13.5	1.5	2.25
81	84	17	10	7	49
96	91	3	5.5	-2.5	6.25
91	78	8	17	-9	81
88	80	12.5	16	-3.5	12.25
83	87	16	9	7	49
94	95	4	3	1	1
93	94	5.5	4	1.5	2.25
					245

r= 1- 6ED²

               N(N² – 1)

Where D= difference between ranks of corresponding value of X and Y

            N= Number of pairs of value (X,Y) in the data

            1 and 6 are constant values.

            ED² =  245,  N = 20,   N²= 400

r= 1-     6(245)

           20(400 – 1)

r= 1 – 1470

          20(399)

r= 1 – 1470

           7890

r= 1 – 0.184

r= 0.82