1.1 Background to the Study
Since the Human Immunodeficiency Virus (HIV) was first discovered three decades ago, it is estimated that globally approximately 1.8 million adults and children had died of Acquired Immune Deficiency Syndrome (AIDS)-related illnesses by the end of 2010 (UNAIDS, 2010). In the same year 2010, it was estimated that there were 34 million people living with HIV globally, with the bulk, 22.9 million, residing in Sub-Saharan Africa. Globally, adolescents bear the brunt of the epidemic as they account for one third of currently HIV and AIDS infected individuals and half of new infections of HIV globally (Dehne & Riedner, 2005; UNAIDS, 2011).
According to the United Nations Joint Programme on HIV and AIDS (UNAIDS), 2.1 million people were newly infected with HIV in 2013, and an estimated 35 million people were living with the virus (UNAIDS, 2015; Wilson, Wright, Safrit & Ruby, 2011). It has since been dubbed as one of the greatest humanitarian and development challenges facing the global community in recent times (Adekeye, 2010). Globally, there is an estimated 1.2 billion adolescents, constituting 18% of the world’s population (UNICEF, 2012). Available evidence shows that about 2.2 million of these (60% of them, females) are living with HIV, and many are unaware of their infection (WHO, 2016).
The first case of AIDS was reported in Nigeria in 1986 in a sexually active 13-year-old girl as recorded by the Federal ministry of Health and Human Services (1992). Since this first report, the prevalence rate of HIV infection has been on the increase in Nigeria; from 1.9% in 1993 to 5.8% in 2001 and with a decline to 4.6% in 2010 (NACA, 2011). In adolescents, 15-24 years rates declined from 6.0% in 2001 to 4.1% in 2010. One third of currently infected individuals are adolescents aged 15 to 24 years, and half of all new infections occur in this same age (Dehne & Riedner, 2005). It was also estimated that Nigeria accounted for the highest AIDS-related deaths in Sub-Saharan African (Global Burden of Disease: Nigeria, 2010; UNAIDS, 2013).
One reason for high prevalence rates is that most people are unaware of their HIV status, Sekatawa (2000) revealed that75% – 80% of new infections came about as a result of unprotected sexual contact with an infected person, attributable to the low level of HIV testing among adolescents (Idele, Gillespie, Porth, Suzuki, Mahy, Kasadde et al., 2014; John, Okolo & Isichei, 2014; UNAIDS, 2013). It was estimated that less than 40% of the people in Sub-Sahara Africa know their HIV status despite the fact that the present HIV intervention packages depend on the knowledge of individual’s HIV status (Mbamara, Obiechina & Akabuike, 2013).
The rate of HIV and AIDS increase is very alarming amongst adolescents who are found within the age brackets of 15 and 24 years especially among students of higher institutions of learning who do not have knowledge of their HIV status (Kennedy & Ibinabo, 2013; Schantz, 2012). Risky sexual behavior and alcohol consumption has been regarded as the major health risk behavior engaged by adolescents that predisposes them to infection of HIV (Elkington, Bauermeister & Zimmerman, 2010; Nkansah-Amankra, Diedhiou, Agbanu, Harrod & Dhawan, 2011). Early initiation of sexual intercourse, sexual intercourse under the influence of alcohol, unprotected sexual intercourse and multiple sexual partners constitute sexual risky behavior exposing adolescents to several health problems especially HIV infection (Baltazar, Conopio, Moreno, Ulery & Hopkins, 2013).
Knowing HIV status of individual has been established to be the entry point to other HIV services and an opportunity for individuals to learn not only their HIV status but correct knowledge and also gain accurate risk perceptions, thereby encouraging safer behavior, it helps the individual to make informed decision, assess personal risk for HIV and further develop risk reduction strategy (WHO, 2010) however, barriers to HIV Voluntary Counseling and Testing (VCT) has been revealed to include lack of awareness of available services, low perception of personal risk, fear of negative consequences associated with a positive test result (including stigma), concerns about confidentiality, financial burden of testing, and lack of HIV and AIDS knowledge and this has immensely contributed to willingness and utilization of VCT by adolescents (Idele, Gillespie, Porth, Suzuki, Mahy, Kasedde et al., 2014; Musheke, Ntalasha, Gari, Mckenzie, Bond, Martin-HIber et al., 2013; Oginni, Obianwu & Adebajo, 2014).