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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 99-106 |
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Awareness and knowledge of HIV/AIDS among senior secondary school students in Zaria, Nigeria
Abdulhakeem A Olorukooba1, Fahad A Saulawa1, Babandi S Zaharaddeen1, Ismail A Raji2, Halima O Olorukooba3, Salamatu Belgore1
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
3 Nursing Department, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| Date of Submission | 15-Jun-2021 |
| Date of Decision | 22-Oct-2021 |
| Date of Acceptance | 21-Dec-2022 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Abdulhakeem A Olorukooba
Department of Community Medicine ABU, Zaria
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_26_21
Background: Nigeria has one of the largest human immunodeficiency virus (HIV) epidemics in the world and one of the highest rates of new infections in Sub-Saharan Africa. The younger age group has been identified as bearing half of the burden of HIV worldwide. This includes secondary-school children. Objectives: The aim of this study was to determine the awareness and Knowledge of senior secondary-school (SSS) students concerning HIV/AIDS. Materials and Methods: A cross-sectional, descriptive study was conducted among SSS students in Zaria, Kaduna state, Nigeria. Respondents were selected using a multistage sampling technique. Data were collected using a pretested, semi-structured, self-administered questionnaire. Descriptive statistics were used to represent univariate level data, whereas chi-square and Fisher’s exact test where applicable were used to identify the relationship between knowledge of HIV and other categorical variables with a level of significance of P < .05. Results: The mean age (± SD) of respondents was 16.1 ± 1.1 years. All (100%) of the respondents were aware of HIV/AIDS. The majority of the respondents knew HIV/AIDS was caused by a virus (89%). Almost a quarter of the respondents (22.1%) believed that antibiotics can prevent HIV. The mean (±SD) knowledge score was 80.5 (± 15.8) out of a total of 100%. Overall, 62 (84.9%) of the respondents had good knowledge of HIV/AIDS. There was a statistically significant relationship between knowledge and tribe as well as the religion of the respondents (P = 0.008 and P = .016, respectively). No statistically significant relationship was found between knowledge and other sociodemographic factors (P > .05). Conclusion: HIV/AIDS awareness and knowledge were good among respondents though some misconceptions still existed. Respondent’s tribe was significantly associated with the level of knowledge of HIV/AIDS. The school authorities and all other concerned agencies should design campaigns targeted at correcting specific misconceptions and gaps in knowledge for the benefit of the students in the study area and the country at large. Keywords: Adolescents, HIV/AIDS, misconceptions, prevention, secondary schools
How to cite this article:
Olorukooba AA, Saulawa FA, Zaharaddeen BS, Raji IA, Olorukooba HO, Belgore S. Awareness and knowledge of HIV/AIDS among senior secondary school students in Zaria, Nigeria. Int J Med Health Dev 2023;28:99-106 |
How to cite this URL:
Olorukooba AA, Saulawa FA, Zaharaddeen BS, Raji IA, Olorukooba HO, Belgore S. Awareness and knowledge of HIV/AIDS among senior secondary school students in Zaria, Nigeria. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:99-106. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/99/372145 |
| Introduction | |  |
The human immunodeficiency virus (HIV) has had its toll on every single part of the world from the time it was first documented in the 1980s up till this moment.[1] This pandemic is one of the most challenging health and development problems in the world. Even when most developed countries have been able to control the pandemic to a certain extent, in sub-Saharan Africa, it is still a huge problem where the efforts of most countries are still majorly at the primary level of prevention.[2],[3]
The younger age group has been identified as bearing half of the burden of HIV worldwide.[3] Every day 5000 young people aged between 15 and 25 years in the world become infected with HIV, which translates into almost 2 million new infections per year.[3] Even though individuals of any age and gender are susceptible to HIV, young people aged 15–25 years are more at risk of contracting the virus.[3] A recently published Nigeria HIV/AIDS Indicator and Impact Survey(NAIIS), one of the largest population-based HIV/AIDS household surveys ever conducted, found the prevalence of HIV to be 1.4%.[4] This is a remarkable decline from the 2.8% recorded in 2017.[5] In 2016, 240,000 adolescents (between the ages of 10–19) were living with HIV, making up 7% of the total number of people with HIV in Nigeria.[6] HIV prevalence among this age group varies regionally, with as high as 4.3% of 15- to 19-year-olds living with HIV in the South-South, compared to as low as 1.3% in the South East.
According to the World Health Organization and the Joint United Nations Program on HIV/AIDS, youths are much more prone to HIV infection as a result of a lack of correct health information, indulgence in risky behaviors, and lack of access to adequate reproductive health services. Young people face greater challenges and more exposure to risks, including economic exploitation, changing lifestyles, global, regional, and national conflicts, and the spread of sexually transmitted infections and HIV/AIDS.[7] They are also usually more sexually active at an earlier age with the age at first intercourse even reported as low as 16 years.[8] Consequently, if interventions are targeted at the young age group before they become sexually active, it may help to reduce new HIV infections.
According to the UNAIDS prevention gap report 2016, only a minority of youths worldwide have comprehensive knowledge of HIV/AIDS.[9] Lack of awareness and inadequate knowledge and risky practices are major hindrances to preventing the spread of HIV among these groups of individuals.[10] Also, lack of knowledge of the modes of transmission of HIV could lead to involvement in risky behaviors which could, in turn, lead to increased risk of STIs including HIV. Awareness about HIV/AIDS has been created through the media, schools, peer education, and family communication in Nigeria (Kaduna state inclusive).[11] However, the impact of such programs on our youthful population has not been well documented in Kaduna State.[12] There have been gaps in determining the current level for specific knowledge of HIV/AIDS as there are no recent studies to show the impact of health education programs that have been conducted by the state government to prevent the spread of HIV in the youthful population of Kaduna state. Previous research conducted on the knowledge of HIV/AIDS among secondary-school adolescents in Nigeria concluded that general awareness of the disease may be high but the specific knowledge of the disease is still poor.[1],[13] It is important to determine the current level of knowledge of HIV/AIDS to provide accurate information for planning and execution of interventions that would help to prevent the spread of HIV among the youths in the community and by extension the state and country. Information obtained from our study will equip policymakers on the current level of awareness and knowledge which could aid in instituting appropriate and timely population-level measures that will help to prevent this menace. This study was carried out to determine the level of awareness and knowledge of HIV/AIDS among secondary-school students in Zaria metropolis, Kaduna state Nigeria.
| Materials and Methods | | |
Zaria metropolis has 22 public secondary schools and 9 private secondary schools. Some are male-only, others female only, whereas others are mixed. A few have boarding facilities. They mostly have about three to four arms per class. The arms in the senior secondary are mainly Arts, Sciences and Social Sciences.[14]
The schools are located in the communities most of which are host communities to tertiary institutions. Around these areas are also various notable cinema houses, recreation areas, some hotels including bars. These (cinema houses and recreation areas) cumulatively contribute to increased risk of spread of risky behavior and invariably HIV/AIDS.
A cross-sectional descriptive study was employed. The study population consisted of students in secondary schools in Zaria metropolis. Only students in the senior secondary section were included in the study. Students who were sick or absent during data collection were excluded from the study.
Sample size (n) was determined using Fisher’s formula for determining sample size for cross-sectional studies:[15]
where n = minimum sample size,
Z = confidence interval (CI) 95% = 1.96 for normal standard deviation,
p = 96% =0.96 prevalence of awareness from a previous study in Katsina,[16]
q = 1–p = 1–0.96=0.04, and
d = Margin of error=5% =0.05.
Thus, n = 1.962 × 0.96 × 0.04=0.148 = 59.006 0.052 0.0025
Allowance of 20% for non-response = 0.2 × 59.006 = 11.801
Minimum sample size is 59 + 11.801 = 70.801. Approximately 71 students
A multistage sampling technique was used. In the first stage, a list of public schools in Zaria metropolis was made. Six schools were selected out of the 22-public using simple random sampling by balloting. In the second stage, stratified sampling (based on class) was used to select 4 eligible students from each class from SS1-SS3 using their class registers. This process of selection was done in each of the selected schools until the required sample size was obtained.
A semi-structured, pretested, validated, self-administered questionnaire which was adapted from previous similar studies was used.[1],[10],[16] The questionnaire had 4 main sections; sociodemographic data of the respondents; Awareness of HIV/AIDS, source of information on HIV/AIDS, knowledge on HIV and AIDS, and its prevention. Data collected were cleaned, entered, and analyzed using Statistical Package for Social Sciences (SPSS) for Windows, version 20.0[17] and was presented in form of charts and tables. Knowledge score was computed from the knowledge questions with each correct score having 1 mark and a wrong score corresponding to Zero.[18] The percentage knowledge score of each individual was computed. The scores were graded into the following categories based on a similar study: 60%–100% was classified as good, 50%–59% as fair, and <50% as poor.[18] Frequencies and percentages were used to summarize categorical variables, whereas descriptive summary statistics such as mean and standard deviation were used for quantitative variables at the univariate level, whereas at bivariate level analysis chi-square test was used to determine the relationship between categorical variables at the level of significance of P < .05.
Ethical approval was sought and obtained from the Ahmadu Bello University Teaching Hospital Health Research Ethics Committee (Reference number: ABUTHZ/HREC/B14/2020). Permission was obtained from the principals of the selected schools. Written informed consent was obtained from each respondent. Confidentiality of the information was assured and privacy of respondent was maintained. Data collected were stored in a password-protected computer. Only the researchers had access to the computer.
| Results | | |
The mean age ± SD of respondents was 16.1 ± 1.1 years. The respondents were predominantly females (54.8%), 65.8% were Hausa with Islam accounting for 87.7% of the respondents’ religion. The majority (52.1%) belonged to a monogamous family setting [Table 1]. All (100%) of the respondents were aware of HIV/AIDS and mass media was the most prevalent source of information (76.7%) [Table 2]. The respondents selected unprotected sex as the most common means of HIV transmission (98.6%) [Table 3]. The most conversant symptom of HIV/AIDS known by the respondents is progressive weight loss (90.4%) [Figure 1]. The majority of the respondents knew HIV/AIDS was caused by a virus (89%) [Table 3]. The majority of the respondents believe that HIV is preventable (93.2%) [Table 3]. The common methods of HIV prevention were believed to be avoiding injection with unsterilized materials (94.1%). Some of the respondents thought it could be prevented by advising infected mothers not to breastfeed their babies (76.5%) [Table 1]. The mean (±SD) knowledge score was 80.5(± 15.8) out of 100% Overall, 62(84.9% of the respondents had good knowledge [Table 4]. There was a statistically significant relationship between the knowledge and tribe of the respondents (P < .008 and P = .016, respectively). No statistically significant relationship was observed between knowledge and other sociodemographic factors such as age, sex, religion, education of mother, and father (P > .05) [Table 5].  | Table 2: Awareness of HIV/AIDS and first source of information among secondary-school students in Zaria (n = 73)
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 | Figure 1: Ways of HIV prevention known to secondary-school students in Zaria (n = 73)
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 | Table 5: Relationship between knowledge of HIV/AIDS and tribe of respondents (n = 73)
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| Discussion | | |
As neither a viable cure nor a vaccine is readily available, the best approach to addressing the HIV/AIDS pandemic remains prevention via the creation of awareness and sensitization.[19] This is particularly so for youths who most times do not have full knowledge of the dangers around them. We found all respondents in our study to be aware of the term HIV. This is similar to the findings of other studies where all respondents were aware of the term.[20],[21],[22] This was a remarkable finding because when every student is aware of HIV, it makes it easier to improve their knowledge thus making the work of the public health authorities less tasking.[19] Public health education programs would also be able to target more important areas of intervention when the aspects of awareness are already present among the population. Though similar studies also nearly all of their respondents being aware of HIV,[1],[16] some other studies found much lower values for awareness of HIV among their respondents.[23] The reason for this difference could be because the respondents used in their study were as young as 12 years (they used both junior and senior secondary) and may not be aware of HIV as compared to our study where all our respondents were only senior secondary-school (SSS) students. The major source of information on HIV for respondents was the mass media. This finding is similar to what was obtained in a study in Katsina, Nigeria.[16] Also in India, researchers found the mass media as the main source of information about HIV.[24] In a study conducted in China, information on HIV/AIDS was also said to be gotten mainly from the mass media.[25] Thus, it is clear that the mass media has been largely successful in creating awareness on HIV/AIDS among the general population as well as the student population. However, it should be known that the mass media should not be relied on as a sole means of impacting adequate knowledge that will help in controlling the disease.[26] As the issue of HIV is closely related to a person’s way of life and attitude, there is always a need to follow-up the awareness created by the mass media with more comprehensive and individualized health educational methods. This can be attained using parents[27] who at the moment are not making much impact as our study shows that only half of the respondents received information about HIV from their family members. A similar study also showed that parents are not making the desired contribution to knowledge about HIV/AIDS which should not be the case.[1]
In our study, only a tenth of our respondents did not know that HIV/AIDS was caused by a virus. This is different from a study done in Calabar, Nigeria where about a third of the participants did not know the etiological agent of HIV/AIDS.[1] This could be attributed to the interventions that have been going on in the study area. This study found that most of the respondents knew that a person can still appear healthy while still having the infection. This is in contrast with the Calabar study where a much smaller proportion of the respondents knew that HIV-infected individuals can look normal without showing any overt signs or symptoms of the disease.[1] Also, almost all respondents in this study knew that HIV is a preventable disease. This is a welcome finding because research has shown that there is a positive correlation between Knowledge of HIV prevention and risk reduction behavior.[28] When students adopt a risk reduction behavior due to their awareness and knowledge of HIV transmission, this could invariably help in reducing the spread in the student population specifically as well as the general populace. This is a good finding because knowing that a person can have HIV infection and still appear healthy is very important in prevention. Thus, it is likely that all necessary precautions will be taken with anyone whether he or she appears healthy or not. This may not be the case if the knowledge is not appropriately applied but knowing in the first place is very important and could act as a stepping stone in aiding the development of risk-free behavior.
In our study, the majority of the respondents knew at least one sign or symptom of HIV/AIDS. This is in contrast with another Nigerian study where the majority (89.5%) did not know any sign or symptom of HIV/AIDS.[1] In our study, only senior secondary students were interviewed while in the other study both junior and SSS students participated in their survey, this could account for the difference in our results as it is known that senior secondary students are generally more knowledgeable than junior students regarding HIV/AIDS.[1] In our study, weight loss and fever were the common symptoms known by the respondents. It is apparent from our study that most of the students know how HIV presents clinically. This is in contrast with the Calabar study that found Fever and chronic cough as common symptoms known by respondents.[1] It is important to know how HIV presents as this will serve to help the individual to have a high index of suspicion and thus encourage them to seek medical help if they suspect or notice any similar symptoms in themselves or others.
The commonest mode of transmission mentioned by the students in our study was unprotected sexual intercourse. This is similar to the findings of other Nigerian studies.[1],[16],[29] The knowledge of sex as the major route of transmission is a good finding among respondents. As this was linked with the knowledge of how to protect oneself against the disease as over half of them knew that Abstinence could prevent acquiring HIV/AIDS and a considerable proportion of the respondents mentioned keeping to one sexual partner as well as the use of condoms and as being very important for preventing the disease. These findings of good knowledge of preventive measures could imply strength in the HIV/AIDS health education program in the schools studied.[30] Although this may not entirely be the sole reason as we know that several other actors are present in the state and providing information and education about the disease and how to prevent it. This finding is in contrast with the Calabar study where the majority of the respondents did not mention abstinence or use of condoms as a way of preventing the infection.[1] The differences in the age range of our respondents could account for the difference as our respondents were much older and were likely to have better knowledge than younger students. Also, the students in a similar study may not have had the opportunity to speak freely about HIV prevention due to the nature of the survey that was conducted.
Particularly worrisome is the finding in our study that taking herbal preparations as well as antibiotics could help to prevent HIV, some students erroneously believed that this could help to boost immunity and prevent HIV. This could have very serious implications which could have serious consequences. This kind of misconception should never be allowed to spread as there is the likelihood that when the youth have this kind of mindset, they can act on this false information to engage in risky behavior. This might expose them to the risk of the infection but they would hope that they could purchase and use local herbs or antibiotics to prevent them from contracting HIV or any other venereal disease. Other studies have also reported similar misconceptions on HIV prevention and transmission.[1] A similar study conducted in Laos also recorded various misconceptions about HIV/AIDS among the respondents, though the study was it was done only among male students.[10]
Most of the respondents in our study scored a good overall knowledge grade for HIV/AIDS knowledge. Though this is a good finding, it may not directly imply that our respondents are likely to have a better perception and attitude toward HIV/AIDS prevention and care which could translate to better preventive practices. Nonetheless, this is a step in the positive direction as public health interventions could be easier to implement when the recipients have good knowledge about the subject. Other studies done among secondary-school students were in contrast with this finding.[18],[31]
Our study found a statistically significant relationship between the level of knowledge of respondents with ethnicity as well as religion. This has been corroborated by other similar studies.[32],[33] These factors can be exploited when designing further studies that could help to give a better picture of the kind of interventions that are needed to keep HIV/AIDS under check. There was however no association between level of knowledge and other sociodemographic factors like age and sex. This is in contrast to a study that found a significant relationship between knowledge of HIV/AIDS and age as well as sex.[22] The reason for this difference could be as a result of the small sample size in our study as compared to the other study which was more diversified and had a much larger sample size.
However, our study was not devoid of limitations; The findings of our study being a cross-sectional one is only a snapshot of the current batch of secondary-school students and may not be a true representation of the knowledge of students in the whole of Kaduna or Northern Nigeria. Acquiescence response bias may have occurred with the use of a self-administered questionnaire. However, we overcame this by ensuring that not all the correct answers for the knowledge questions were positive also assured the respondents of the anonymity of their responses. Despite these limitations, the researchers believe that this study will be a practical source of information for further research and policy formulation.
| Conclusion | | |
HIV/AIDS awareness and knowledge were good among respondents although some students had misconceptions. The tribe, as well as the religion of the respondents, had a significant influence on the level of knowledge of HIV/AIDS. Any misconceptions concerning this deadly disease must be cleared by intensifying all health education efforts by the school authorities together with other relevant agencies and directing them toward correcting any wrong knowledge or beliefs concerning HIV transmission or prevention.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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