Knowledge, acceptance, and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome among undergraduates of a public university in Southwestern Nigeria

INTRODUCTION

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have persisted as a disease of public health importance around the world. It is known globally as one of the most important public health crises, with about 39 million people living with HIV/ AIDS globally in 2022.^[1] According to UNAIDS (the joint United Nations program on HIV and AIDS), about 630,000 people died from AIDS-related illnesses at the end of 2022, and an estimated 1.3 million people have been newly infected with HIV.^[1] Nigeria has one of the highest rates of new infection in Sub-Saharan Africa at an estimated 130,000, and about 1.9 million live with the virus in Nigeria.^[2]

Young people within the ages of 15 and 24 are at the highest risk for HIV/AIDS epidemic in Nigeria.^[2] They are vulnerable to HIV because of the strong influence of peer pressure and the development of their sexual and social identities. In West and Central Africa, this age group has an estimated HIV prevalence of 3.5% among other countries.^[3] The epidemic is driven by this age group in the matrix of low-risk perception, risky sexual behavior, low condom use, lack of knowledge, and access to appropriate reproductive health services.^[4] In Nigeria, HIV/AIDS is further aggravated by inadequate sexual health education, inadequate voluntary HIV testing and counseling, unhealthy cultural practices, and poor health care systems, especially in secondary and tertiary institutions.^[5]

Voluntary counseling and testing (VCT) is one of the preventive measures put in place to prevent the transmission of HIV/AIDS. VCT is important in HIV prevention, care, and treatment since early detection of the virus reduces transmission and mortality. It is the process by which an individual, couple, or family receives HIV testing and confidential dialogue on HIV prevention, treatment, care, and support.^[6]

University undergraduates in Nigeria are mostly adolescents and youths within the ages of 15 and 24, which is the high-risk population for HIV/AIDS. University students are at risk because they tend to be sexually adventurous, often with multiple partners, and do not consistently use condoms.^[7] Although studies show that there is increased knowledge of HIV/AIDS among young people, uptake and utilization of HIV testing and counseling services among them has been reportedly low.^[7] It is therefore important that a youth-friendly counseling service such as the VCT be provided in universities in the fight against the epidemic in this high-risk population. The previous studies show that this study population is more knowledgeable on HIV/AIDS issues compared to the general population. There is, therefore, a need to investigate their knowledge and acceptance of VCT for HIV/AIDS, as well as their level of uptake of VCT services.^[7] This will enable appropriate and accessible VCT services to be provided on university campuses, thereby increasing the uptake of the service among the undergraduate population.

MATERIAL AND METHODS

The study adopted a descriptive cross-sectional study design. Multistage sampling technique was used to select 425 undergraduates in the Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Stage one involved random sampling of 8 faculties among the 13 faculties in the university.^[8] These faculties selected were basic medical sciences, agricultural science, technology, law, arts, dentistry, pharmacy, and social science. In the second stage, a proportionate sampling technique was used to identify the total number of students to be selected from each of the faculties. Stage three involved random sampling of 425 undergraduates from their various faculties.

Data collection was done with a self-administered questionnaire. The questionnaire had five stages: Stage I collected information on the socio-demographic data of respondents, stage II assessed respondents’ knowledge about VCT for HIV, stage III assessed respondent’s acceptance of VCT for HIV, stage IV assessed respondent’s utilization of VCT for HIV, while stage V assessed the factors influencing the utilization of VCT among respondents.

The data were checked for completeness and entered, cleared, and exported in SPSS version 25 for analysis. Descriptive statistical techniques, which include percentages, frequencies, mean, and standard deviation were used to give a clear picture of background variables such as age, sex, and other variables. Inferential statistics were also used to test the relationship between variables of the study.

An ethical clearance letter was obtained from the Human Research Ethical Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife (IPHOAU/12/2192). Verbal consent was also obtained from the students, and confidentiality of all information provided and anonymity of the respondents were maintained.

RESULTS

Four hundred and twenty-five questionnaires were administered to the respondents. The mean age of the respondents was 19 ± 2.6 years [Table 1]. Over half, 226 (53.2%) of the respondents were within the age range of 18–25 years and were majorly female 345 (81.2%). Furthermore, the majority of the respondents were Christians 374 (88%), single 403 (94.8%), and had never had sex 300 (70.6%), and over half 240 (57%) of the respondents had good knowledge of VCT. Results showed a high level of VCT acceptance among more than half, 254 (59%) of the respondents. The majority, 326 (76.2%) of the respondents had a low level of utilization of VCT [Figure 1].

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Figure 1:

Knowledge, acceptance and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome.

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Findings on the association between the socio-demographic characteristics of respondents and uptake of VCT showed that respondents’ age (χ² = 55.599^a, P = 0.000), gender (χ² = 19.094^a, P = 0.000), religion (χ² = 8.990^a, P = 0,038), marital status (χ² = 8.411^a, P = 0.038), and their age at first sex (χ² = 61.847^a, P = 0.000) were significantly associated with uptake of VCT. There was also a significant association between the uptake of VCT and respondents knowledge (P = 0.021) and acceptance (P = 0.000) of VCT for HIV/AIDS [Table 2].

The dependent variable (uptake of VCT) was regressed on predicting independent variables of selected socio-demographic characteristics, knowledge, and acceptance of VCT. The independent variable significantly predicts the uptake of VCT (F [8,416] = 20.163, P < 0.05), which indicates that the three factors under study have a significant impact on the uptake of VCT. Moreover, R² = 0.279 depicts that the model explains 27.9% of the variance in uptake of VCT.

In addition, in Table 3, the coefficient was further assessed to ascertain the influence of each factor on the criterion variable (uptake of VCT). Hypothesis 1 evaluates whether there is a significant association between selected socio-demographic characteristics and respondents’ level of VCT utilization. The results revealed that respondents’ age (0.002), sex (0.013), and age at first sex (0.014) had a significant association with their level of knowledge. Hypothesis 2 evaluates the association between respondents’ level of knowledge of VCT and their utilization of VCT services. The results showed a significant negative association between respondents’ level of knowledge and their utilization of VCT (B = −0.117, t = −3.236, P = 0.001). Furthermore, hypothesis 3 evaluates the association between respondents’ level of acceptance of VCT and their utilization of VCT. The results showed a significant association between the level of acceptance and utilization of VCT (B = 0.323, t = −8.575, P = 0.000).

DISCUSSION

Findings from this study revealed that over half of the respondents had good knowledge of VCT for HIV/AIDs. This is similar to the findings of studies conducted in Nigeria, where most undergraduates had adequate knowledge of VCT.^[5,6] Although the literature on the knowledge of VCT for HIV/AIDs among undergraduates in Sub-Saharan Africa is not conclusive, several studies have reported good knowledge of VCT for HIV/AIDs in the region. In a study on the knowledge of VCT among university students, the majority (93.4%) of the students were knowledgeable about VCT, which is also similar to the findings of this study.^[9] A study conducted in Uganda also showed that most participants had adequate VCT knowledge of what, why, how, where, and when VCT services were conducted.^[10]

In this study, there was a high level of VCT acceptance for HIV/AIDs among a majority of the respondents. However, the majority of the respondents have never gone for HIV VCT and have not visited their schools’ facilities for VCT service. These are similar to the findings of Kalimbo, where most of the respondents have never gone for an HIV VCT.^[11] The previous studies have highlighted that the majority of undergraduates will not willingly accept to be tested for HIV at their school VCT facility. Several factors may attributed to this, such as not being satisfied with the facilities and manner of personnel conduct of the counseling and testing services, as also stated by over half of the respondents in this study.

These are contrary to the findings of a study conducted in Ghana, where most of the undergraduates in the study were willing to test for HIV/AIDs. However, this willingness was influenced by respondents’ gender, history of sexual intercourse, good background knowledge of HIV/AIDs and its transmission, and parental influence.^[12]

The utilization of VCT in this study appears to be notably low, mirroring the findings of a similar investigation in Abia state, Nigeria, which reported a high prevalence of nonuptake of VCT among participants.^[5] This study’s results indicate a significant association between respondents’ age, sex, and age at first sexual activity with the uptake of VCT. These trends align with a study conducted in Sudan, where VCT uptake was similarly low among university students and associated with factors such as age and risk perception.^[13] In addition, a recent study in a southwestern state in Nigeria concurs with the current findings, highlighting a widespread low level of VCT utilization.^[14] Notably, a majority of the respondents in this study have never undergone HIV/AIDS testing using VCT, and none have engaged in VCT within the past 12 months. This echoes the results of a study by Ogbonna et al., wherein the vast majority of participants had not utilized VCT in the preceding 12 months.^[15] The consistency of these findings is further emphasized by a study among undergraduates in Osun state, revealing that only a small proportion of respondents had utilized the VCT centers within the school for VCT uptake. Probable reasons for the low VCT utilization may include insufficient awareness, social stigmas associated with HIV/AIDS testing, and a lack of perceived risk among the target population.^[8,14] Further, research may delve into these factors to inform strategies aimed at improving VCT uptake in the context of HIV prevention, care, and treatment among university undergraduates.

CONCLUSION

In this study, the adequate knowledge and high acceptance of VCT among the majority of the respondents did not translate to the uptake of VCT for HIV/AIDS. There is a need to create more awareness of the need and benefits of VCT and innovatively encourage the use of VCT for HIV/AIDs among the undergraduate population in the study area.