PERCEIVED FACTORS AFFECTING HIV VOLUNTARY COUNSELLING AND TESTING UPTAKE AMONG NURSING STUDENT IN ABIA STATE UNIVERSITY

CHAPTER ONE

INTRODUCTION

Background to the study: HIV is widely recognised as a significant national and global issue and continues to be regarded as a pivotal public health emergency of our era. The World Health Organisation (WHO) estimated in the early 1990s that by the year 2000, around 26 million people would be globally infected, with almost 90% of cases originating from low-income countries (Mariam & Ndikom, 2023). Regrettably, this prognosis has been confirmed as an indisputable reality, as empirical literature has demonstrated a swift escalation in HIV prevalence in low-income nations. These findings provide additional support for the WHO's 2015 estimate, which ranked Nigeria as the second country with the highest disease prevalence and number of AIDS-related fatalities. This information is based on reports from the National Agency for the Control of AIDS (NACA) in 2014, page 18, and a study by Taimi et al. in 2021. Since the onset of the epidemic, about 85.6 million individuals (with a range of 65.0–113.0 million) have contracted the HIV virus, resulting in approximately 40.4 million deaths (with a range of 32.9–51.3 million) due to HIV.

At the conclusion of 2022, the global population of individuals infected with HIV amounted to 39.0 million [33.1–45.7 million]. Approximately 0.7% [0.6-0.8%] of persons aged 15–49 years globally are currently affected by HIV. However, the severity of the epidemic differs significantly across nations and regions. The World Health Organisation (WHO) The African Region continues to experience the highest prevalence of HIV, with approximately 3.2% of adults living with the virus. This region also accounts for almost two-thirds of the global population living with HIV. Africa, as a continent, and Nigeria, as a country, have achieved significant progress in slowing down the transmission of the disease and reducing the number of deaths caused by it (WHO, 2018).

In Nigeria, the majority of new HIV infections, approximately 80%, are attributed to unprotected heterosexual intercourse. The remaining HIV infections primarily occur within critical demographics, including sex workers, males who engage in sexual activities with other men, individuals who inject drugs, and transgender individuals. The issue of HIV disease, prevalence, and death is a worldwide and public health matter. The Joint United Nations Programme on HIV (WHO, 2022) report highlights the need for more action in Africa. At the conclusion of 2016, the report unveiled a worldwide occurrence of 35 million illnesses. The increased prevalence can be ascribed to a larger number of individuals seeking treatment and subsequently experiencing longer lifespans (UNAIDS, 2018). Nevertheless, the cumulative number of fatalities attributed to AIDS throughout this period reached 1.5 million worldwide (UNAIDS, 2018). A particularly disconcerting observation is that sub-Saharan Africa accounted for around 1.5 million fresh cases of HIV worldwide in 2013, and has seen significant mortality due to the disease (UNAIDS, 2018). These statistics have compelled international health organisations and governments of both affluent and impoverished nations to focus their endeavours on combating HIV disease.

The World Health Organisation (WHO) reported a significant decline of 41% in the incidence of new infections in Africa from 2000 to 2014. Nevertheless, it is imperative to further diminish the transmission of HIV (NACA, 2014, p. 13; Yahaya et al., 2014). Although significant progress has been made in wealthy nations to reduce the death rate of this feared illness, the situation is not the same in low- and middle-income countries (LMIC) such as Nigeria (NACA, 2014, p. 13). Furthermore, with the ongoing acceleration of globalisation and immigration, it is imperative to give additional focus to addressing the burden of HIV sickness. Some low- and middle-income countries (LMIC), including Nigeria, Zambia, and Zimbabwe, have implemented a strategy to combat HIV by promoting counselling and testing, particularly among individuals residing in rural areas (Corbett et al., 2006; Matovu & Makumbi, 2007; Miller et al., 2014; Osborn & Obermeyer, 2016; Wringe et al., 2008; Yahaya et al., 2014).

The adoption of HIV testing and counselling is essential for any advancement to be achieved in the prevention and treatment of the illness. Okai and Anaba (2022). Early diagnosis of infected individuals increases the probability of their adherence to the management programme, hence decreasing the chance of disease transmission within their communities. Put simply, the sooner patients get testing and counselling, the greater their likelihood of experiencing an improved quality and duration of life (Ashipala et al., 2018).  The distribution of HIV in Nigeria indicates that the sexually active demographic bears a substantial burden of the disease (Odimegwu et al., 2019), with young people comprising a major proportion of this population segment in Nigeria. Surprisingly, there is a scarcity of research conducted to investigate the viewpoint of young people on strategies to effectively reduce the transmission of HIV throughout the country. Despite the fact that some authors have demonstrated that expanding Voluntary Counselling and Testing (VCT) services is a crucial method for decreasing the prevalence of HIV, there is less knowledge regarding the current situation (Eremie & Kennedy, Margaret, 2023; Shipanga, Taimi, & Kloppers, 2018). Adeyemi, Kolude, and Abe (2021) conducted a study on university students in north central Nigeria, which uncovered an increasing prevalence of illnesses within this demographic. Despite the youth having a strong understanding of diseases, only a small number actively pursued voluntary counselling and testing (VCT) facilities. Research consistently suggests that addressing the underlying causes of the poor utilisation of Voluntary Counselling and Testing (VCT) can effectively enhance the participation of individuals in VCT services, perhaps leading to a modification in their engagement in risky behaviours (Ayu & Andriyanti, 2020).

Statement of problem                                                                          

Nigeria has the second largest number of people living with HIV/AIDS globally, and Abia State is ranked eighth in virus prevalence among states in the country (Federal Ministry of Health Nigeria, 2010; National Agency for Control of AIDS, 2012; Hutomo, Pramukti, & Sari, 2023). The epidemic is driven by various factors, such as limited awareness of HIV among a significant portion of the population, a low perception of risk among less than 40% of individuals, predominantly male-driven risky sexual behaviour, and relatively low rates of condom use among women (32.2%) and men (71.1%) (Odimegwu, Adedini, & Ononokpono, 2013). Halid & Ogunlade (2023) emphasised the role of religious and cultural norms in the transmission of the disease, as well as the impact of limited knowledge, inadequate risk perception, and limited access to healthcare. It is worth noting that a significant portion of individuals living with HIV/AIDS and those who contract new infections fall within the age range of 15 to 24 years (Onoja et al., 2020).

According to the sero-prevalence survey, there is a 4.6% prevalence among individuals aged 20-24 years, while those aged 25-29 years have a prevalence of 5.6%. This situation has caused significant devastation to individuals, families, communities, and countries. HIV/AIDS has a significant impact on both the well-being and financial stability of households, in addition to the individuals who are infected. The consequences of this situation can be quite severe, resulting in reduced engagement in formal education among young individuals, as well as a decline in family income due to unemployment, ultimately leading to poverty. Voluntary Counselling and Testing is a significant intervention that plays a crucial role in reducing the transmission of HIV (Adeyemi, Kolude, & Abe, 2021). The information about HIV/AIDS is presented accurately and in a timely manner. It also focuses on promptly providing care and treatment to those affected by HIV, while also promoting behaviour change among those who are not affected. Although the services are being accessed by a relatively small number of people. According to a study conducted among students in various higher institutions in Osun State, it was found that a mere 5% of them were aware of their status (Halid & Ogunlade, 2023). Research has indicated that there is a significant prevalence of risky sexual behaviour among students in Nigerian universities, which increases the likelihood of HIV transmission. There is limited information available regarding the uptake of HCT and the factors associated with it among nursing students in Abia State University. The nursing students at Abia State University exemplify the qualities of students in higher education institutions. In addition, they offer a diverse range of individuals who come from various ethnic and cultural backgrounds in Nigeria. This study aimed to investigate the factors that influence the uptake of HIV voluntary counselling and testing among nursing students in Abia State University.

​​​​​​​Objectives of the study

1. To identify the rationale for  HIV voluntary counselling and testing uptake among nursing student.

2. To identify perceived factors affecting HIV voluntary counselling and testing uptake among nursing student.

3. To make recommendations that will facilitate HIV voluntary counselling and testing uptake among nursing student.

​​​​​​​Research questions

1. What are the motivations for HIV voluntary counselling and testing uptake among nursing student?

2. What are the perceived factors militating HIV voluntary counselling and testing uptake among nursing student?

3. What ways can HIV voluntary counselling and testing uptake among nursing students be enhanced?

Research Hypotheses

H0: There is no poor HIV voluntary counselling and testing uptake among nursing students..

Ha: There is a poor HIV voluntary counselling and testing uptake among nursing students.

​​​​​​​Significance of the study

The results of this study will offer valuable insights into the uptake of HIV voluntary counselling and testing among nursing students at Abia State University. This finding highlights the importance for health care authorities to develop innovative HIV voluntary counselling and testing awareness and modalities. In addition, the study's findings will provide health care providers in Abia state with valuable data to re-evaluate their policies on HIV awareness and testing. This will ultimately contribute to enhancing prevention efforts among nursing students at Abia state university. In addition, the results of this study will help raise public awareness about the importance of practising proper hand hygiene. If implemented correctly, this action will significantly reduce the spread of infections among the public.

​​​​​​​Scope of study

This study is conducted and documented within specific parameters. The main focus of this problem is centred around voluntary counselling and testing for HIV. Furthermore, Abia state university is used as the case study. This location was chosen due to its significance to the research problem and its close proximity to the researcher. This suggests that data will be gathered from individuals who are willing to participate at this establishment. Furthermore, it suggests that the conclusions of this study are limited to this specific case and may not be comprehensive enough to be relied upon for significant decision-making. Further research may be necessary. In addition, the study encompasses nursing students at Abia State University. Nevertheless, the study's limitations do not hinder its findings; instead, they contribute to the accuracy and brevity of the results.

​​​​​​​Operational definition of terms

Perceived Factors: are a cognitive variables that involves the interpretation of sensory information. Various factors, including emotion, motivation, culture, and expectations, can influence our perception.

HIV Voluntary Counselling and testing: when a person chooses to undergo HIV/AIDS counselling so that they can make an informed decision about whether to be tested for HIV.