Risky HIV sexual behavior and utilization of voluntary counseling and HIV testing and associated factors among undergraduate students in Addis Ababa, Ethiopia

The study was conducted from May to June 2013 in Addis Ababa City administration.

Cross sectional study design.

All regular students of Addis Ababa Science and Technology University were considered as the study population.

Sample size was determined based on assumptions including 95% confidence level, 4% margin of error (to increase degree of precision) and 15% for anticipated non-response rate of the respondents. Hence, a total of 602 participants were considered.

Schools were identified based on their labeled departments in the University. At the same time, the study populations were also categorized from source population based on their schools. Then, Out of the total 23 departments, 15 departments were selected based on simple random sampling. The number of study subjects included in each department was proportional to their size. The students from the selected departments assembled in a room and were made to fill out a questionnaire in the presence of date collectors.

Students who were not attending their class at the time of data collection and those students who were learning in the evening were excluded from the study.

Data were collected using self-administered structure questionnaire. The questionnaire was prepared in English. Questions used to assess knowledge, attitude and practice of students towards HIV transmission and on VCT were adopted from different related studies. A Pre-test was conducted on 10% (60) of the students in the University. This helped us to verify the validity and reliability issues. The questionnaire was revised based on the findings of the pilot test.

Data collection was conducted by two graduate nurses. Data collectors received a half day training on issues concerning the questionnaire (on the objective of the study, the how of approaching the participants, how to administer and collect the questionnaires timely) was done. Consequently, the questionnaire was revised before data collectors were disseminated to collect data. Confidentiality of the study participants were kept during distribution and data collection periods. Above all, ethics, coding and entry were maintained throughout the process.

Knowledge and attitude of students towards HIV risk perception were considered as dependent variables.

Age, sex, region, department, year of study and religion were considered as independent variables.

Basic Science Departments: Industrial Chemistry, Computer Science and Information Technology, Ecobiology, Earth Science, Biotechnology).

Engineering Departments: Water Supply Engineering, Urban Planning and Design Engineering, Manufacturing Engineering, Food Processing Engineering, Environmental Engineering, Electro-Mechanical Engineering, Electrical and Electronics Engineering, Architecture Engineering.

A situation in which an action will result in an outcome that is not known with certainty, but the set of possible outcomes and their associated probabilities are known or can be estimated.

Various voluntary movements undertaken by the body in response to motives and decision related to HIV preventive methods.

Students’ attitude towards perceiving themselves as susceptible to HIV infection.

Questionnaires were checked for completeness. Partially completed questionnaires were excluded from analysis. The questionnaires were coded and the data entered in to EPI-Info version 2002 statistical package and analyzed by SPSS Version 16.0 package. Departments from which students are selected to participate were categorized into three broad themes (as Health Science, Basic Science and Engineering students). The score of one or zero was given based on the correct or wrong answer to individual knowledge and attitude questions. The knowledge score of 50.0% or above was graded as good knowledge and below this cut-off point as poor knowledge. The score of 50.0% and below was graded as unfavourable attitude and above this cut-off point as favourable attitude. Whereas students were categorized as with safe practice when they were involved in none of the risky practices. Collected data were summarized using frequency, percentages, and ratios. Chi-square (χ2), binary/ multiple logistic regression analyses were computed in order to assess the association and measure the level of significance of the association, respectively. Further, logistic regression was used to adjust for possible confounding factors. Results were reported using P < 0.05 level of statistical significance.

Ethical approval was obtained from the Institutional Review Board of Addis Ababa Science and Technology University. Consent was requested and obtained from each student prior to the study. No personal identification was recorded on the questionnaire for ethical reason. The respondents had the right not to participate in or withdraw from the study at any stage.

A total of 602 students agreed to participate and completed the questionnaire. An overall response rate of 92.6% were reported. Whenever the number of students responded for a particular question is lees that 602 are shown in bracket next to each question. Participant students were in the Health Science 108(18%), Basic Science 234(38.9%) and Engineering 260 (43.2%) fields of studies (Fig. 1).

The study revealed that out of the total participants 361 (60%) of the participants were males, and the mean age of the participants was 20.3 ± 1.6 which ranges from 17 to 25 years old. The majority 385 (64%) of the participants were in the age group of 17 and 20 years. Most of the students 263 (43.7%) were from Amhara Ethnic group followed by Oromia 170 (28.2%). Orthodox 408 (67.8%) and Protestant 94 (13.8%) religion followers were the dominant religions among the participants (Table 1).

Two hundred forty three (42%) of the participants believed that HIV can be transmitted through kissing and sharing different equipment. Among 576 study subjects who responded, 66 (11.5%) of individuals did not know about Sexual Transmitted Diseases (STDs), and further 51 (10%) of study subjects also didn’t have the knowledge of HIV as one of STDs. The overall mean score of knowledge of students towards HIV was 65.9% (Table 2).

Participants’ perception on their risk of acquiring HIV infection was asked. Among the 560 students who replied, the result indicated that 199 (35.5%) of them believed to have risk and 361 (64.5%) not. The proportions of students who perceived themselves at risk of contracting HIV were not similar for both sexes (123 (61.8%) for male and 76 (38.2%) for female) and moreover, students enrolled in the non-health departments reported to have high risk 171 (85.9%) for acquiring HIV when compared to health students 28 (14.1%).

Among the 582 participants who responded, 83 (14.19%) did not believe that HIV is severe, and it affects more youth than other group of population. And, 116 (20.7%) of students did not believe that maintaining virginity before marriage doesn’t help for the prevention of HIV/AIDS. The overall mean score of attitude of students towards risk perception on HIV was 56.6% (Table 3).

One hundred sixty one (26.8%) of the respondents had sexual experience. Out of whom, 33 (20.5%) were females and the rest 128 (79.5%) were males. The students’ age to start sex was ranged from15 up to 19. With regards to use of condom, 74 (46%) of respondents claimed that they did not use at the first time of intercourse (Table 4). Among those students who responded to question about use of condom during sexual intercourse, 25 (21.4%) did not use condom during sex (Table 4). Among those who responded to the question for whether they had more than one sexual partner 40 (28.2%) of them said yes. The main reasons mentioned by students for having multiple sexual partners include to satisfy sexual desire 33 (82.5%), due to cultural reasons 6 (15%), due to seeking to have more children 1 (2.5%) and economic reason 1 (2.5%). Among male students who started sex, 23 (18%) of them ever had sex with commercial sex workers (Table 4).

Students enrolled in health departments were three times more knowledgeable (P < 0.05) [AOR (95% CI) = 2.83 (1.67, 4.80)] in risks involved in HIV transmission than students in non-health departments (Table 5). Moreover, students enrolled in health departments had almost two and half times more favourable attitude [AOR (95% CI) = 2.55 (1.60, 4.06)] (P < 0.05) towards HIV prevention methods than students in non-health departments (Table 6). However, variables like sex, age, study year, religion and ethnicity did not show any association with both knowledge and attitude of students (P > 0.05) towards HIV prevention strategies.

Among those students who responded to the question, 488 (83.4%) heard about VCT services. Majority of the participants 510 (89.9%) thought that getting VCT service is necessary. But, 210 (36%) of participants did not know about the existence of the service at the University (Table 7).

Out of 589 students who responded to the question, 457 (77.6%) were willing to be tested for HIV if they are asked to while the rest 132 (22.4) were not (Table 7). Moreover 468 (81%) of students wanted to hear their test result on face to face basis. On the other hand, among reasons mentioned 114 (52.8) and 50 (23%) of participants were not ready to take the VCT service because of the absences of previous sexual intercourse and fear of stigma by the society, respectively. A total of 479 (82.4%) respondents agreed that getting HIV blood test would provide safety for others (Table 7).

With regards to timing for testing, majority of the students 459 (81.9%) said that one should undergo VCT at any time, 58 (10.3%) thought when an individual falls ill, 23 (6.0%) thought when an individual having many sexual partners and 13 (2.4%) agreed just before marriage. Moreover, among the respondents who had used VCT 202 (76.5) believed that HIV test helps in alleviating anxiety and the rest 24(9.1%) disagreed (Table 7).

Out of 573 students, only 275 (48%) ever used VCT. Reasons mentioned to undergo VCT were, 83 (31.7%) did it for marriage, 75 (28.6%) to know ones sero-status, 65 (24.8%) to prevent transmission of virus to the fetus, and 39 (14.9%) just to confirm to friends Among reasons mentioned not to use VCT, no experience of sexual intercourse was the highest 114 (52.8%) and 50 (23%) of them mentioned feared stigma by the society if found positive (Table 7).