Deterrents to voluntary HIV testing among university students in Uyo, southeastern Nigeria

C. Otutubikey Izugbara, Ph.D, Dept. of Sociology/Anthropology, 
Faculty of Social Sciences, University of Uyo P. M. B 1017, Uyo Akwa Ibom State, Nigeria. 

Key words: Nigerian students, voluntary HIV testing, fear, stigma

Introduction

The impact of HIV/AIDS on contemporary life is profound.1 Globally, the epidemic is generating complex issues with far-reaching implications for the world and its peoples. The challenge poised by the HIV/AIDS is most critical in sub-Saharan Africa where nearly two-thirds of all those infected with the disease are found. Sub-Saharan Africa was also home to nine-tenths of the estimated 3.8 millions children under age 15 who were living with HIV in 1997.2 The UNAIDS has reported that about 7% of Sub-Saharan African adults ages 15 to 49 were infected with the HIV in 1997 alone3, a percentage which Goliber4 argues was several times higher than that of any other world region.
The UNAIDS reports that in 1999 alone, over two million AIDS-related deaths occurred in the countries of Africa with infection rates of 5 or more percent (Table 1). This was about three-quarters of the global total. As a result of so many deaths, these countries confront the demanding challenge of responding to the needs of a burgeoning number of orphans. In each of these four countries - Ethiopia, Uganda, Tanzania and Nigeria - the number of AIDS orphans exceeds one million, while in each of four others - Zimbabwe, Kenya, Zambia and the Democratic Republic of Congo - it exceeds half a million (other estimates give much higher figures for all countries, with orphan numbers standing close to or in excess of a million in each of Ethiopia, Kenya, Malawi Mozambique, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe).

Table 1 HIV Estimates, Sub-Saharan Africa, 1990

Source: UNAIDS report on the Global HIV/AIDS Epidemics, June 2000, page 124.

During the year 2000, an estimated 2.4 million people died of HIV/AIDS related illnesses in Sub-Saharan Africa while a further 3.8 million became infected.5 Indeed about 80% of the global total of AIDS death during 2000 occurred in Sub-Saharan Africa and almost 72% of the new infections6
Nigeria is the demographic giant in this region. It is argued that nearly one of every five Sub-Saharan African is a Nigerian7. Although however adults prevalence in Nigeria is still below 5 percent, she has a large and growing number of HIVperson-infected individuals. From an estimated 2.2 million in 1997, the number of people currently living with HIV in Nigeria has risen to about 4 million.

The impacts of HIV/AIDS are quite profound. Apart from erasing the strategic and hard won gains in child survival, life - expectancy and citizen welfare, the pandemic is fast creating a critical generation of missing adults, sick men, women, and children, orphans, and destabilized families8. The economic impacts of the pandemic are also telling. Households and communities must care for a growing number of orphans, the elderly, and sick persons. Since AIDS strikes adults during their most productive years, its effects are felt in the military, education, industry, agriculture, transportation, and the economy in general. The reduction in household incomes, the increase in privately-borne medical expenditures, and the reduction in time devoted to productive activities signal a dramatic deepening of poverty for affected households.

Presently, there is no effective HIV/AIDS vaccine but available therapies are also quite expensive. Against this backdrop, prevention has remained the pivot of many efforts at stemming the tide of the HIV/AIDS epidemic. As part of the HIV/AIDS prevention efforts, people are encouraged to undergo voluntary HIV testing. In Nigeria HIV testing is free in public hospitals but costs about N500 (4US dollars) in private laboratories. It is believed that establishing the HIV- status of an individual will go a long way in shaping his/her future involvement in risky behaviours. While infected people may be identified and encouraged to adopt a positive attitude towards life, uninfected people may be encouraged by negative HIV results to continue avoiding risky sexual practices.9

Despite the fact that HIV testing is free in public hospitals, there is no evidence that people go voluntarily for HIV testing in Nigeria. However HIV testing is essential for the identification and management of HIV seropositive individuals, and in ensuring that uninfected people do not engage further in risk behaviours.

Aims and methods of this study

The present study was done primarily to develop understanding of the key issues which mediate Nigerian students' willingness to go for voluntary HIV testing. The focus on students is deliberate. The university of Uyo is a federal multidisciplinary institution located in the heart of Uyo, the capital of Akwa Ibom state in south-eastern Nigeria. Young people have been identified as a high risk group for contracting HIV/AIDS.10 In Nigeria, young people account for about 60% of those infected after infancy. One out of every six young Nigerian aged 10-27 now gets infected with HIV each minute. University students have been the target of many efforts to prevent the spread of HIV/AIDS. Cok et al (2001) argued that the vulnerability of this group stems from their relatively high level of sexual activity, tendency for multiple sex partners, and involvement in very risky behaviours which they often define as part of adolescence and part of growing up. In Nigeria, there is lack of data and information on the uptake of voluntary HIV-testing among students and, the factors that mediate students' willingness to go for the test. If the current fight against the spread of the epidemic is to be won, we urgently need information on these issues. A 24-point questionnaire was developed to investigate these issues. The study utilized the fishbowl sampling design to identify the departments from which the students were selected. The students were selected using the systematic random sampling technique. The register of students in the sampled departments provided the sampling frame of this study. All the students approached for this study volunteered to participate. Of students in the sampled departments provided the sampling frame of this study. All the students approached for this study volunteered to participate. I could not immediately lay hands on any existing research on this theme. So I built on previous research on related issues to develop a 24 - point questionnaire. Three University expert methodologists, blind to each others' assessment, modified and standardized the questionnaire used for this inquiry.

Results

Majority of the participants (61%) were seniors while 36% were freshmen. Three percent were pre-degree students in various certificate, and remedial programmes. Thirty nine percent of the participants were social and management science majors, 27%, natural and applied science students, while 37% were in the humanities and law. Of the participants, 44% were male while 66% were female. Only four participants indicated homosexual orientation.

The mean age of participant stood at 20.3%. Single persons were in the majority accounting for 96% of the participants. With respect to residence, 46% lived off campus, 37% in the hostels, and 17% lived in the city with their families. The religious profile of the respondents showed Christian as the majority (91%). Muslim comprised 6% of the respondents while 3% belonged to religious groups such as ECKANKAR, Grail Message, Bahai faith etc. The participants displayed a number of HIV-risk behaviours. Seventy-two percent had engaged in unprotected sex in the last three years while thirteen percent admitted infections with some sexually transmitted disease in the last two years. Twenty-seven persons had never used condoms and yet another 32% said they rarely use condoms. Only 18 persons (5%) reported having ever undergone HIV testing although they all confirmed knowledge of the importance of HIV testing and could mention some places it could be obtained. Of this number; 7 (2%) did so in the last one-year. Only 2 (0.5%) of these who reported ever having undergone HIV testing did so voluntarily. Nobody however reported testing HIV positive. We did not include the 18 persons who reported having tested for HIV in our subsequent analyses.

Table 2 Reasons why respondents have not gone for Voluntary HIV Testing

Total exceeds sample size due to multiple responses

Table 2 displays the reasons that respondents adduced for not going for voluntary HIV testing. Data show that regular use of condom by respondents came up as the most frequently mentioned reason for not going for HIV testing voluntarily. Respondents noted that they were constantly using condom during sexual intercourse and presumed they were safe from risks associated with HIV, and needed not bother themselves with HIV testing. Fear of testing positive was mentioned by 16% of the respondents as explaining their unreadiness to go for voluntary HIV testing. Many respondents also noted that they had been faithful to their partners and that their partners had been faithful to them in which case these was nothing to fear. Other major reasons why respondent have not gone for HIV testing include confidence that one could not have become infected (12%), notion that one's sexual partners were clean people and very unlikely to be carriers (9%), not being afraid of HIV or dying (12%). Belief that AIDS will soon have a cure (10.%), lack of money to go for HIV testing (4.4%), belief that laboratory tests and instruments were unreliable (4.4%), and the notion that AIDS does not exist (10%) were also reported as reasons for not going for voluntary HIV testing. Some respondents also reported that their sexual partners had gone for testing recently with HIV negative results which they saw as evidence of their own health status (10%) and yet others noted that it never occurred to them to do it as the need for it had never arisen (7%).

Discussions and Policy Implications

Emerging from the study are a number of critical issues which altogether raise need for policy and further research. In this reported study, many respondents have not undergone HIV testing because they feared testing positive. This is a reflection of the silence which surrounds HIV/AIDS in Nigerian. Indeed serious silence pervades AIDS/HIV on campuses in Nigeria and translates into fear. Kelly reports, that a most pernicious aspect of HIV/AIDS in African campuses is fear; fear of those who are infected; fear by those who are infected, and above all, fear that the disease cannot be overcome.12 Although this fear is not well-grounded, it is, in the meantime, translating into death, more infections, and pandemonium. This fear arises largely from the awful silence surrounding the epidemic and constrains the emergence of space for voice, learning, interaction, and dialogue.
It is bad enough that respondents felt that they could rely or sight and feelings to establish their HIV status and that of their sexual partners. That one's partner, appears healthy, clean, and fit, we know is no guarantee. Nor is the fact that one's partner recently tested negative. The implications of this lack of adequate knowledge of HIV/AIDS is greater tendency towards risk behaviours.

While emerging findings also betray the respondents as currently engaged or having recently engaged in HIV - risk behaviours, it succinctly underlines the strong stigma which is still associated with HIV/AIDS in Africa. In Africa, HIV/AIDS is highly stigmatized. It is still viewed as evidence of waywardness, promiscuity, lack of self control, and irresponsibility. Victims of the disease experience prejudice and ostracisation which may deter those who are already infected to come out publicly about their HIV-status.

Further, there is evidence of that the dominant attitudes towards AIDS are denial, fatalism, and sense of invulnerability. These are clearly borne out by some of reasons adduced for not going for HIV testing. Respondents said they were not scared of AIDS, believed that AIDS did not exist, felt a cure was on the horizon, believed that their partners were uninfected persons, or just had the faith they were not infected. These reasons are clearly ridiculous and suggest shortcomings in basic knowledge about HIV/AIDS among the participants. They also raise need for strategic approaches to raising and sustaining HIV/AIDS awareness and education among young peoples generally.
The provision of accurate and objective information will help release people from the shackles of fear that contribute to the prevalent attitudes of invulnerability, fatalism, denial, and stigmatization towards HIV/AIDS. It is important therefore for the Nigerian government to begin to plan for the implementation of a systematic HIV/AIDS education programme for the University and for efforts of HIV/AIDS organisations already working in Nigeria to be strengthened to recognize the unique nature of universities and their populations. Health professionals, social workers, researchers, activists, people living with AIDS, and other stakeholders in the Nigerian HIV/AIDS scene need to pool their activities, strategies, and visions together in order to consolidate and broaden their efforts. The ultimate goal of these efforts as I have argued elsewhere 13 will be to shatter the social and cultural walls that constrain the free flow of information on HIV/AIDS and sexuality to youths, preparing them for more positive health - related orientations and practices that will help reduce new infections to absolute zero as we enter into the 21st century. 

References

1. Botchwey, K. (2001), 'AIDS and Development' Theme paper for Africa Development Forum Addis Ababa, December 2000, ADF Secretariat, Economic Commission for Africa.
2. Goliber, T. J. (1997) Population and Reproductive Health in Sub-Saharan Africa PRB 52 (4), Washington, DC.
3. UNAIDS, (June, 2000) Report on the Global HIV/AIDS Epidemic Geneva; UNAIDS. 
4. Goliber, T. J. op cit
5. Kelly M. J. (2001), Challenging the Challenger: Understanding as Expanding the response of Universities in Africa to HIV (AIDS) ADEA working Group on Higher Education, Washington D.C.
6. UNAIDS (December 2000), AIDS Epidemic Update: Geneva UNAIDS.
7. Goliber, T. J. op cit
8. International Labour organization (2001), HIV/AIDS in Africa: The Impact on the world of work. Document for Africa Development Form 2000, Geneva, ILO Office.
9. Kelly, M.J. op cit 
10. Stanecki, K. A. (2000), The AIDS Pandemic in the 21st Century: The Demographic Impact in Developing Centuries: Paper presented at the xiiith International AIDS conference Durban, South Africa, 9 - 14 July 2000 (Processed).
11. Cok, F et al (2001) "Turkish University Students' sexual behaviour, knowledge, attitudes, and perception of risk related to HIV/AIDS Culture, Health and Sexuality 3 (1) 81 - 100.
12. Kelly M. J. op cit
13. Izugbara, C. O. (2001) "Tasting the forbidden first: The Social Context of debut sexual encounters among young persons in a rural Nigerian community." The African anthropologist 8 (1) 96 - 107.

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