ABSTRACT

 This study aims at investigating knowledge and utilization of Voluntary Counseling Testing (VCT) services on the prevention of HIV/AIDS among Students of Tertiary Institutions of Bauchi State. However, to achieve the aim seven objectives and research questions each were postulated to guide the study and seven hypotheses were formulated and tested. The study adopted an ex-post facto design using a multistage sampling method, stratified sampling technique was used to divide the Tertiary Institution into four strata and one school from each stratum was drawn using random sampling, proportional and cluster sampling were deployed in meeting the 381 respondents using modified self-developed questionnaire which contain three sections. Descriptive statistic of mean, standard deviation were used to analyze the items in the various section of the questionnaire while t-test, ANOVA and Pearson product moment correlation coefficients were used to test the hypothesis at 0.05 level of significance. The data collected was analyzed using statistical package of social sciences (SPSS). The result revealed that majority of students in Tertiary Institutions of Bauchi State have knowledge on VCT services and are utilizing VCT services; there are no significant difference between male and female in their knowledge of VCT services among respondents; the result indicated no significant difference between male and female in their utilization of VCT services among respondents; significant difference existed on knowledge and utilization among students of different tertiary institution; and knowledge of VCT services influences the utilization of VCT services among respondents. Based on these findings it was recommended that VCT centres should be cited in educational institutions for proximity to the people. Both sexes should have to be encouraged to accept VCT for HIV through peer initiated VCT services at all levels of care including in universities; to intensify health education to convince the remaining minority who are still skeptical or ignorant of the benefits of VCT. Since knowledge of VCT influenced the utilization of VCT services among the respondents. Health personnel should intensify enlighten campaigns on the benefits of VCT utilization.

CHAPTER ONE

INTRODUCTION:

1.1      Background to the Study

The human immunodeficiency virus (HIV) was unknown until the early 1980s, but since that time it has infected millions of persons in a worldwide pandemic (Edward, 2006). The result of HIV infection is relentless destruction of the immune system leading to onset of the acquired immunodeficiency syndrome (AIDS). The AIDS epidemic has already resulted in the deaths of over half of its victims. All HIV-infected persons are at risk of illness and death from opportunistic infections and neoplastic complications as a consequence of the inevitable manifestations of AIDS (Moss, & Bacchetti, 1989).

HIV/AIDS is a global crises, a challenge to human life and dignity with ability to erode social and economic development. It has great influence on stability, life expectancy and economic development. It is a major public health problem with sub-Sahara Africa severely affected by the epidemic (Lancet, 2002).

World Health Organizations (WHO) interventions for prevention focused on key areas such as counseling and testing as the entry point to treatment, prevention and comprehensive programs to prevent HIV/AIDS infection among infants, women and young people. Only 5 percent of people with HIV/AIDS are estimated to be aware of their

status worldwide (WHO, 2004).        The scope of the AIDS pandemic has already led to

serious consequences, not only for health care systems of countries that are unable to cope with many AIDS victims, but also for the national economies of those countries because of the loss of young to middle aged who are economically most productive. At

the beginning of the 21^st century, 95 percent of new HIV infections and deaths occurred in developing nations, and two-third of persons living with HIV infection reside in Sub-

Sahara Africa. The age groups most affected are young persons from 15 to 24years of age, accounted for 40 percent of new HIV infection (Merson, 2006). Worldwide, over half the victims of AIDS are women and the consequence of this is perinatal infection resulting in a significant number of children born with HIV infection (Lancet, 1996).

Nigeria recorded the first case of AIDS in 1986 (FMH, 2005). Heterosexual intercourse remains the primary mode of transmission for HIV and accounts for 80-95 percent of HIV infection in Nigeria (Adeyi & Kanki, 2006). Nigeria has the second highest number of people living with HIV in the World after South Africa with estimated number of 33.4 million of people living with HIV in 2008 (UNAIDS, 2009).

With an estimated 3.5 million people living with HIV/AIDS, Nigeria remains a home to 1 of every 11 of the 40 million people living with HIV/AIDS worldwide (UNAIDS, 2002). The HIV prevalence among adults in Nigeria has increased from 1.8% in 1991 to an estimated 5.8% in 2001 (UNAIDS 2002). Prevalence ranges from 2 percent to 14.9 percent in the country’s 36 states and Federal Capital Territory (FMH, 2001). According to official estimates, Nigeria faces 200,000 new infections and approximately 170,000 AIDS death in 2003 alone, (UNAIDS, 2002) and these numbers are projected to increase each year. There are geographic differences in prevalence of HIV/AIDS (UN system in Nigeria, 2001) which ranges from 2 percent to 14.9 percent in the country’s 36 states and Federal Capital Territory (FMH, 2001). Young people – 15-24 year olds – account for nearly half of all new HIV infections worldwide. They are the largest youth generation in history and need a protective environment – regular schooling, access to health and support services – If they are to play their vital part in combating the epidemic (UNAIDS, 2004). Adolescents and young adults in their 20’s are mostly affected with HIV/AIDS and have little access to reproductive health services and information.

Prevalence for girls and young women aged 15-24 is higher than for males in that age group (UN System in Nigeria, 2001).

The number of sites providing VCT has been on the increase. As at December 2008, there were 908 functional VCT sites across the country (Nigeria) providing counseling and testing services compared with 864 at the end of 2007. Closely linked to this is an increase in expressed desire to get an HIV test; 72 percent of respondents in the 2007 National HIV/AIDS and Reproductive Health Survey (NARHS) expressed a desire to get tested. The total number of people who were counseled, tested and received their test results also rose from 2,350,000 in December 2007 to 3,371,220 at the ends of 2008 (NACA, 2009). In Bauchi state, 61,851individuals received HIV counselling and Testing (HCT) of which1233 tested positive (Liman, 2011).

HIV counseling and testing (HCT) has been identified as a critical intervention tool in HIV prevention and care strategies. Voluntary Counseling and Testing (VCT) provides an opportunity for one to know his/her HIV status after receiving enough information to make the decision. A study (Allen, Serufilira, Bogaerts, Van de Perre, Nsengumuremyi, Lindan, et al. 1992) had shown that VCT has been useful in facilitating and sustaining behavior change. However, it has been observed that utilization of VCT services in conventional health care setting has been limited. This is especially the case for hard to reach targets such as young people (especially out- of- school youth), migrant fisher men and farmers, nomadic, long distant truck drivers, and street based commercial sex workers.

HIV counseling and testing is crucial in controlling HIV transmission in those who tested negative and in those who tested positive by promoting the appropriate contraceptive and the practice of safer sex, early management of opportunistic infections

and sexually transmitting infection (STI), referral services to support groups and acceptance of status (FHI, 2007).

In Nigeria there is a distinct lack of HIV testing programmes. In 2010 there was only 1.4 HIV testing and counseling facilities for approximately every 100,000 Nigerian adults and only 11.7 percent of women and men aged 15-49 had received an HIV test and found out the results (FMH 2012, WHO/UNAIDS/UNICEF, 2011). This shows how desperately the government needs to scale up HIV testing services. Whilst an estimated 2.2 million people aged 15 years and above received HIV testing and counseling in 2010, this amounts to only around 31 people per 100,000 of the total adult population (WHO/UNAIDS/UNICEF, 2011). This research therefore, aimed at assessing knowledge and utilization of VCT services on the prevention of HIV/AIDS among students of tertiary institution in Bauchi state.

1.2  Statement of the Problem

Voluntary counseling and testing is an effective and pivotal strategy for both HIV/AIDS prevention and care, and is also a principal entry point to care and support for people living with HIV/AIDS (PLWHA). VCT help HIV negative people make informed choices when engaging in sexual intercourse, such as having single partner or using a condom. There is strong evidence that voluntary HIV counseling and testing can affect sexual behaviors and a multi-country trial suggested that VCT is cost- effective and efficacious in promoting behavior change, particularly in high HIV prevalence setting and VCT can even lower HIV incidence rates (Allen, Serufilira, Bogaerts, Van de Perre, Nsengumuremyi, Lindan, et al., 1992).

However, relatively few studies have focused on client’s experience of VCT, particularly among tertiary institution students, young people between the ages of 15-35years, the majority of who are currently in schools, colleges and Universities, have

been identified as vulnerable to HIV infections (UNAIDS/WHO 2005; Horizons Project, 2001). According to the World Bank (2001), University students in Africa are at high risk of contracting HIV AIDS because of high-risk activities such as “sugar daddy practices” and unprotected casual sex with multiple partners. The use of VCT services by young people has also been limited, primarily due to the issues such as lack of confidentiality, cost of services and unfriendly attitudes of clinical staff (UNFPA, 2004).

It is against this background that the researcher intends to conduct a study on knowledge and utilization of VCT services on the prevention of HIV/AIDS among students of tertiary institutions of Bauchi State.

1.3 Research Questions

Based on this, and the fact that there is paucity of literature on this topic in the area of study, the researcher formulated the following questions to guide this study.

1. What is the level of knowledge of VCT services among Students of tertiary institutions in Bauchi state?
2. What is the level of utilization of VCT services among Students of tertiary institutions in Bauchi state?

1. Are there differences between male and female students of Bauchi State tertiary institutions in their knowledge of VCT service?
2. Are there differences between male and female students of Bauchi State tertiary institutions in their utilization of VCT services?
3. Are there differences among the students of different tertiary institutions of Bauchi State in their knowledge of VCT services?
4. Are there differences among the students of different tertiary institutions of Bauchi State in their utilization of VCT services?
   1. Is there any relationship between knowledge and utilization of VCT services on the prevention of HIV/AIDS among students of Bauchi State tertiary institution?

1.4      Purpose of the Study

The purpose of this study is to assess knowledge and utilization of voluntary counseling and testing services in the prevention of HIV/AIDS among student of Bauchi State tertiary institutions. Specifically, the study sought to:

1. Find out the level of knowledge of VCT services on the prevention of HIV/AIDS among students of tertiary institution of Bauchi State.
2. Find out the level of utilization of VCT services on the prevention of HIV/AIDS among students of tertiary institution of Bauchi State.
3. Examine the difference between male and female in their level of Knowledge of VCT services on the prevention of HIV/AIDS among students of tertiary institution of Bauchi State.

1. Determine the difference between male and female in their level of Utilization of VCT services on the prevention of HIV/AIDS among students of tertiary institution of Bauchi State

1. Find out differences in knowledge of VCT services on the prevention of HIV/AIDS among students of different tertiary institutions in Bauchi State.
2. Find out the differences in utilization of VCT services on the prevention of HIV/AIDS among students of different tertiary institutions in Bauchi State.
3. Find out the relationship between knowledge and Utilization of VCT services among student of tertiary institution of Bauchi State

1.5       Basic Assumptions

The following assumptions were made for the study.

1. Level of knowledge of VCT services among Student of tertiary institution help on the prevention of HIV/AIDS in Bauchi state.

1. Level of utilization of VCT services among Student of tertiary institution help on the prevention of HIV/AIDS in Bauchi state.
2. Male and female students of tertiary Institution have the same level of knowledge of VCT services in Bauchi state.
3. Male and female students of tertiary Institution have the same level VCT services utilization in Bauchi state.
4. More Students from health Institutions are aware of VCT services then student of other tertiary Institution on the prevention of HIV/AIDS.
5. More Students from health Institutions are utilizing VCT services then student of other tertiary Institution on the prevention of HIV/AIDS.

1. Knowledge of VCT services helps in the utilization of VCT among students of tertiary institutions on the prevention of HIV/AIDS.

1.6      Hypotheses

1.6.1  Major Hypothesis

The students’ demographic variables do not significantly differ in their knowledge and utilization of VCT services for the prevention of HIV/AIDS in Bauchi State.

1.6.2  Sub-Hypotheses

In this study the following sub-hypotheses were formulated:

1. There is no significant difference between male and female students of tertiary institution in their knowledge of VCT services for the prevention of HIV/AIDS in Bauchi State.
   1. There is no significant difference between male and female students of tertiary institution in their utilization of VCT services for the prevention of HIV/AIDS in Bauchi State.

1. There is no significant difference in the knowledge of VCT services among Students of different tertiary institutions in Bauchi state.
2. There is no significant difference in the utilization of VCT services among Students of different tertiary institutions in Bauchi state.
3. There is no significant relationship between knowledge and utilization of VCT services in the prevention of HIV/AIDs among student of tertiary institution in Bauchi State.

1.7      Significance of the Study

The outcome of the study would be of great importance to the tertiary institution of the study area, Bauchi State government, particularly, Ministry of Higher education and Ministry of Health for the creation of more VCT site in the schools.

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

1.8      Delimitation of the Study

This study would be delimited to knowledge of HIV/AID VCT and utilization of VCT services among student of tertiary institutions age 15-49 years in Bauchi State.

1.9      Limitation of the Study

This study has the following limitations, which were considered while interpreting the results.

1. Some of the respondents refused to respond appropriately to the questions asked as such the trained research assistant explain and solicit for the true from the respondent.

1. After retrieving the questionnaire, it was found that some of the questionnaires were returned not completely answer; as such it was not included in the analysis.
2. There was delayed in the return of the questionnaire by the respondents, as such one week was added to retrieve the questionnaires.