EFFECT OF PEER EDUCATION AND PROVISION OF ON SITE HCT ON KNOWLEDGE OF HIV/AIDS SEXUAL BEHAVIOR AND UPTAKE OF HCT SERVICES AMONG PUBLIC SECONDARY SCHOOL STUDENTS IN ABAKALIKI EBONYI STATE.

EFFECT OF PEER EDUCATION AND PROVISION OF ON SITE HCT ON KNOWLEDGE OF HIV/AIDS SEXUAL BEHAVIOR AND UPTAKE OF HCT SERVICES AMONG PUBLIC SECONDARY SCHOOL STUDENTS IN ABAKALIKI EBONYI STATE.

Abstract

HIV/AIDS is a source of health economic and social burden. Sub-Saharan Africa has about 10% of the world’s population but 60% of all people living with HIV/AIDS (PLWHAs). Less than 10% of these people are aware they are infected, majorly because of limited availability of, access to, and uptake of HCT. The prevalence of HIV/AIDS in the south-eastern part of Nigeria is still high and sentinel survey reports the prevalence of HIV/AIDS as 5.3% for urban and 3.0% for rural areas. Ebonyi state has a prevalence of 3.3% and Abakaliki being about 3.0%. In Nigeria the prevalence among adolescents aged 15 to 19 years is 3.0% and reports have shown that this is aggravated by inadequate sexual health education, inadequate HIV counselling and testing, unhealthy cultural practices, and parents not wanting their children under 16 years to get tested and poor health care system. These figures can be reduced with adequate access to HCT and strategies to reduce stigmatisation and discrimination among adolescents. It is therefore necessary to educate adolescents on effective sexual health and HIV prevention programs, this is to increase their knowledge and skills to adopt and maintain healthy behaviours that can eliminate their risk of becoming infected. Also making HIV testing in schools routine through the establishment of on-site HCT services in an adolescent friendly centre and training appropriate HCT service providers, is an important strategy for increasing the up-take of HCT and reducing stigma and discrimination among adolescents.
Successful educational HIV Prevention programmes have made use of several strategies, one of which is peer education. The use of peer education to reach out to adolescents and youths to achieve tangible results have been documented as a popular communication channel/strategy that has been adopted in reproductive and adolescent health promotion, also on-site HCT services have been reported to increase the up-take of HCT. Based on the successes of peer health education and provision on-site HCT services in promoting reproductive health behaviour change, this study was undertaken to determine the effect of peer education and
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provision of onsite HCT services on the knowledge of HIV/AIDS, sexual behaviour and uptake of HCT among students. This was a school-based intervention study undertaken in Ebonyi state, Nigeria, among senior secondary school students of two selected schools. Multistage sampling technique was used to select 466 students each from the schools. A peer education training manual adapted from FHI was used to train peer educators and an HCT training manual adapted from National guidelines for HIV/AIDS VCT was used to train the HCT counsellors. A pre-test semi structured self and/or interviewer administered questionnaire was used to collect information about respondents’ knowledge of HIV/AIDS, sexual behaviour and uptake of HCT. Knowledge was scored on a 26-point scale, and categorised into good, fair or poor. Sexual behaviour was also rated as; no risk, low risk and high risk using a 10-point scale depending on the level of sexual risk exposure. The up-take of HCT and factors affecting it were also assessed. Data was analysed using the Statistical Software for Social Sciences (SPSS) version 21.Tests of statistical significance were done and statistical significance was set at p value of less than 0.05.
At baseline assessment, majority of respondents in both groups had good knowledge of HIV/AIDS, 86.1% in the study group and 81.5% in the control group but about half of the respondents had some misconceptions about HIV transmission; 198 (42.5%) in the study group and 218 (46.7%) in the control group said HIV could be contracted through sweat while 264(56.6%) in the study group and 252(54.1%) in the control group said HIV could be contracted through mosquito bite. Their mean knowledge scores were 19.51(±4.58) for the study group and 17.61(±5.09) for the control group. Almost a quarter of respondents practiced high risk sexual behaviour, 111(23.8%) in the study group and 99 (21.2%) in the control group. About 80% of respondents in the groups were willing to screen for HIV, but only 56(12%) in study and 61(13.1%) in the control group had ever screened. At 3 months Post-intervention, there was a further increase by 10.6% in the proportion of respondents with good knowledge
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of HIV in the study group and only by 4.2% in the control group. (p<0.01). There was also a reduction in the proportion of respondents in the study group than control group with misconceptions about HIV transmission. Only 10(2.3%) in the study group compared to 226(49.1%) in the control group reported that HIV could be contracted through mosquito bite (p<0.01). The proportion of respondents that said HIV could be transmitted through sweat also reduced significantly by 9.6% in the study but increased by 9.2% in control group, (p<0.01). High risk sexual behaviour of respondents reduced significantly in the study group while it increased in the control group; 49(11.4%) and 164(35.7%) respectively, (p<0.01). Willingness to screen increased significantly in the study than control group; 352(82.2%) and 325(70.7%) respectively and a higher proportion of respondents in the study group than control group screened for HIV. Increasing uptake of HIV/HCT by 61.6% (from 12% to 73.6%), p<0.01 within the study group. Logistic regression revealed that being female, sexual exposure and condom use were predictors of HCT uptake. Other reasons given by respondents were fear of having a positive result, perception of not being at risk of contracting HIV and distance to HCT centre. In addition focused group discussion revealed; fear of needle prick, sight of blood, fear of blood being used for rituals and confidentiality in the process as additional reasons for not screening. Peer health education and the provision of on-site HCT services significantly improved respondents’ knowledge of HIV/AIDS, sexual behaviour and up-take of HCT. Therefore, Integrating peer education and HCT into school health programme is therefore recommended as a strategy for increasing the up-take of HCT and subsequently reducing the incidence and spread of HIV.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

EFFECT OF PEER EDUCATION AND PROVISION OF ON SITE HCT ON KNOWLEDGE OF HIV/AIDS SEXUAL BEHAVIOR AND UPTAKE OF HCT SERVICES AMONG PUBLIC SECONDARY SCHOOL STUDENTS IN ABAKALIKI EBONYI STATE.

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