KNOWLEDGE AND COMPLIANCE OF EBONYI STATE UNIVERSITY UNDERGRADUATES TO VOLUNTARY COUNSELLING AND TESTING FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

ABSTRACT
Early detection and treatment of infected individuals is an important step in the control of HIV epidemic.  Voluntary counselling and testing is a concept developed in this direction.   The study was conducted to determine the knowledge and compliance of Ebonyi State University Undergraduates to VCT for HIV/AIDS using a descriptive survey design. The sample consists of 384 full-time undergraduates selected from 3 campuses by simple random sampling. Self structured questionnaire was used to collect data. Data generated were analyzed and presented in frequency tables and percentages, chi-square (X²) was used to test the four hypotheses formulated for the study.  The findings showed a good level of knowledge of VCT for HIV/AIDS (69.9%) among EBSU students. More knowledge existed among females (36.7%) although   not statistically significant. Presco campus students (40.2%) have more knowledge than the other two campuses. All the students claimed to have done HIV test at one time or the other (i.e. did HIV test two times or more at three or six months interval voluntarily) but only 12.1% totally complied to HIV test voluntarily. Half of the respondents (73.4%) did HIV text “by own volition”. Confidentiality (78.7%) was the most important factor that would make EBSU undergraduates use VCT services for HIV test. The study noted that the number of students with good level of knowledge of VCT for HIV/AIDS did not reflect in the compliance level. It was recommended that awareness campaign on routine voluntary HIV test and safe behaviour practices to prevent HIV should be intensified to the public at large. Health care providers should ensure enabling environment that will make young people use VCT services for HIV test
CHAPTER ONE
INTRODUCTION
Background to the Study
Globally about 70 million people have been infected with HIV virus while 35 million people have died of AIDS and 34million people were living with HIV by the end of 2011(WHO, 2014). An estimate of 0.8% of adults aged 15 – 49 years worldwide are living with HIV with variation in epidemics between countries and regions. Sub-Saharan Africa remains most affected with nearly 1 in every 20 adults living with HIV and accounting for 69% of people living with HIV worldwide (WHO, 2014). In Africa, an estimate of 1.7 million young people is infected annually (WHO /UN Joint Programme on HIV/AIDS, 2006). Many youths engage in risky behaviours, with fewer than 10% of the sexually active adolescent females from countries in sub-Saharan Africa reporting condom use (Human Development Report, 2004). In Nigeria 3.4million people are living with HIV/AIDS (UNAIDS, 2013).Thus voluntary counselling and testing (VCT) for young people have been recognized as a major priority within the Nigerian HIV- prevention programme.
 
Voluntary counselling and testing (VCT) for Human immunodeficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS) is the process whereby an individual or couple undergo counselling to enable him/her make an informed choice about being tested for HIV ( Federal Ministry of Health, 2003). VCT is a major strategy designed by programme planners to combat the pandemic of HIV/AIDS in Africa (Bruce and Stellenberg, 2007). It involves community mobilization, education, increase in VCT sites, reduction of stigma, policies that protect human rights, counselling, rapid tests and confidentiality. VCT activities are implemented with other measures like sexual abstinence, marital fidelity, condom use and anti-retroviral drugs. Voluntary HIV test is an active search for HIV among healthy people and is therefore a fundamental aspect of primary, secondary and tertiary prevention of HIV infection and AIDS (Park, 2007 and Ikechebelu, Udigwe, Ikechebelu & Imo, 2006). It offers holistic approach that can address HIV in the broader context of people’s lives. HIV screening is advocated for every individual from early teen years of  life especially those who are sexually active or exhibit high risk behaviours ( injection – drug users and their sex partners, sex partners of HIV – infected persons and heterosexual persons with more than one sex partners). The age group coverage for voluntary HIV test is as low as 15 years in developing world since there is evidence that 25% of them have initiated sex by then (HDR, 2004). Apart from early exposure, young people are at risk of HIV infection because of  lack of skill to negotiate safe sex behaviour and vulnerability to sexual abuse. This has necessitated the campaign on youth friendly programmes to encourage youths know their HIV status. According to WHO (2003), regardless of test result after the first test, routine check continues regularly at least every 6 months, but every 3 months for those that are sexually active. Each HIV test follows the process of pretest counselling, test and post test counselling.
Voluntary counselling and testing is being advocated for because it has been shown to enable individuals, whether HIV positive or negative to change their behaviour appropriately (Okojie and Omume, 2004).Healthy lifestyle is achieved during interaction with service providers as the individual understands the need to maintain his or her HIV status. Although knowing HIV status is regarded as an important component of a healthier lifestyle, the decision to undergo VCT is entirely that of the individual being tested (FMOH, 2003). The willingness to do HIV test may be because of HIV services that are accessible, affordable and with observed confidentiality that will increase the clients trust or as routine during antenatal care, for premarital decision, or an institutional requirement. People’s willingness also depends on public awareness programmes that will give understanding of what VCT is.VCT education is one major component in the strategy of voluntary counselling and testing programme, which one is expected to acquire either from formal school or from other sources that include community, mass media and churches.
Compliance in VCT for HIV/AIDS is the willingness of an individual to undergo the process of knowing own HIV status correctly. It is influenced by knowledge of the procedure, benefit of the test, perception of the test, cost, and accessibility of the services and fear of positive result. Individual characteristics such as age, gender, social support, personality trait and personal beliefs about health are associated with people’s compliance to medical advice. Rejection of HIV screening has been linked to psychological trauma, infringement on fundamental human rights, fear of living with positive screening and stigmatization at place of work (Omoigberale, Abiodun and Famodu, 2006).
 
One hundred and nineteen countries reported a total of 95 million people that tested for HIV in 2010 (WHO, 2014). The compliance of  Nigerians to voluntary counselling and testing for HIV/AIDS has improved with time although it is still on low side compared to its population of 150,000,000 (National Population Commission, 2009). A comparism of the 2003 and 2007 result of the proportion of Nigerians who took HIV test increased from 6.6% to14.4% for females and from 7.7% to14.17% in males (National Policy on AIDS, 2009). An estimate of 2.2 million people aged 15years and above received HIV testing and counselling in 2010, which amounts to only around 31 people per 100,000 of the total adult population (WHO/UNAIDS/UNICEF, 2011). In 2010 National Action Committee on AIDS (NACA) launched a comprehensive strategic framework with the aim to reach 80% of sexually active adults and 80% of most at risk population with HIV counselling and testing by 2015. This is to reinforce the existing guideline addressing the needs of young people. (National Strategic Framework 2010-2015, 2009). However, the success of VCT programme will depend to a large extent on the political will driving its implementation and client compliance to VCT.
 
There are many VCT centres in Ebonyi state that extends to the local government areas. This resulted from the effort of the government and interest of different non governmental organizations. Some of the VCT centres are located near these campuses: College of Agricultural Science (CAS), with its campus about 2 kilometres away from a VCT centres (St. Lukkes Laboratory); College of Health Sciences (Presco) campus which is about 100metres away from the State public VCT centre. Ishieke and Permanent site campuses are about 4 and 8 kilometres away from mile 4 VCT centre. Ebonyi state university has a permanent site and four other campuses that are within and outside the capital city. The university community amidst others have enjoyed so many preventive measures to HIV prevention to which VCT is one (Ebonyi State Action Committee on AIDS, 2009). The university government and non governmental organizations also organizes programmes to inform students on the need to live healthy life styles which usually end up with free HIV services. VCT services is therefore accessible to students, hence the need to explore their knowledge and compliance to the services.
Statement of the problem
The burden of HIV/AIDS disease is felt in economically depressed countries like Nigeria (National Policy on AIDS, 2009 and UNAIDS, 2007). A lot of money has been spent by government of Nigeria and agencies concerned with HIV/AIDS in a bid to inform people of what voluntary HIV counselling and testing is and its importance in HIV control. This is evidenced in the strategies to improve access to VCT services through increase in sites, increase in awareness campaign, simple rapid test and test results, free test services, training of service providers and protection of rights of victims of AIDS diseases (National Policy on HIV/AIDS, 2009).
The social position of adolescents which is characterized by dependency, physical and emotional immaturity makes youths vulnerable to sexual and reproductive diseases. They lack skill to negotiate safe sexual behaviours, have poor access to contraceptives and are vulnerable to sexual abuse. Despite their high risk for HIV infection there is low National prevalence of VCT among youths (15-24 years) of 2.6% with regional variations (Nwachukwu & Odumegwu, 2011).
 
Ebonyi state government, university government and agencies concerned with HIV/AIDS have floated many programmes on awareness and prevention of HIV/AIDS in Ebonyi State University which usually end up with free HIV test services (EBOSACA, 2009).Aside such programmes are numerous VCT service centres that are in the state. These programmes and services are expected to yield positive results in order to meet NACA target of 80% HIV counselling and testing among the sexually active and at risk group by 2015.
The researcher severally observed low turnout and participation of student during HIV preventive programmes in the University. Moreso, in one of the VCT centres of about 100metres from Presco Campus, only 0.8-12% of the total population that have HIV test between 2009 to 2011 are undergraduates of EBSU. (State public VCT Centre). This informed the research to know the knowledge EBSU undergraduates have about VCT for HIV and their level of compliance.
 
Purpose of the Study 
The purpose of the study is to determine the knowledge about voluntary counselling and testing for HIV/AIDS among Ebonyi State University undergraduates and to asses their level of compliance to testing.
Specific objectives of the study includes to;

1. Determine the knowledge that EBSU undergraduates have about VCT for HIV/AIDS.
2. Determine the level of compliance with VCT for HIV among undergraduates.
3. Explore what prompts undergraduate to engage in VCT for HIV/AIDS.
4. Identify factors that would make EBSU undergraduates use VCT services for HIV test.

Significance of the study
Findings from this study will provide the following:
(i)         Show the level of knowledge about VCT among EBSU undergraduates and show their compliance level to the test. It will also show students condition for compliance and factors that will improve VCT compliance.  The university by this discovery may plan and introduce programmes that will improve students’ knowledge and compliance to VCT for HIV/AIDS
(ii)        When the result of this study is utilized by Ebonyi State and agencies concerned with HIV/AIDS, other strategies to improve student’s knowledge and compliance to VCT services will be incorporated into their programme so as to increase the prevalence of VCT. This will in effect lead to early detection and treatment of HIV clients.
(iii)       This study will spur other researchers to carry out further studies on the topic.
Hypotheses
The following null hypotheses were tested at 0.05 level of significance:-

1. There is no significant association between gender and knowledge of VCT for HIV/AIDS of EBSU students.
2. There is no significant association between campus location and knowledge of VCT for HIV/AIDS of EBSU students.
3. There is no significant association between campus location and compliance to VCT for HIV/AIDS among EBSU students.
4. There is no significant association between gender and compliance to VCT for HIV/AIDS among EBSU students.

Scope of the study
The study is delimited to 200-500 level undergraduates of Ebonyi State University. One hundred level students were excluded from the study because most of them do not have class rooms.
 
Some of them have not fully settled with school registration requirement. Three campuses were used and include Ishieke, Presco and College of Agricultural Sciences. It covers their knowledge of voluntary counselling and testing for HIV/AIDS, compliance to voluntary counselling and testing services, factor that made them comply/not comply and under what condition those who received testing were tested.
Operational Definition of Terms.

1. Knowledge of VCT for HIV/AIDS

For this study knowledge is graded in levels according to the number of question answered correctly (< 3 – 5 correct answers – poor level of knowledge, 6 – 8 correct answers – moderate level of knowledge, 9-12 correct answers – good level of knowledge). It will be assessed by respondents’ ability to:
(i)         Accurately state what VCT for HIV/AIDS means
(ii)        Accurately recall one importance of VCT.
(iii)       Identify a body fluid that can be used for HIV/AIDS test.
(iv)       Identify the type of test used during VCT for HIV/AIDS
(v)        State correctly, what is done during pre-test and post-test counselling for
HIV/AIDS.
(vi)       State the time interval between each VCT visit.
(vii)      State the implication of a positive test result.
Compliance to VCT for HIV/AIDS
Compliance is graded as

1. Partial – compliance: – those that did HIV test once.

1. Moderate – compliance: – those that did HIV test more than once but at intervals above 6 months.

• Total – compliance:- those that voluntarily received VCT services for HIV/AIDS 2 times and more at 3 and 6 months interval.

 
Voluntary counselling and testing
A confidential client/provider interaction that results in a client willingly offering to do HIV test.