CHAPTER TWO
2.6 Overview of HIV/AIDS
2.6.2 Challenges of measuring adolescents’ sexual behaviours and HIV-related knowledge, attitudes and practices
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Cultural practices that permit men to have multiple sexual partners, such as polygamy, concubinage, wife hospitality, and wife inheritance
The erroneous belief of virgin-cleansing. It is believed that having sex with females with disability and young girls, who are most likely to be virgins, can cure HIV and other STIs. This is the reason for some cases of rape among these groups of females
A poor or weak healthcare system due to political instability and mismanaged economy has made it difficult to provide enough services for prompt diagnosis and treatment of STIs; HIV counselling, testing, prevention; and lack of antiretrovirals. Prescription drugs can easily be obtained without prescriptions, leading to self-medication and sub-optimal treatment of STIs
Poor community support for HIV/AIDS prevention programmes and condom use
Harmful traditional practices such as female genital mutilation, scarification and tribal marks
2.6.2 Challenges of measuring adolescents’ sexual behaviours and HIV-related knowledge,
119 their sexual behaviours from independent sources who are in a position to have a good idea about the respondents‘ sexual behaviours. It is also better to try to use self- administered questionnaires to obtain information on sexual behaviours so that respondents can be more honest in their responses, unless the literacy level of the target population is not good.
Often, recall bias is present, whereby some of the reports may not be completely accurate because respondents cannot fully remember exactly what happened due to a considerable time lapse (Donenberg et al., 2003). This is particularly so for questions meant to elicit information about sexual practices 3, 6, or 12 months prior to the study.
Cross-sectional design is often used. This is correlational in nature, and it is difficult to establish cause-and-effect relationships (Donenberg et al., 2003; Taylor et al., 2007).
Therefore, there are fewer interpretations of data obtained from such surveys.
In an African setting, reporting bias is a possibility, whereby females under-report and males over-report. This is as a result of mores and norms that regulate sexual activities and which expect females to be chaste and to show deference to men and men to be virile and to initiate sex (Kaaya et al., 2002).
2.6.2.1 HIV/AIDS knowledge and attitudes among adolescents in Nigeria
Awareness of HIV/AIDS: Data from NDHS (2003) shows that awareness of HIV/AIDS is higher among 15-19-year-old boys (92.9%) than girls (82.8%). The level of awareness increases with education, and it is universal (100.0%) among both males and females with higher education. In addition, people in the urban areas are more aware of HIV/AIDS than those in the rural areas.
However, among urban in-school adolescents, awareness of HIV/AIDS appears to be universal (100.0%) (James et al., 2006) compared to what it was about a decade ago (90.0%) (O.I. Fawole et al., 1999).
Knowledge of modes of transmission of HIV: Knowledge of modes of transmission of HIV is low among adolescents in secondary schools in Nigeria. For example, O.I. Fawole et al. (1999) documented that sexual intercourse was the mode of transmission that most (83.3%) of the
120 students were aware of, followed by blood transfusion (78.4%), using unsterilised instruments and equipment (56.9%) and sharing needles and syringes (59.3%). The study also indicated that adolescents‘ knowledge scores on HIV issues increased with age and educational level.
Similarly, respondents in another study could only identify sexual intercourse, blood transfusion and sharing of needles as the modes of transmitting HIV, and they demonstrated inaccurate knowledge about HIV (Nwokocha & Nwakoby, 2002).
Knowledge of mother-to-child transmission (MTCT): Less than half of the 15-19 years age group knew that HIV can be transmitted through breastfeeding (National Population Commission (NPC) [Nigeria] & ORC Macro, 2003). Interestingly, more boys (44.6%) than girls (40.8%) had this knowledge. The level of knowledge of mother-to-child transmission through breastfeeding increased with the level of education, and is highest in people with higher education. In addition, those in the urban areas possessed more knowledge than those in the rural areas. Moreover, the knowledge of trans-placental transmission of HIV, either in-utero or during labour, among in- school adolescents was low. O.I. Fawole et al. (1999) revealed that less than half (47.1%) of the participants in their study were aware of trans-placental transmission of HIV.
Attitudes and risk perception towards HIV: Furthermore, adolescents demonstrate negative attitudes towards HIV and people living with HIV (PLWHA). The study by O.I. Fawole et al.
(1999) showed that only 54.9% of the participants felt AIDS was a problem in Nigeria. Over a quarter (29.8%) attributed it to a curse from God and another 15.2% believed it was due to witches and wizards. Linking HIV infection to a curse from God could make them stigmatise or discriminate against PLWHA. So it is not surprising that most (70.7%) of the sample do not want to be near PLWHA. About half (49.5%) of the participants in a study by Nwokocha and Nwakoby (2002) would eat with a friend who is infected with HIV. Additionally, over two thirds (68.4%) of the respondents believed that they could never be infected with HIV, showing their low level of HIV risk perception despite their documented risky sexual practices.
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