Research Article - (2017) Volume 7, Issue 4
Background: Acquired immunodeficiency syndrome (AIDS) is a disease of Human immune system caused by the human immunodeficiency virus (HIV). It is a major public health problem in many parts of the world, and is considered as a pandemic disease. Voluntary test and counseling of HIV is internationally acknowledged to be an essential strategy for HIV prevention and also entry point to AIDS care.
Objective: To assess knowledge, attitude and practice toward HIV voluntary testing and counseling among students of Mizan High School, in Mizan-Aman town, SNNPR, South-West Ethiopia.
Methods: Institutional based descriptive cross-sectional study design was used from March 01-March 20, 2017. The total sample size (341) of the study participants were selected by using systematic sampling techniques. Data was collected by using structured self-administered questionnaire. Prior to analysis, data was entered using Epi data and cleaned and exported in to SPSS version 20.00 and descriptive statistics was computed.
Results: A total of 329 students participated in the study with non-response rate 3.6%. Almost all 325 (98.8%) of respondents had heard about HIV/AIDS and 311 (94%) were heard about voluntary HIV testing and counseling. Two hundred sixty four 264 (80.2%) agreed that voluntary HIV testing and counseling service was necessary. Majority 297 (90.3%) the study participants were knowledgeable about voluntary testing and counseling of HIV and 243 (73.8%) of the study participants had positive attitude towards voluntary testing and counseling of HIV. According to this study, only 103 (31.3%) of the respondents had voluntary testing and counseling of HIV.
Conclusion: The finding of this study showed that most of the youths have a good level of knowledge regarding HIV/AIDS and VTC. Majority 243 (73.8%) of the study participants had positive attitude towards voluntary testing and counseling of HIV. Still the practice of voluntary test and counseling of HIV was very low among students of Mizan High school
Keywords: Voluntary testing and counseling; Attitude; Knowledge; Practice; Mizan; Ethiopia
AIDS: Acquired Immune Deficiency Syndrome; HIV: Human Immunodeficiency Viruses; KAP: Knowledge, Attitude and Practice; PMCT: Prevention of Mother to Child Transmission of HIV; UNAIDS: United Nation Program on HIV/AIDS; VHTC: Voluntary HIV Testing and Counseling, VTC: Voluntary Testing and Counseling; WHO: World Health Organization
Acquired immunodeficiency syndrome (AIDS) is a disease of Human immune system caused by the human immunodeficiency virus (HIV) and HIV is transmitted primarily via unprotected sexual intercourse [1]. Voluntary testing and counselling (VTC) is a process that is under taken when a person wants to find out if they are infected with HIV or not. It is recognized approach for people to find out their HIV status at VTC center and moreover internationally an efficient method. It has become one of the most effective and popular ways of diagnosing people who may have been exposed to the virus or who have been infected. VTC is an important tool for preventing the spread of HIV especially in communities where the virus is wide spread. It allows adolescents to find out their HIV status in order to evaluate their behavior and its consequences [2]. Most people who take the advantage of VTC service find that they are not infected with HIV and this help them to reduce their risk of infection and encourage colleagues to use VTC service. VTC is the gateway to treatment care and prevention as it refers both to testing and counseling services [3].
HIV/AIDS is major Public health problem in many parts of the world, and is considered as a pandemic disease [1]. HIV/AIDS has spread rapidly through the world. Statistics from the UNAIDS and WHO in 2012 reported that the number of people living with HIV at the end of 2011 were 34 million and about half of them do not know their status. The region of sub-Saharan African carries the greater burden of epidemics. In 2011 there were an estimated 1.8 million new HIV infections in sub-Saharan Africa, compared to 2.4 million new infections in 2001 [4]. Despite encouraging progress in reducing the new infection, the total number of new HIV infection remains and 2.5 million new infections were reported in 2011 [4-6].
HIV/AIDS has caused immense human suffering in the African continent; the most obvious effect of this crisis has been illness and death. But the impact of this epidemic has certainly not been confined to the health sector, households, schools, work places and businesses have also been badly affected. During 2010 alone an estimated 1.2 million adult and children died as result of AIDS related illness in Sub- Saharan Africa [7,8].
Since the beginning of the epidemic more than 15 million Africans have died as result of AIDS related illness. In all heavily affected countries the HIV/AIDS epidemic is adding additional pressure on the health sector [9].
The number of people died in Sub-Saharan Africa due to AIDS related illnesses were 1.1 million (1.0-1.3 million) in 2013 and it witnessed the fall by 39% from those deaths in 2005. Although there have been a significant falls both with new infections and people who died due to AIDS related causes are still the proportional to share of Sub-Saharan Africa and unacceptably high and needs more aggressive interventions. Ethiopia is one of the hard hit countries in Africa by HIV/AIDS epidemics and has been suffering from public health problems related to the epidemic. Per the sub national estimates compiled by Ethiopian Public health Institute the estimated national adult prevalence of HIV is 1.22% in 2015 with the total estimated 7,41,478 (2,91,414 males and 4,50,063 females) HIV infected population. The estimated new infections for all age groups were 24,050 (9,396 males and 14,655 females) in 2015 [10].
In Ethiopia, national guidelines were last published in 2007, new information as well as evidence based best practice have become available to make testing and counseling and more effective and accessible, creating a need to increase access to service and improve quality more effectively [11].
The use of testing globally, is very low, recent estimates based on VTC surveys in 12 high burden countries in sub-Saharan Africa indicate that just 12% of men and 10% of women in the general population have been tested for HIV and received the result, even in more developed countries about 20% to 30% of seropositive individual are unaware that they are HIV positive. This means that most people living with HIV get testing and counseling only when they already have advanced clinical disease [12].
Link HIV positive clients to care and treatment services to achieve that UNAIDS goal of 90% of all people living with HIV will know their HIV status (90% diagnosed) and targeted HTC services should be implemented across the range of community and facility-based settings. One of the targeted groups for HIV testing and counseling is all key populations and adolescent/youth clients (15-24 years) [10].
So it is a crucial time to assess the adolescents’ knowledge, attitude and knowledge about HIV voluntary testing and counseling. The purpose of this study is to assess the knowledge, attitude and practice of the students of Mizan High School.
Study area and period
The study was conducted in Mizan-Aman town high school from March 01-March20, 2017. Mizan-Aman town is about 561 km distant from Addis Ababa capital city of Ethiopia. Mizan-Aman has five kebeles. The total population of Mizan-Aman town is estimated to be 52,210 of whom 18,625 are male and 33,585 are female. From total population, 31,135 are estimated to be adults among whom 17,233 are females and 13,902 are males. Mizan-Aman town has one health centers, one teaching hospital and 15 private clinics.
Study design
Institutional based quantitative descriptive cross-sectional study was used to assess knowledge, attitude and practice of students towards voluntary HIV testing and counseling.
Source and study population
All Students attending their education at Mizan high school in the academic year of 2016/2017 were considered as source of population and selected grade 9 and 10 students in this academic year considered as study population.
Sample size determination
The sample size was calculated by using single population proportion formula by using expected prevalence 64% (this prevalence was taken from study conducted in Addis Ababa among high school student in 2014), level of significance 1.96 and 0.05 margins of error. Then the calculated sample size was 354. Since our source population was less than ten thousand. So, the correction formula was used as follows NF=ni/1+ni/N=NF=354/1+354/2485=309.98~310. The final sample size was after considering non response rate was 341.
Sampling technique
The total sample size (341) was proportionally allocated to grade nine and ten. Systematic random sampling technique used select individual students. The participant was selected by calculating K value that mean k=N/n=2485/341=7.28=7. The first student was selected lottery method from the list of students’ name from registration book. The rest of study participants were selected systematically that is every 7th student until the required sample was achieved.
Inclusion and exclusion criteria
All grade 9 and 10 students at Mizan high school and available on the day of data collection were included in the study and students who were ill/with discomfort during data collection period were excluded.
Operational definition and definition of terms
Knowledge: There are 7 questions which covered the basic knowledge about the VTC and HIV/AIDS. Each question assigned score of one for each correct response and 0 for each incorrect answer.
Good knowledge: When the respondents answered more than 7 questions (60%) of knowledge questions correctly [13].
Poor knowledge: When the respondents scored less than 60%.
Attitude: There are 7 questions regarding the attitude towards the VTC; it assigned score of one for each favorable response and 0 for each unfavorable response.
Positive attitude: When respondents, favorably answered more than 4 questions (60%) of questions for attitudes [13].
Negative attitude: When respondents, unfavorably answered less than 60% of questions for attitudes.
Indifferent: Those individual whose response was neutral
Practiced/utilized: WHEN respondents reported that they have ever undergone HIV tests at least once.
Data collection tool
Data was collected using a structured self-administered questionnaire prepared in English which include information of socio demographic characteristics, knowledge; attitude and practice questions and the English version questionnaires was translated to Amharic version and then to English to check its consistency [13,14].
Data collectors and data quality assurance
Three data collectors were recruited to collect the data. Before conducting the actual data collection, the questionnaire was pretested at Aman High School to determine whether it was good enough to collect data on variables of interest. After pre-test necessary modification to questionnaire were made based on the nature of the gap identified in the questionnaire.
To control data quality, the questionnaire was prepared based on specific objective and pre-test and data collectors advised appropriately for 30 min about how to fill the questionnaire with study participants. Moreover, for completeness and consistency of data, the filled questionnaire was cross-checked at the day of data collection.
Data processing and analysis
Data was compiled, summarized and analyzed using scientific calculator, the finding of this study was analyzed using SPSS software version 20.0, frequency distribution and percentage were then interpreted and presented by figures, tables and narratives.
Ethical clearance from Mizan Tepi University and permission from respective authorities and written consent of respondents’ was obtained before the data collection. To get full co-operation, respondents were reassured about the confidentiality of their response. They were also ensured their voluntarily participation and right to take part or terminate at any time they wanted. Strict confidentiality was insured throughout the study in which names of participants were not mentioned on the data collection forms but rather numeric codes were used to identify the questionnaire.
Socio-demographic characteristics of respondents
A total of 329 students participated in the study, with response rate of 96.4%. Among study participants 160 (48.6%) were females, 159 (48.3%) were between 13-17 years of age, 227 (69%) were from urban residence, 148 (45.0%) were bench in their ethnicity and 308 (93.6%) were single (Table 1).
| Characteristics | Frequency | Percent | |
|---|---|---|---|
| Sex | Male | 169 | 51.40% |
| Female | 160 | 48.60% | |
| Age group in year | <13 | 53 | 16.10% |
| 13-17 | 159 | 48.30% | |
| >18 | 117 | 35.60% | |
| Grade | 9 | 211 | 64.10% |
| 10 | 118 | 35.90% | |
| Marital status | Married | 18 | 5.50% |
| Single | 308 | 93.60% | |
| Divorced | 3 | 0.90% | |
| Religion | Protestant | 147 | 44.70% |
| Orthodox | 93 | 28.30% | |
| Muslim | 65 | 19.70% | |
| Other | 24 | 7.30% | |
| Ethnicity | Oromo | 54 | 16.40% |
| Amahra | 60 | 18.20% | |
| Benchi | 148 | 45.00% | |
| Tigre | 35 | 10.60% | |
| Kefa | 21 | 6.40% | |
| Other | 11 | 3.30% | |
| Place of residence | Urban | 227 | 69% |
| Rural | 102 | 31% | |
Table 1: Distribution of respondent by socio-demographic characteristics, Mizan High School, Ethiopia, 2017.
Knowledge about HIV/AIDS
Almost all respondents 325 (98.8%) had heard about HIV/AIDS but their sources of information varied. The study respondents have got information about HIV/AID; 123 (37.4%) were from school, 65(19.8%) were from radio, 78 (23.7%) were from TV and 48(14.6%). Regarding study participants’ knowledge on the routes of HIV/AIDS transmission like unprotected sexual intercourse, transfusion of infected blood and blood products, transmission from infected mother to child and sharing of infected blades, needles and unsterilized medical equipment. Those who listed all four correct were graded as “Excellent” knowledge, 3 correct as “Good”, 2 correct as “Fair” and only one correct as “Poor”.
Out of the total study participants, only 24.3 % had excellent knowledge, (51.4%) had good knowledge, 20.1% had fair knowledge and 2.7% of them were poor knowledge on the routes of transmission of HIV (Figure 1).
Figure 1: Distribution respondents having information about VTC before data collection among Mizan High School students, Ethiopia, 2017.
Awareness about voluntary testing and counselling
Majority of the respondent 311 (94.5%) had heard about of VTC before, the remaining 18 (5.5%) had never heard about VCT before the day of data collection. Majority of them, 139 (42.2%) of respondents had, heard about VCT from health workers. Those who heard about VTC from their friends constituted 80 (24.3%), 7 and 5 (2.1% and 1.5%) heard from church and mosque (Table 2).
| Variable | Frequency | Percent | ||
|---|---|---|---|---|
| Ever heard about VTC | Yes | 311 | 94.5% | |
| No | 18 | 5.5% | ||
| From which medium you get | Mass media | 73 | 22.2% | |
| Friend | 80 | 24.3% | ||
| Health worker | 139 | 42.2% | ||
| Church | 7 | 2.1% | ||
| Mosque | 5 | 1.5% | ||
| Internet | 3 | 0.9% | ||
| Other | 4 | 1.2% | ||
| VTC involves individual being tested on their own will | Yes | 229 | 69.6% | |
| No | 16 | 4.9% | ||
| I don’t know | 84 | 25.5% | ||
| VTC important to prevent HIV | Yes | 244 | 74.2% | |
| No | 26 | 7.9% | ||
| I don’t know | 59 | 17.9% | ||
| VTC process involves pre-test and post-test counseling | Yes | 186 | 56.5 | |
| No | 25 | 7.6% | ||
| I don’t know | 118 | 35.9% | ||
| VTC involves confidentiality | Yes | 180 | 54.7% | |
| No | 24 | 7.3% | ||
| I don’t know | 125 | 38% | ||
| Do you know where VTC service is offered | Yes | 205 | 62.3% | |
| I don’t know | 124 | 37.7% | ||
| Over all knowledge of study participants about VTC | Had good knowledge | 297 | 90.3% | |
| Had poor knowledge | 32 | 9.7% | ||
Table 2: Distribution of respondents by the source of information and knowledge about the advantage of VTC among Mizan High School students, Ethiopia, 2017.
According to the settled criteria for knowledge of the study participants about voluntary testing and counseling of HIV, 297 (90.3%) were found to have good knowledge and 32 (9.7%) had poor knowledge about voluntary testing and counseling (Table 2).
Attitude towards voluntary HIV testing and counselling
From the total study participants, 264 (80.2%) agreed that VCT service is necessary, 214 (65%) don’t agree that HIV test is only for the ill, 293 (89.1%) agree VCT for HIV should be available for all individual needs to know their status, 269 (81.8%) were accepted that couples should undergo HIV test before marriage, 215 (65.3%) were not agree that VTC is designed for those who are at risk of acquiring HIV infection, 184 (55.9%) were agreed that VCT is necessary for starting new relationship, 261 (79.3%) were agreed that VCT is necessary for pregnant women and for those who have an HIV like symptom (Table 3). According to the settled criteria, 243 (73.8%) of the study participants had positive attitude towards voluntary testing and counseling of HIV. However about 86 (19.3%) of them had negative attitude towards voluntary testing and counseling of HIV.
| Attitude statement | Agree | Disagree | Neutral | |||
|---|---|---|---|---|---|---|
| Frequency | Percent | Frequency | Percent | Frequency | Percent | |
| VCT is necessary | 264 | 80.20% | 54 | 16.40% | 11 | 3.30% |
| Test is only for the ill | 74 | 22.50% | 214 | 65% | 41 | 12.50% |
| VCT for HIV should be available for all individual needs to Know their status. | 293 | 89.10% | 27 | 8.20% | 9 | 2.70% |
| Couples should undergo HIV test before marriage. | 269 | 81.80% | 49 | 14.90% | 11 | 3.30% |
| VCT is only designed for those who are risk of acquiring HIV infection. | 97 | 29.50% | 215 | 65.30% | 17 | 5.20% |
| VCT is necessary for starting new relation ship | 184 | 55.90% | 127 | 38.60% | 18 | 5.50% |
| VCT necessary for pregnant women and for those individual who have HIV like symptoms | 261 | 79.30% | 49 | 14.90% | 19 | 5.80% |
Table 3: Distributions of respondents by attitude towards VTC, in Mizan High School, Ethiopia, 2017.
Utilization of HIV testing and counselling services
According to this study, only 103 (31.3%) of the respondents had tested for HIV (practiced voluntary testing and counselling of HIV) before data collection (Figure 2).
Figure 2: Practice of VTC among Mizan High School students.
Among the study participants practiced VTC before data collection, the reasons that influence their decisions to test was just to know their status 30 (9.1%), had unprotected sexual intercourse 26 (7.9%). And the reason not practiced VTC; 74 (22.5%) were because of scared of positive result, 55 (16.7%) didn’t knew where the service was given, 44 (13.4%) were not tested due to afraid of stigmatization and 37 (11.2%) were not tested because they were certain that HIV infection was not in their blood. From the total 329 respondents 131 (39.8%) of the respondent were voluntary for future test if the service is available in youth friendly service and school (Table 4).
| Variable | Frequency | Percent | |
|---|---|---|---|
| Ever Tested for HIV | Yes | 103 | 31.3% |
| No | 226 | 68.7% | |
| Decision for HIV test | Due to illness | 16 | 4.9% |
| Had unprotected sexual intercourse | 26 | 7.9% | |
| Raped | 6 | 1.8% | |
| To donate blood | 15 | 4.6% | |
| Cut with sharp material | 10 | 3.0% | |
| Just I want to know my HIV status | 30 | 9.1% | |
| Reason not to be tested | Scared of positive result | 74 | 22.5% |
| The test is expensive | 16 | 4.9% | |
| Afraid of stigmatization | 44 | 13.4% | |
| I don’t know where the test is done | 55 | 16.7% | |
| I am sure I don’t have HIV | 37 | 11.2% | |
| Readiness for future test | Yes | 131 | 39.8% |
| No | 198 | 60.2% | |
Table 4: Distribution of respondent’s by utilization of VCT, in Mizan High School, Ethiopia, 2017.
Various studies have shown low utilization of VTC service particularly in developing countries. This study tried to assess knowledge, attitude and utilization VTC among Mizan High School students. The results of this study showed that majority of respondent (90.3%) were knowledgeable about HIV/AIDS and voluntary testing and counseling of HIV. This find was inconsistent with study conducted in Bahirdar University stated that 45.7% of the respondents were knowledgeable about HIV/AIDS [15]. The possible reason for this difference may be due to increasing awareness of students towards HIV in study area and the study period.
Majority of respondent 311 (94%) of the student had heard about VTC before the day of data collection. Similar study conducted in Addis Ababa among high school student stated that 75.7% of the students were aware about voluntary HIV testing and counseling service [16]. The possible variation might be due to recent accelerated expansion of the VTC service and increasing knowledge regarding to the benefits of VTC, an improvement in health intervention currently, availability of the service in the school and establishment of anti-HIV club in the school all of these things may be the reason for the variation.
According this study majority 243 (73.8%) were found to be positive attitude towards VTC, 86 (26.1%) were negative attitude about VTC of HIV. Similar study conducted in Lao people Democratic republic stated that from the total participant Positive attitudes towards VTC of HIV/AIDS were observed among 55.7% of respondents [17]. The possible reason may be due to variation in study area.
From the total participant one-third (31.3%) of the respondents had practiced for VTC of HIV previously. This finding is not similar with the study reported among high school student of Addis Ababa 62.2% of respondent were used the service [16] and among Ambo university students (67.2%) respondent were used VTC services [18]. The possible reasons for this discrepancy could be due to variation in study area and their variation in study participant knowledge about VTC. Reasons not to be tested included scared of positive result 22.5%, they thinking that the test was expensive 4.9%, afraid of stigmatization 13.4%, the other 11.2% were not tested because they were certain that HIV infection was not in their blood , the other 16.7% didn’t tested because they didn’t know where the service was given.
Overall, 39.8% study subjects showed their willingness to undertake HIV counseling and testing in the future. However, this low percentage of willingness to take the VTC service by the study participants different from the actual practice. This might be due to less mobilization activity and fear of testing and its consequences and other reason may be due to lack of perceived benefits of VTC. The possible limitation of this study was as its descriptive study, the result did not show the association between dependent and its independent variables.
The current study sought to explore the knowledge, attitude and practice of VTC in Mizan High School students. The finding of this study showed that most of the youths have a good level of knowledge regarding HIV/AIDS and VTC. A majority 243 (73.8%) of the study participants had positive attitude towards voluntary testing and counseling of HIV. Still the practice of voluntary test and counselling.
We would like to express our deepest gratitude to Mizan Tepi University for financial support. Our appreciation also goes to our data collectors, supervisors; school leaders and study participants for their valuable contribution to this study.
