Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study

Addis et al. BMC Public Health 2013, 13:714 http://www.biomedcentral.com/1471-2458/13/714 RESEARCH ARTICLE Open Access Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study Zelalem Addis1*, Aregawi Yalew1, Yitayal Shiferaw1, Abebe Alemu1, Wubet Birhan1, Biniam Mathewose1 and Belayenesh Tachebele2 Abstract Background: Voluntary counseling and testing (VCT) is one among different approaches which have been implemented as an attempt to slow the spread of HIV infection and minimize its impact at the individual, family and society level. VCT is perceived to be an effective strategy in risk reduction among sexually active young people like tertiary level students. Ethiopia as a country with high burden of HIV started responding to the epidemic by preparing and updating guidelines on VCT. The objective of this study was to assess the level of knowledge, attitude and practice of Voluntary Counseling and Testing (VCT) for HIV among university students in North West Ethiopia. Methods: A cross sectional study was conducted from February to May 2010 using a stratified sampling method to enroll students from different faculties into the study. A total of 330 university students filled in a self-administered questionnaire with response rate of 97.3%. Main outcome measures included level of knowledge, attitude and practice of VCT for HIV. A chi-square test was used to determine an association between a number of independent factors and dependant variables. Result: About 66.1% of the study participants were males with a mean age of 20 years. Majority (75.6%) of the respondents were Orthodox with 63% reported living in urban areas before joining the university. From the study participants 86.3% were knowledgeable on VCT, 73.3% had positive attitude towards VCT for HIV and 61.8% had had VCT for HIV in the past. Previous residence before joining the university, level of education, sex and religion were among the sociodemographic variables that showed statistically significant association with the one or more of the outcome variables. Fear of positive results, stigma and discrimination following the positive results were reported as main barriers for VCT uptake. Conclusion: The findings reveal important barriers for VCT uptake and suggest strategies to reduce stigma and discrimination. Keywords: Voluntary counseling and testing, Knowledge, Attitude, Practice * Correspondence: 1 University of Gondar, College of Medicine and Health Science, School of Biomedical and Laboratory Sciences, P.O. Box 196, Gondar, Ethiopia Full list of author information is available at the end of the article © 2013 Addis et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Addis et al. BMC Public Health 2013, 13:714 http://www.biomedcentral.com/1471-2458/13/714 Background Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) is a major health problem in many parts of the world, and is considered as a pandemic disease [1]. By the year 2010, the World Health Organization (WHO) estimated 34 million people living with HIV and an estimated 1.8 million deaths around the world [2]. Sub-Saharan Africa remains the region most heavily affected by HIV. In 2010, about 68% of all people living with HIV resided in subSaharan Africa. Sub-Saharan Africa also accounted for 70% of new HIV infections and almost half of the deaths from AIDS related illness in 2010 [3]. Almost a quarter of people living with HIV are under the age of 25. Young people ages 15–24 represent 45% of all new HIV infections. In sub-Saharan Africa, nearly 3.3 million youth are living with HIV. Lack of information, skills, and access to services for youth is expected to fuel the epidemic [4]. Ethiopia, as a country in the Sub-Saharan region, is a country with high HIV prevalence. According to the single point estimate, the Ethiopian adult HIV prevalence was 2.2% in 2008 with an estimated 1,037,267 people living with HIV in the country [5]. According to the Ethiopian demographic and health survey report of 2011, the percentage of HIV positive in the age group 15–24 years was less than one percent [6]. Many countries have been trying to take many different approaches in an attempt to slow the spread of HIV infection and minimize its impact on the individual, family and society. Among these strategies include; voluntary counseling and testing (VCT), provider initiated counseling and testing (PICT), diagnosis of HIV in infants and young children, family care and partner testing and counseling based on index care, condom promotion and provision, detection and management of sexually transmitted infections, safer sex and risk reduction counseling, male circumcision, targeted interventions for sex workers and homosexuals [7]. Among these VCT is internationally recognized as an effective and important strategy for both prevention and care of HIV [8]. VCT is the process by which an individual undergoes counseling enabling him or her to make an informed choice about being tested for HIV. This decision must be entirely the choice of the individual and he or she must be assured that the process will be confidential [9]. VCT is an effective strategy for facilitating behavioral change around both preventing HIV as well as getting early access to care and support. It is also instrumental in bringing about behavioral change, reducing unprotected sex and helping reduce the incidence of HIV and other STIs [10]. However, the availability of VCT services in Ethiopia has been uneven, and even when available, uptake has been relatively low [11]. Page 2 of 8 Ethiopia responded to the HIV epidemic as early as 1985 by developing polices different guidelines (PMTCT, ART, IP, VCT etc.) and strategic documents to create an environment conducive for the implementation of HIV prevention, care, and treatment and support programs. As part of this effort, the first counselling and testing guidelines were published by the Federal Ministry of Health (FMOH) in 1996 and subsequently edited in 2002 and 2007 [11]. Studies in different areas indicated that knowledge, attitude and practice of tertiary school students towards VCT is low and its uptake is minimal. The low uptake was found to be associated with ignorance, fear of being positive, cost of VCT, inadequate number of VCT centers and stigmatization constituted major hindrances to acceptances of VCT for HIV [7,8,12-14]. There are reports on the awareness and uptake of VCT service among different study groups in the study area [10,15]. However, there are no studies conducted on the knowledge, attitude and practice of University students towards VCT serv (...truncated)