Perceived Barriers and Benefits of HIV Voluntary Counseling and Testing Among University Students in Nigeria

Background. Nigeria, the most populous country in Africa is one of the sub- Saharan nations most affected by HIV and AIDS. However, due to stigma most people at risk of infection refuse testing, thereby likely increasing the transmission of HIV. Voluntary counseling and testing (VCT) has been shown to influence behavior change and it is important to explore how to increase rates of VCT in young people who may experiment with sexual activity in this environment that holds increased risks due to nationally elevated rates of HIV. Purpose. To examine intention to use HIV voluntary counseling and testing (VCT) services among undergraduate students in Nigerian universities. Methods.A cross-sectional mixed method study was conducted in two phases: six key informant interviews (KIs), and four focus group discussions (FGs) were conducted during the qualitative phase to explore the context of risk taking for these young adults; a survey instrument based on the Theory of Gender and Power and the Health Belief Model adapted with information from the qualitative phase was then developed, pilot tested and administered to 301 students attending the University of Lagos. Analysis. Responses generated from KIs and FGs were transcribed verbatim using the software Cool Edit 2000, and coded and analyzed using Grounded Theory Methods. Once collected, entered, and cleaned, the quantitative data was factor analyzed to determine emergent factors using Promax rotation. Demographic variables and theorybased emergent factors were then used to explore their bi-variable relationships with intention to engage in VCT. The significant variables were then entered into a multivariate regression model. Results. Both qualitative and quantitative data support that these Nigerian university students had reasonably high knowledge about HIV and VCT, reported relatively “easy” access to VCT, and among those who are sexually active, many have responded to this knowledge by using condoms consistently. Many have concerns about the actual protection they get from condom use. Possibly due to this, nearly 50% of the sexually active respondents had engaged in VCT in the past and even among those reporting not being sexually active nearly one third have actually also engaged in VCT. Stigma, confidentiality and error in reporting HIV test results were the biggest barriers to VCT reported. In the final regression only concerns about a potentially risky partner was a significant predictor for intentions to seek VCT in the future. Conclusion.These findings support that past HIV education and the availability of easy access to VCT has had important positive effects in Nigerian university students in Lagos. In light of these successes the recently proposed World Health Organization (WHO) and Centers for Disease Control (CDC, 2001) guidance to emphasize rapid testing and forgo culturally sensitive counseling before and after HIV testing should be reconsidered, as VCT may provide a unique “teachable moment” that seems to have worked well for these young adults