Knowledge of HIV/AIDS and predictors of uptake of HIV counseling and testing among undergraduate students of a privately owned university in Nigeria

The spread of HIV/AIDS among the productive age group particularly young adults is a major public health concern in Nigeria. Sub-Saharan Africa which accounts for just a little above 10% of the world’s population is however, the worst hit region in the world. The region has a rapidly increasing rate of infection among adolescents [1]. The ages between 15 and 24 years represent the highest at risk group for the infection of the virus [2]. They account for over 40% of all new HIV infections among adults [3–5]. Researches in Nigeria and neighboring Ghana indicate that the lifestyles of students on university campuses put them at increased risk of contracting the HIV [6–8]. This is because the university environment has been shown to promote sexual activity among the general student population [9, 10]. Hence, it is understandable that the predominant mode of transmission of HIV in sub-Saharan Africa, accounting for approximately 90% of all infections is by the heterosexual means [1].

Peer pressure within campus environments lead many young women and indeed men to engage in transactional sex [11]. An abundance of evidence exists to show that although knowledge about a disease is a prerequisite for but is not a predictor of behavioural change [12, 13]. Recent studies on HIV among young adults in Nigeria has predominantly focused on public universities [9–11]. There is a paucity of data on private university students, despite the presence of more than 50 private universities in Nigeria as indicated by the National Universities Commission a parastatal under the Federal Ministry of Education that facilitates the establishment of both public and private Universities [14].

National data show that universal awareness is yet to be achieved (93%) and that comprehensive knowledge is abysmally poor at 25% [15]. The same report indicated that only 24.2% of males and females aged 15–24 were able to correctly identify factual information and reject common misconceptions [15]. This reflected a slight increase from 22.5% in 2005 [16]. This has significant implications for the formulation of policy and HIV prevention interventions. Schools especially universities are the most likely arena for initiating sexual contacts and also represent an arena for sexual risk taking and thus university students are at risk of HIV [17, 18].

Access to HIV counseling and testing (HCT) is a major pillar of the National strategic framework adopted by Nigeria for HIV control. The federal government of Nigeria has introduced and implemented various programmes to increase the uptake of HCT. Notwithstanding these interventions, HIV testing uptake is still low (11% of women and men aged 15 to 49 years) and unknown to many Nigerians [15, 16], due to the fear of the testing outcome and HIV related stigma [16]. There is a paucity of information on HIV counseling and testing among university students and the factors that influence them to test for HIV in the sub-Saharan region. It is also not clear if the factors that influence the general population and public university students to test for HIV [19, 20] can be attributed to HIV testing uptake among private university students.

Despite young adults’ increased vulnerability to HIV infection as a consequence of risky sexual behaviours, there are no studies that have examined HIV/AIDS knowledge and the uptake of HIV testing among private university students in Nigeria.

The study participants were universally aware of HIV/AIDS. Their knowledge about the cause, mode of transmission and prevention of HIV was quite high, with an average score of 8.18 out of a total of 10.0 and standard deviation of 1.60. However, the uptake of HIV screening in the preceding six months to the study was only 30.4%. The study also demonstrated a significant gender difference in HIV knowledge among private university students in Nigeria, with males being more knowledgeable than females, though females were more willing to have an HIV test than males. The willingness to have HIV test was also associated with increasing age and having good knowledge of HIV. Good knowledge of HIV, the female gender and ages from 21 years and above were found to be associated with an increased odd to be willing to have an HIV test.

The universal awareness and very high level of HIV knowledge among the private university students as shown in this study is attributable to sustained health education programmes. In the last 10 years, the Nigerian government through the National Agency for the Control of HIV/AIDS (NACA) and its development partners increased public awareness on the causes and prevention of STIs including HIV/AIDS. Higher levels of knowledge have been reported in other university students in Nigeria [21]. Besides, studies have associated higher levels of education with higher levels of HIV knowledge [22, 23]. In Ghana, similar efforts to those of NACA have been complemented by the establishment of HIV/AIDS Clubs in tertiary institutions. This can be adopted and be scaled up to cover secondary schools as well [24]. The aim of such Clubs would be to train university students to contribute to HIV/AIDS awareness and knowledge in their respective campuses as peer educators [24, 25].

The level of HIV knowledge differed between male and female university students in this study. This finding is consistent with studies conducted among university studies in other parts of Nigeria [21, 26], Ghana [24, 27] and other parts of the world [22, 23] which found that AIDS knowledge differs on the basis of gender among university students. However, other studies have indicated no gender differences on HIV knowledge and attitudes among university students [28, 29]. This gender difference found in this study which favors males is however, contrary to other studies which showed that females had a better knowledge about HIV/AIDS than male university students [21, 24, 26, 27]. It is thought that female university students show more concern about their health than males, thus seeking to know more about issues related to health including HIV/AIDS [24]. It is suggested that the higher knowledge of HIV shown by males could be due to difference in access to information, media and participation in different anti-HIV/AIDs club [22].

Majority of the private university students reported having received AIDS information from the mass media followed by health workers. Only a few of them received such information from their schools and parents. This is in spite of the fact that they spend a considerable part of the time in school or with their parents at home. This is however a finding that is consistent with other studies which have shown that university students rely on the mass media as the major source of information on HIV/AIDS [26, 30, 31]. However, the mass media did not prove to be more effective at disseminating correct information on HIV/AIDS than other means. This is in spite of the fact that the mass media has proved to be a more effective tool for addressing specific HIV issues including knowledge, self-efficacy of condoms use, social norms, interpersonal communication and awareness of health services [24, 32]. The mass media therefore have an important role to play in dissemination of information about HIV/AIDS among private university students. The various media including television, radio and social media should therefore be intensely engaged to spread the knowledge about HIV and other health reproductive issues. The Internet is also an important source because young people are very active Internet users [33]. The finding that schools and parents were not the main sources of knowledge about HIV/AIDS are similar to other studies [34]. This shows that schools based reproductive health education programs are not quite emphasized. Although talking about HIV/AIDS with parents improves students’ knowledge about HIV/AIDS [35], Parents have difficulty in speaking openly about HIV/AIDS with their children [33]. Such discussions are rare because of lack of relevant information by the older generation, family structure, the conservative culture, religious and traditional beliefs on issues of sexuality, condom usage and marriage [24, 36]. There is a need for parents to discuss reproductive sexual issues with their children and young adults and for schools to devise means to promote school based reproductive health education. This is important because protection by adults has been shown to decrease their young people’s risk of HIV infection [37].

The very good knowledge about HIV and near universal knowledge of where to have an HIV test done did not translate to HIV test uptake. All Babcock university students are required to have an HCT as part of pre-admission health screening exercise. The rate is relatively high when compared with university students in Bayelsa and Lagos in Nigeria and Ghana where 53.8%, 26.1 and 45% of the students respectively reported having ever tested for HIV [24, 38, 39]. In these Universities, HCT is not included in the pre-admission health screening process. In the six months preceding this study, 30.4% of the students had taken a test. The gap between knowledge and uptake may be attributable to fear of stigmatization as well as discrimination associated with the counseling and testing and AIDS [24]. Fear of stigma have been shown to influence young adults to become less likely to engage in preventive behaviours [2] and an increase in knowledge about HIV does not predict behavioural change [12, 13]. The gap may also be attributable to the fact that the majority of the students report no sexual activity and have a perception that they are not at risk of HIV/AIDS, hence they are unable to appreciate the need for a periodic screening. The fact that over 70% of the students were willing to take an HIV test is quite encouraging. The willingness to have HIV test done was predicted by age from 21 years and above, female gender, being single and having good knowledge. It is therefore imperative to explore all strategies to sustain and further enhance the knowledge about HIV. It has been shown that sensitization program on benefits of HCT will improve uptake of HCT among the young people in Nigeria [40]. Hence, proactive measures should be pursued to ensure periodic screening by university students. Knowing where to test for HIV it does not necessarily influence their desire to get tested in the future [24]. Therefore, beyond making HCT facilities available on various university campuses, the operators of such facilities must go beyond the wait for students to have voluntary counseling and testing (VCT) and take the screening exercises to the students through various innovative campaigns.

The university administration should explore all strategies to sustain and further enhance the knowledge about HIV through innovative school based programs. The willingness of the students to take HIV test should be leveraged upon to promote periodic screening. The operators of HCT facilities must go beyond the wait for students to have VCT and take the screening exercises to the students through various innovative campaigns. Future studies in institutions with similar pre-admission HCT programs may be necessary underline the effect of such programs on subsequent uptake of HCT and intention to have HCT. Future qualitative studies are also required to explore the barriers to uptake of HCT among private university students.