ABSTRACT

Improving knowledge, fostering positive attitudes, and promoting changes in sexual behaviour towards HIV/AIDS remain fundamental objectives of HIV prevention initiatives. HIV/AIDS is one of the major public health challenges in Nigeria, where approximately 7.1% of the population was reported to have been infected with the disease in 2012. Against this background, the study examined the determinants of HIV/AIDS transmission among youths aged 18–26 years in Ikot Ekpene Local Government Area (LGA) of Akwa Ibom State. The specific objectives were to determine youths’ knowledge of HIV prevention, examine their sexual behaviours, identify beliefs and practices associated with sexual promiscuity, and assess how knowledge of HIV/AIDS, prevailing social conditions, attitudes, and sexual behaviours influence the spread of the disease among youths.

The literature reviewed revealed that the knowledge and information possessed by secondary school youths concerning HIV/AIDS are often inaccurate, as misconceptions about the disease continue to persist. Some youths initiate sexual activities as early as 11 years of age, during early adolescence. Such early sexual exposure increases their vulnerability to HIV infection, particularly when their understanding of appropriate preventive measures is inadequate. Furthermore, socioeconomic circumstances, including poverty, may restrict youths’ access to voluntary counselling and testing (VCT) services and condoms, which are essential resources for HIV prevention. Negative attitudes towards people living with HIV/AIDS also undermine prevention efforts by promoting stigma and discrimination.

The study adopted a descriptive research design, with youths in Ikot Ekpene LGA constituting the target population. A sample of 371 youths was selected through a stratified sampling technique. Data were collected using questionnaires containing both structured and unstructured questions and analysed using descriptive statistical methods. The findings indicated that all the respondents (100%) had heard about HIV/AIDS. At least 80% demonstrated awareness of the major routes of HIV transmission, including unprotected sexual intercourse, the sharing of sharp objects, and blood transfusion. However, 44.7% of the respondents strongly agreed that the HIV-positive status of a family member should be kept confidential. Furthermore, 63.1% strongly supported the introduction of condom-use education in their schools and local communities.

The findings also revealed that 63.1% of the respondents had engaged in sexual intercourse at least once in their lifetime, while 56% reported using a condom during their most recent sexual encounter. In addition, 81.1% had undergone HIV testing. Regarding social conditions associated with vulnerability to HIV infection, 53.8% identified unprotected sexual intercourse as the major adverse condition exposing youths to the risk of contracting HIV. Similarly, 27.1% indicated that they could be vulnerable to HIV/AIDS because of risky leisure activities, such as alcohol consumption.

The study concluded that youths lacked sufficiently accurate information and knowledge about HIV/AIDS. It therefore recommended improving the quality and accuracy of HIV-related information available to young people as a strategy for preventing further transmission. The study further established that youths’ sexual behaviours and prevailing social conditions could increase their vulnerability to HIV infection. Consequently, young people should be encouraged to use condoms consistently and avoid risky recreational activities, including substance abuse. In addition, the government, in collaboration with local communities, should intensify efforts to address the stigma associated with HIV/AIDS in order to strengthen prevention initiatives.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Over the past several decades, HIV/AIDS has had devastating consequences for young people, resulting in loss of lives, social exclusion, and stigmatization. Preventing HIV/AIDS is therefore essential to the development of a healthy, productive, and sustainable population. According to the World Health Organization (WHO) $i$, approximately 95% of the global population should possess accurate knowledge about HIV/AIDS to prevent new infections. Nevertheless, in low- and middle-income countries, only 24% of young women and 36% of young men reportedly have comprehensive and accurate knowledge of the disease. Inadequate knowledge limits individuals’ ability to adopt appropriate preventive practices, including condom use, thereby increasing their vulnerability to HIV infection.

Developing positive attitudes towards HIV/AIDS and individuals living with the disease is equally important for effective prevention. Positive attitudes help reduce stigma and discrimination, thereby encouraging people to undergo HIV testing and seek appropriate medical treatment. Conversely, negative perceptions associated with HIV/AIDS, which emerged during the early 1980s, continue to persist in contemporary society. These perceptions are evident in the fear, stigma, and discriminatory treatment experienced by people living with the disease. Many individuals regard HIV/AIDS as a life-threatening condition associated with death and connect it with behaviours that are socially disapproved of, including homosexuality, drug use, sex work, and infidelity.

The fear and negative perceptions resulting from these associations contribute to discrimination and stigmatization, discouraging individuals from undergoing HIV testing, disclosing their HIV status, and adhering to antiretroviral treatment $ii$. When individuals are reluctant to undergo HIV testing, diagnosis may be delayed, thereby reducing opportunities for timely treatment and increasing the possibility of unknowingly transmitting the virus to others.

According to $iii$, adopting safer sexual practices is essential for reducing the transmission of HIV/AIDS. Such practices include avoiding unprotected sexual intercourse, reducing exposure to high-risk sexual activities, and avoiding multiple sexual partnerships where these increase the risk of infection. Risky sexual behaviour continues to constitute a major obstacle to HIV prevention, as condom use among individuals aged 15–49 years remains inadequate in several regions, including sub-Saharan Africa, the Middle East, and Latin America. Available estimates indicate that only 51% of individuals in these regions use condoms $iv$. Globally, behaviours associated with increased exposure to HIV, including certain sexual practices and having multiple sexual partners, continue to occur in many countries.

The Centers for Disease Control and Prevention (CDC, 2012) identified poverty as one of the important social conditions associated with the spread of HIV/AIDS in both urban and rural communities. Individuals living in poverty may be unable to obtain condoms, access reliable HIV/AIDS information, or afford antiretroviral medications because of limited financial resources. People living with HIV who cannot meet essential housing needs may also experience difficulties maintaining regular healthcare appointments and adhering consistently to prescribed medication. Poor treatment adherence can result in increased viral load and a greater risk of transmitting the virus to other people.

Family rejection represents another social circumstance that may increase vulnerability to HIV infection. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) $v$, lesbians, gay men, and bisexual individuals who experience rejection by family members or caregivers are 3.4 times more likely to engage in risky sexual behaviours. Such findings highlight the importance of supportive family and community environments in promoting HIV prevention and reducing behaviours that increase the likelihood of infection.

At the end of 2011, approximately 34 million people worldwide were living with HIV. An estimated 0.8% of adults aged 15–49 years globally were living with the virus, although the burden of the epidemic differed considerably across countries and geographical regions. Sub-Saharan Africa remained the most severely affected region, with approximately one in every 20 adults (4.9%) living with HIV and accounting for 69% of the global population of people living with the virus $vi$. The number of people living with HIV/AIDS in sub-Saharan Africa was reported to be five times higher than the corresponding number in South, Southeast, and East Asia.

According to UNAIDS $vii$, the global number of new HIV infections was declining, although the pace of reduction varied across geographical regions and countries. Between 2001 and 2011, the Caribbean and sub-Saharan Africa recorded the highest reported declines in new infections, at 42% and 25%, respectively (UNAIDS, 2012). In contrast, new infections in the Middle East and North Africa increased by more than 35% during the same period. Similarly, HIV infection rates in Eastern Europe and Central Asia had been increasing steadily since 2007 (UNAIDS, 2012).

Overall, the historical account presented in the reviewed literature indicated that developed countries, including the United States and Japan, generally had lower HIV/AIDS prevalence rates than several developing countries in Africa and the Middle East. This difference was associated, in part, with the availability of advanced and affordable healthcare services that supported HIV prevention, diagnosis, and treatment. In many African countries, however, high prevalence rates were linked to weaknesses in healthcare systems and inadequate access to essential services, including antiretroviral drugs, HIV testing, and counselling. Certain cultural practices, such as wife inheritance, were also identified as factors that could contribute to HIV transmission in some African communities.

Across the African region, HIV/AIDS prevalence had either declined or remained relatively stable in many countries over the preceding five years. In Nigeria, the national infection rate reportedly declined from approximately 10% in the late 1990s to about 5% in 2011 $viii$, $ix$. This reduction was attributed partly to increased condom use among sexually active youths and adults $x$.

Uganda also experienced a substantial reduction in HIV prevalence, from 18.5% in 1992 to approximately 5% in 2000 $xi$. This decline was associated with strong political leadership that promoted changes in sexual behaviour among young people as part of efforts to control the spread of the virus. Other contributing factors included open discussions that improved public understanding of HIV/AIDS and a strong, decentralised, multisectoral, and community-based response to the epidemic. By 2005, the prevalence rate had stabilised at approximately 6.4%. However, it increased to 6.7% in 2012, a development attributed partly in the original account to the government's emphasis on abstinence-only approaches rather than safer-sex practices.

In Tanzania, HIV prevalence was reported to be high among older age groups and women who had limited access to treatment and information about the disease. The country's national prevalence rate was approximately 6.5% in 2011 $xii$. Rwanda, by comparison, recorded a prevalence rate of approximately 3% in 2010, with women experiencing higher infection rates than men. More than 60% of the adult population in Rwanda reportedly possessed satisfactory knowledge of HIV transmission and prevention $xiii$. Furthermore, the number of people who underwent HIV testing increased by 38% in 2010, improving opportunities for infected individuals to obtain timely treatment.

Somalia reportedly had a relatively low HIV prevalence rate of approximately 2%. Nevertheless, knowledge of HIV transmission remained limited, while condom use was uncommon. Young people aged 18 years and above were identified as one of the groups particularly vulnerable to HIV infection because of risky sexual behaviours, attitudes towards HIV/AIDS prevention, and inadequate knowledge of the disease $xiv$. Among adolescents aged 15–19 years, approximately 70% were reported to be sexually active, while some girls experienced their first sexual intercourse before reaching 15 years of age. Sexual intercourse was identified as the principal route of HIV transmission in the area under discussion $xv$. These circumstances underscore the need for urgent and sustained interventions to reduce HIV infection among young people.

1.2 Statement of the Problem

HIV/AIDS continues to represent one of the major public health challenges confronting Nigeria. The infection rate in the southern region was reported to be 26.3%, which was described in the original study as almost twice the prevalence level. Approximately 70% of individuals aged 18–30 years were reported to be sexually active, while some girls engaged in their first sexual intercourse before the age of 15 years $xvi$. Since sexual intercourse is a well-established route of HIV transmission, a considerable proportion of young people, particularly those attending schools, may be exposed to the risk of contracting the virus because of their sexual activities.

To effectively prevent the transmission of HIV/AIDS, at least 95% of young people should possess accurate knowledge of the disease and the measures required to prevent infection. In Nigeria, the government has made efforts to improve young people's understanding of HIV/AIDS through the introduction of educational programmes in schools. These initiatives have contributed to increased general awareness of the disease among young people. However, awareness does not necessarily translate into accurate knowledge, as misconceptions and myths concerning HIV/AIDS continue to persist among youths. Inadequate and inaccurate information may prevent them from adopting appropriate preventive measures, such as consistent condom use, and may consequently increase their vulnerability to contracting or transmitting the virus.

Furthermore, the community is expected to develop positive attitudes towards young people living with HIV/AIDS as part of broader efforts to prevent the spread of the disease. Acceptance of HIV-positive youths can help eliminate stigma and discrimination, encouraging them to undergo HIV testing, disclose their status when appropriate, and seek necessary medical care. Despite these expectations, fear, stigma, and discriminatory attitudes continue to constitute barriers to HIV/AIDS prevention in Nigeria. Negative perceptions of young people living with the disease can intensify their experiences of social exclusion and discourage them from accessing testing services, disclosing their HIV status, or adhering to antiretroviral treatment. These barriers may undermine prevention efforts and contribute to continued transmission of the virus.

Young people are also expected to practise safer sexual behaviours to reduce their susceptibility to HIV/AIDS. Through awareness campaigns and educational programmes, the government continues to sensitise the public, including young people, to the dangers of risky behaviours such as unprotected sexual intercourse. Nevertheless, some youths continue to engage in behaviours that expose them to HIV infection, partly because of socioeconomic circumstances such as poverty. Other conditions, including gender inequality and sexual violence, also require attention because they may limit individuals' ability to negotiate safer sexual practices. For instance, gender inequality can undermine women's ability to insist on condom use or negotiate safer sex with their partners.

Until effective preventive interventions and curative treatments are available, reducing behaviours that increase the risk of infection remains an essential component of controlling the HIV/AIDS epidemic. In particular, the spread of HIV among school-age youths and other young people can be reduced by discouraging risky sexual practices, including unprotected sexual intercourse, and promoting access to accurate and comprehensive information about the disease. In addition, positive attitudes towards HIV/AIDS and people living with the virus can encourage young people to participate more actively in prevention initiatives.

Despite the efforts undertaken to increase awareness and promote preventive practices, the persistence of misconceptions, risky sexual behaviours, negative attitudes, and adverse socioeconomic conditions raises concerns about the continued vulnerability of young people to HIV infection. It is therefore necessary to examine how these factors influence HIV/AIDS transmission among youths in specific local contexts. Against this background, the present study sought to investigate the determinants of HIV/AIDS spread among youths aged 18–26 years in Ikot Ekpene Local Government Area of Akwa Ibom State.

1.3 Objectives of the Study

The main purpose of this study was to examine the determinants of HIV/AIDS transmission among youths aged 18–26 years in Ikot Ekpene Local Government Area of Akwa Ibom State. Specifically, the study was guided by the following objectives:

1. To determine the level of knowledge possessed by youths concerning HIV/AIDS and the preventive measures available in Ikot Ekpene Local Government Area of Akwa Ibom State.

2. To establish the extent to which youths' attitudes influence their participation in HIV/AIDS prevention in Ikot Ekpene Local Government Area.

3. To examine how the sexual behaviours of youths influence their participation in HIV/AIDS prevention in Ikot Ekpene Local Government Area of Akwa Ibom State.

4. To identify the beliefs and practices associated with sexual promiscuity among youths in Ikot Ekpene Local Government Area of Akwa Ibom State.

5. To determine the extent to which the social and economic circumstances of youths influence their participation in HIV/AIDS prevention in Ikot Ekpene Local Government Area of Akwa Ibom State.

1.4 Research Questions

The study was designed to provide answers to the following research questions:

1. What is the level of knowledge possessed by youths concerning HIV/AIDS and its prevention in Ikot Ekpene Local Government Area of Akwa Ibom State?

2. To what extent do the attitudes of youths influence their participation in HIV/AIDS prevention in Ikot Ekpene Local Government Area?

3. How do the sexual behaviours of youths influence their participation in HIV/AIDS prevention in Ikot Ekpene Local Government Area?

4. What beliefs and practices are associated with sexual promiscuity among youths in Ikot Ekpene Local Government Area of Akwa Ibom State?

1.5 Significance of the Study

The reported HIV/AIDS prevalence rate of 26.3% underscores the need for intensified prevention efforts in Nigeria and other regions experiencing comparable levels of infection $xvii$. Although national surveys provide valuable information about the distribution and magnitude of the epidemic, conducting such surveys often requires substantial financial resources. Consequently, this study is expected to provide useful information that may assist the target population and other relevant stakeholders in developing appropriate strategies for preventing HIV/AIDS.

The findings of the study may be beneficial to the government, particularly the Ministry of Education, by providing information that could inform the formulation and revision of policies relating to HIV/AIDS education in schools. Although abstinence is one of the approaches that may be promoted in educational institutions, a considerable proportion of young people become sexually active by the age of 18 years. Therefore, HIV/AIDS education should adequately address the realities of young people's experiences and provide age-appropriate, accurate information about effective prevention measures.

Furthermore, the study may contribute to improving the content and delivery of HIV/AIDS educational programmes by identifying gaps in youths' knowledge, attitudes, and preventive practices. Such information may help educational authorities and other stakeholders develop interventions that respond more effectively to the needs of young people.

The study may also be useful to healthcare professionals, community leaders, parents, and organisations involved in HIV/AIDS prevention and control. By highlighting the relationship between sexual behaviour, social circumstances, knowledge, and attitudes, the findings may assist these stakeholders in designing targeted awareness campaigns and community-based interventions. In addition, understanding the influence of stigma and discrimination may support the development of strategies that encourage HIV testing, treatment adherence, and social acceptance of people living with the virus.

Finally, research focusing specifically on young people remains limited in certain contexts, while some existing findings may not adequately resolve the questions surrounding the factors responsible for HIV transmission among this population. Accordingly, this study is expected to contribute to the existing body of knowledge and support the formulation of policies and programmes aimed at preventing and controlling HIV/AIDS among youths.

1.6 Limitations of the Study

One of the major limitations encountered during the study was the reluctance of some respondents to disclose information concerning their sexual behaviours. Since sexual practices constitute a sensitive subject, some participants may have been uncomfortable providing complete or accurate responses to questions relating to their personal experiences. This challenge had the potential to affect the completeness of the information obtained.

To minimise this limitation and encourage greater openness, anonymous questionnaires were administered to the respondents. This approach was intended to protect their identities, improve their confidence in the confidentiality of the information provided, and encourage them to supply the relevant details required for the study.

1.7 Scope of the Study

This study focused on the determinants of HIV/AIDS transmission among youths aged 18–26 years in Ikot Ekpene Local Government Area of Akwa Ibom State. It examined the knowledge of youths concerning HIV/AIDS and its prevention, their attitudes towards the disease, their sexual behaviours, the beliefs and practices associated with sexual promiscuity, and the social conditions that may influence their vulnerability to infection and participation in prevention activities.

The research adopted a survey-based approach and involved a sample of 371 participants selected from the study area. The geographical scope was restricted to Ikot Ekpene Local Government Area, while the population of interest comprised youths within the specified age range. Focusing on this population and geographical location was necessary to obtain information about the factors that may contribute to HIV/AIDS transmission among young people and to understand their involvement in preventive practices.

The study was therefore intended to provide context-specific findings that could contribute to the development of appropriate HIV/AIDS prevention strategies for youths in the study area.

1.8 Definitions of Significant Terms

Knowledge of youths: Knowledge refers to justified true belief. For an individual to be considered to possess knowledge, three fundamental conditions must be satisfied: the belief condition, the truth condition, and the grounds or justification condition. Within the context of this study, the term refers to the information and understanding youths possess concerning HIV/AIDS, its transmission, and its prevention.

Attitude of youths: Attitude refers to learned and relatively enduring tendencies to respond favourably or unfavourably towards particular individuals, groups, ideas, or situations. Attitudes may change over time and can influence or predict behaviour. They encompass affective responses, including psychological feelings and emotional arousal; behavioural tendencies; and cognitive components, which involve an individual's thoughts, beliefs, and perceptions. In this study, the term describes youths' perceptions and dispositions towards HIV/AIDS, its prevention, and people living with the disease.

Youth: For the purpose of this study, youth refers to individuals aged between 18 and 26 years.

Prevention of HIV: HIV prevention refers to the adoption of measures and interventions intended to reduce the occurrence of new HIV infections among the target population. Within the context of this study, it focuses on strategies for reducing HIV transmission among young people in the study area.

References

$\mathrm{i<span\; style="font-family:\; Roboto,\; system-ui,\; -apple-system,\; sans-serif;\; font-size:\; medium;">WHO\; (2014).\; HIV/AIDS\; and\; Adolescents.\; Retrieved\; from:\; </span><a\; href="http://www.who.int/child-adolescenthealth/HIV/HIV\_adolescents.htm?utm\_source=chatgpt.com"\; style="font-size:\; medium;\; font-family:\; Roboto,\; system-ui,\; -apple-system,\; sans-serif;">http://www.who.int/child-adolescenthealth/HIV/HIV\_adolescents.htm</a><span\; style="font-size:\; medium;\; font-family:\; Roboto,\; system-ui,\; -apple-system,\; sans-serif;">.</span>}$

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