Relationship between Awareness of HIV/AIDS and Attitudes of Secondary School Students to Premarital HIV Counseling and Testing in Zaria, Northern Nigeria

Background: In Nigeria HIV infection is transmitted mainly through heterosexual route, affecting mostly individuals within reproductive age groups. As a result, HIV/AIDS education is advocated as a strong component of family and reproductive health education in the school curriculum which should emphasize responsible sexual behavior, premarital chastity and protective sexual practice. Aims/ objectives: To evaluate student ’s knowledge of HIV/AIDS, premarital HCT, and reactions to possible discordant HCT results. Methods: Cross sectional questionnaire-based study of 600 students in 6 schools in Zaria/Sabon Gari LGAs. Exclusion criteria: students aged ≤13 years, married, in JSS 1-3, SS1. Results: 550 students completed questionnaire (92% response rate). 54.5% females (ᾱ age =17.5 ±2.7 years) versus 45.5% males (16.5 ±2.7 years), Muslims (53%) and Christians (47%) respectively. 76%, 57%, and 38% knew the meaning of AIDS, HIV and VCT respectively; while all knew both the routes of HIV transmission and preventive measures. More than two -third supported voluntary, free and self initiated premarital HCT, preferably in a private and confidential setting. None would marry a discordant HIV positive partner, while 61% would marry themselves if both have positive HIV results. Conclusion: Many students would shun marriage with discordant HIV+ partner. DOI : 10.14302/issn.2324-7339.jcrhap-13-227 Corresponding author’s e-mail: orobiako87@gmail.com


Introduction
The human immunodeficiency virus (HIV) is currently the world's leading sexually transmitted infection (STI), with at least 10 persons being infected with the virus every minute globally, two-third of these in sub-Saharan Africa [1]. In Africa, Nigeria ranks third after South Africa and Zambia in HIV prevalence, with the prevalence rising from 1.8% in 1991 to 5.8% in 2001, and a decline from 4.4% in 2005 to 4.1% in 2010 [2]. However, the size of Nigeria's population (approximated at 152.6 million by 2011) means that there were an estimated 3.3 million people living with HIV in this country [3], more than 80% of whom are within the sexually active age groups (15-45 years) [2].
The major vulnerable lifestyles linked to the spread of HIV infection and maintenance of its pandemic in Nigeria are unprotected premarital and/or extramarital sexual relationships, which are prevalent among adolescents and young adults, and linked to ignorance, peer pressure and misinformation or/and low perceptions of personal vulnerability to STIs, including HIV [4][5][6]. In addition, the long latency between HIV infection and the development of AIDS-related conditions reduces the likelihood that people will associate a particular sexual contact with the time of transmission, thus compromising the role of voluntary counseling and testing (VCT) or the provider-initiated HIV counseling and testing (HCT) in helping to prevent transmission [4]. As a result the adolescents and youths remain the major propellers and casualties of the pandemic [7].
In many Nigerian societies, premarital chastity was the norm and sex is traditionally a very private subject rarely discussed with teenagers. Attempts at providing sex education for young people are hampered by religious and cultural objections by parents who believe that sexual issues should be limited to married adults, and that information on such issues should be inaccessible to the young ones in order to promote chastity [8,9]. In order to address this problem, various governments in Nigeria introduced aspects of Family and Reproductive Health Education in the school curriculum in the late 1990's [10,11], but by 2009 only 23% of schools were providing life skills-based HIV education, and just 25% of men and women between the ages of 15 and 24 were able to correctly identify ways to prevent sexual transmission of HIV [12]. It was probably in recognition of these gaps that the Nigeria  [19].

The Study Population
The study was carried out among 600 students selected from 6 secondary schools in Zaria and Sabon

Statistical Analysis
The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17, and were expressed in frequencies, percentages, and mean ± standard deviation. Continuous variables were compared using the t-test, while discontinuous variables were compared using chi-square. The relationships between the independent variables, and support for or willingness to perform HCT were analyzed using stepwise linear regressions. All analyses were set at significant levels of 5% (P < 0.005).

Response Rate
All 600 students returned their questionnaires,       Table 3. Reactions to HCT results

Stepwise linear regression for predictors of support for HCT and readiness to submit to HCT.
Stepwise in the late 1990's [10,11]. Yet this finding is in contrast with those obtained in the survey on unmarried tertiary student, where about 35% of the students did not know the meaning of the acronyms: HIV and AIDS [19].
However, like their counterparts in tertiary schools, more than 60% of the students in this study did not know the meaning of VCT, an observation which had been made by several earlier researchers [12,17,23].
The researchers noted that VCT was not taken seriously  [24], and mistrust and loss of confidence of HCGs by HIV positive persons [25]. However, voluntary pre-test counseling, confidential HIV testing and post-test counseling are thought to be more desirable, because people who feel they have been exposed may voluntarily take the test themselves, and the anonymity gives them comfort that they won't have to reveal themselves until they decide to [26].
In this study, 'fear of the unknown' or 'of were strong predictors of support for pre-marital HCT.
The reason for this is not clear, although one can speculate that socio-cultural and religious norms which promote premarital chastity while prohibiting sexual activities among adolescents may be contributory [31].

Conclusion
In conclusion, it is possible that these youths support premarital HCT because they believe that it will encourage sexual abstinence and chastity as an effective barrier to HIV transmission. Secondly, the students still harbor discriminatory tendency towards