LEVEL OF AWARENESS AND ATTITUDES OF STUDENTS TOWARDS HIV/AIDS 

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) remain one of the most pressing public health challenges of our time, more than four decades after the virus was first identified. HIV attacks and gradually destroys the body's immune system, specifically the CD4 cells, leaving an infected person vulnerable to opportunistic infections, while AIDS represents the most advanced stage of the infection, reached when the immune system has been severely compromised. Globally, the burden of the disease remains enormous. According to the most recent data released by the Joint United Nations Programme on HIV/AIDS, an estimated 40.8 million people were living with HIV in 2024, over half of whom were women and girls, while about 1.3 million people were newly infected with the virus that same year (UNAIDS, 2025). Sub-Saharan Africa continues to bear the heaviest share of this burden, and young people between the ages of 15 and 24 account for a disproportionately large and growing fraction of new infections worldwide.

Nigeria, as the most populous country in Africa, occupies a central place in the global HIV/AIDS narrative. The National Agency for the Control of AIDS (NACA) reported that approximately two million Nigerians are currently living with HIV, translating to a national prevalence of 1.4 percent among the general population aged 15 to 64 years, with about 22,000 new infections and 15,000 AIDS-related deaths recorded in 2023 alone (NACA, 2024). Although this prevalence figure appears modest when compared with some other sub-Saharan African countries, the sheer size of Nigeria's population means that the absolute number of persons living with, and at risk of, the infection remains one of the largest in the world.

University undergraduates constitute a demographic group of particular interest and concern to public health researchers and educators. Many undergraduates fall within the 15–24-year age bracket identified globally as being at heightened risk of HIV infection, and the transition into university life often marks their first sustained experience of independence away from direct parental supervision. This newfound freedom, combined with exposure to peer pressure, experimentation with alcohol and other substances, and the pursuit of romantic and sexual relationships, has repeatedly been shown to place undergraduates in situations of elevated vulnerability to HIV infection. An early but still frequently cited study among undergraduates of a Nigerian university found that although students demonstrated fairly good knowledge of HIV transmission and symptoms, very few of them considered themselves personally at risk, even though the overwhelming majority were already sexually active (Harding et al., 1999). Similarly, a study of tertiary institution students in Lagos found that gaps between what students knew about HIV/AIDS and how they actually behaved contributed to their continued vulnerability to infection (Durojaiye, 2011).

More recent evidence continues to reveal a similar pattern in which good knowledge does not automatically translate into safe practice or accurate risk perception. A large study among undergraduates of a privately owned university in Ogun State, Nigeria, found that awareness of HIV/AIDS was virtually universal and that the average knowledge score was very high, yet many students remained unaware of, or unwilling to use, HIV counselling and testing services (Abiodun et al., 2014). A cross-sectional study of pharmacy students in Saudi Arabia similarly found that despite their health-related training, a majority of the students demonstrated low overall knowledge of HIV/AIDS, alongside a largely neutral or negative attitude towards the disease and towards people living with it (Mansy et al., 2025). In Uganda, a study of undergraduates found that knowledge of HIV prevention strategies such as safe male circumcision was inconsistent, and that misconceptions about the practice persisted even among university-educated young adults (Akugizibwe et al., 2024). These findings suggest that the level of awareness of HIV/AIDS among students varies considerably depending on the institution, the discipline of study, and the specific dimension of knowledge being examined, whether that be the causes of the disease, the behaviours that heighten risk of infection, its signs and symptoms, or the measures available for its prevention.

Attitude towards HIV/AIDS, and particularly towards people living with the virus, is as important as knowledge in shaping the trajectory of the epidemic. Negative or stigmatising attitudes discourage people from seeking testing, disclosing their status, and adhering to treatment, and may also normalise risky behaviour among those who regard the disease as remote or shameful rather than as a manageable health condition. A recent secondary analysis of a national survey in Nigeria found that discriminatory attitudes towards people living with HIV persisted even among populations who were themselves at substantial risk of infection, underscoring how deeply entrenched stigma remains in Nigerian society (Olakunde et al., 2025). A cross-sectional study of undergraduate social work students at the University of Benin similarly found that although a majority of the students demonstrated good knowledge of HIV, this did not always correspond with consistently supportive attitudes towards prevention and towards people living with the virus (Chukwurah et al., 2026). Elsewhere in the region, comparable studies among university students in Ghana and South Africa have reported that gaps in knowledge, particularly regarding specific risk behaviours, were often more pronounced among female students, and that these gaps sometimes correlated with less favourable attitudes towards preventive practices such as condom use (Khamisa et al., 2020; Oppong Asante & Oti-Boadi, 2013).

The University of Lagos, Akoka, is one of Nigeria's oldest and largest federal universities, drawing undergraduates from diverse ethnic, religious, socioeconomic, and geographic backgrounds into a densely populated urban campus in Lagos State, Nigeria's commercial nerve centre and most populous state. The cosmopolitan and highly mobile character of Lagos, combined with the size and diversity of the University's student population, makes it a particularly instructive setting in which to examine how well-informed undergraduates are about HIV/AIDS and how they regard the disease and those living with it. Despite the volume of HIV/AIDS-related research that has been conducted among Nigerian tertiary students generally, there remains a need for focused, up-to-date evidence specifically addressing how well University of Lagos undergraduates understand the causes of HIV/AIDS, the behaviours that place them at high risk of infection, the signs and symptoms of the disease, and the measures available for its prevention. It is against this background that the present study was conceived, to systematically examine the level of awareness and attitudes of University of Lagos undergraduates towards HIV/AIDS.

1.2 Statement of the Problem

More than forty years into the global HIV/AIDS epidemic, and following decades of public health campaigns, school-based sex education initiatives, and mass media sensitisation efforts in Nigeria, one might reasonably expect that university undergraduates, as a relatively literate and information-exposed population, would possess comprehensive and accurate knowledge of the disease. However, evidence from the literature suggests that this assumption cannot be taken for granted. Studies conducted among different categories of Nigerian students report markedly inconsistent findings: while some studies among private university students report knowledge levels as high as 97 percent (Abiodun et al., 2014), others conducted among secondary school students in South-East Nigeria found that fewer than half of the respondents possessed adequate and accurate HIV-related knowledge (Orji et al., 2025). Such wide variation indicates that awareness of HIV/AIDS cannot be assumed to be uniform across all categories of students, and that context-specific, institution-based investigation remains necessary rather than relying on the findings of studies conducted elsewhere or among different populations.

A further complication is the well-documented disconnect between knowledge and behaviour. Several studies have found that even students who can correctly describe how HIV is transmitted and prevented continue to engage in behaviours that place them at high risk of infection, and that many do not perceive themselves as personally vulnerable despite these behaviours (Durojaiye, 2011; Harding et al., 1999). This suggests that awareness alone, without an accompanying understanding of personal risk and a supportive attitude towards preventive practices, may be insufficient to protect young people from infection. Compounding this problem is the persistence of negative and stigmatising attitudes towards HIV/AIDS and towards people living with the virus, which have been documented even among educated and health-related student populations (Chukwurah et al., 2026; Mansy et al., 2025; Olakunde et al., 2025). Such attitudes not only affect how students relate to peers who may be living with HIV, but may also discourage students from seeking voluntary counselling and testing services or from openly discussing preventive practices.

Undergraduates of the University of Lagos, drawn from across Nigeria and beyond into a large, densely populated, and socially heterogeneous urban campus, are not exempt from these risks. Yet, there is a paucity of recent, focused empirical evidence specifically examining how well University of Lagos undergraduates understand the causes of HIV/AIDS, the behaviours that expose them to high risk of infection, the signs and symptoms of the disease, and the preventive measures available to them, as well as whether their attitudes and knowledge levels differ meaningfully by gender. Without such evidence, health educators, university management, and public health policymakers working within and around the institution are left to plan HIV/AIDS awareness and prevention interventions based on assumptions rather than on current, locally generated data. It is this gap that the present study sought to address by systematically investigating the level of awareness of, and attitudes towards, HIV/AIDS among undergraduates of the University of Lagos, Akoka, Lagos State.

1.3 Purpose of the Study

This study examined the level of awareness of HIV/AIDS among undergraduates in University of Lagos, Akoka, Lagos state. The specific purposes of the study include:

1. to ascertain the level of knowledge on causes of HIV/AIDS among students in University of Lagos, Akoka, Lagos state.

2. to identify the level of knowledge on the behaviour that leads to high risk of HIV/AIDS infection among students in University of Lagos, Akoka, Lagos state.

3. to ascertain the level of knowledge on the signs and symptoms of HIV/AIDS among students in University of Lagos, Akoka, Lagos state.

4. to identify the level of knowledge of preventive measures used in reducing HIV/AIDS among students in University of Lagos, Akoka, Lagos state.

1.4 Research Questions

The following research questions were raised to guide the investigation:

1. What is the knowledge level of HIV/AIDS among students in University of Lagos, Akoka, Lagos state on the causes of HIV/AIDS?

2. What is the knowledge level of HIV/AIDS among students in University of Lagos, Akoka, Lagos state on the behaviours that lead to high risk of HIV/AIDS infections?

3. What is the knowledge level of HIV/AIDS among students in University of Lagos, Akoka, Lagos state on the signs and symptoms of HIV/AIDS?

4. What is the knowledge level of HIV/AIDS among students in University of Lagos, Akoka, Lagos state on the preventive measures to be used to reduce HIV/AIDS infection?

1.5 Research Hypotheses

The following null hypotheses were formulated and tested to guide the study:

1. There is no significant difference on the knowledge level of the causes of HIV/AIDS among male and female students in University of Lagos, Akoka, Lagos state.

2. There is no significant difference on the knowledge level of behaviours that lead to high risk of HIV/AIDS infections among male and female students in University of Lagos, Akoka, Lagos state.

3. There is no significant difference on the knowledge level of the signs and symptoms of HIV/AIDS among students in University of Lagos, Akoka, Lagos state.

4. There is no significant difference on the knowledge level on preventive measures to reduce HIV/AIDS among students in University of Lagos, Akoka, Lagos state.

1.6 Significance of the Study

The findings of this study are expected to be of value to a broad range of stakeholders. To undergraduates of the University of Lagos, the study will help draw attention to specific gaps in their knowledge and attitudes towards HIV/AIDS, thereby encouraging more informed personal decision-making regarding sexual health and risk-reduction practices. To the University's health services, counselling units, and student affairs division, the findings will provide an evidence base for designing or refining targeted, campus-specific HIV/AIDS awareness campaigns, peer education programmes, and counselling and testing services that respond directly to the identified gaps in knowledge of causes, risk behaviours, signs and symptoms, and prevention, rather than relying on generic, one-size-fits-all messaging.

To public health policymakers and agencies such as the National Agency for the Control of AIDS and the Lagos State AIDS Control Agency, the study offers localised, institution-specific data that can inform the planning and prioritisation of HIV/AIDS intervention programmes targeted at tertiary institutions within Lagos State. To curriculum planners and health educators, the findings may highlight the need to strengthen HIV/AIDS content within general studies or health education courses offered to undergraduates. To parents and guardians, the study's findings may draw attention to the continued need for open discussion of sexual health matters with their wards, even after they have proceeded to tertiary institutions. Finally, the study is expected to contribute to the growing body of Nigerian and African literature on HIV/AIDS knowledge and attitudes among university students, and to serve as a reference point for future researchers seeking to investigate similar questions in other institutions or to track changes in awareness and attitude over time.

1.7 Scope of the Study

This study was restricted to undergraduate students of the University of Lagos, Akoka campus, Lagos State, Nigeria. The content of the study was limited to four specific dimensions of HIV/AIDS awareness, namely, students' knowledge of the causes of HIV/AIDS, their knowledge of the behaviours that predispose them to a high risk of infection, their knowledge of the signs and symptoms associated with the disease, and their knowledge of the preventive measures available for reducing the spread of HIV/AIDS. In addition, the study examined whether male and female undergraduates differed significantly in their knowledge levels across these dimensions. The study adopted a descriptive cross-sectional survey design and relied on self-reported data obtained through a structured questionnaire administered to a sample of undergraduates drawn from different faculties of the University. The study did not extend to postgraduate students, staff of the University, or students of other tertiary institutions, and it did not investigate the actual HIV status, treatment experiences, or clinical management of any respondent.

1.8 Limitations of the Study

Certain limitations are acknowledged in the conduct of this study. First, because the study relied on a self-administered questionnaire, responses on sensitive matters such as sexual behaviour and risk perception may be affected by social desirability bias, in which respondents provide answers they consider more socially acceptable rather than strictly accurate. Second, the study was restricted to undergraduates of a single institution, the University of Lagos; consequently, the findings, while informative for the University itself, may not be fully generalisable to undergraduates of other Nigerian universities operating under different institutional, cultural, or regional conditions. Third, constraints of time and resources limited the size and spread of the sample that could be reached across the University's numerous faculties, which may affect the extent to which the sample proportionately represents the entire undergraduate population. Finally, as a cross-sectional study, the research captured students' knowledge and attitudes at a single point in time and could not track changes in awareness or attitude over the course of a student's academic career. Despite these limitations, appropriate methodological safeguards, including a well-structured and validated instrument, were adopted to ensure that the findings remain reliable and useful for the purposes of the study.

1.9 Operational Definition of Terms

For the purposes of clarity, the following terms are defined as they were used within the context of this study:

Human Immunodeficiency Virus (HIV): A virus that attacks and weakens the body's immune system, specifically the cells that help the body fight off infections, thereby making an infected person more susceptible to other infections and diseases.

Acquired Immunodeficiency Syndrome (AIDS): The most advanced and severe stage of HIV infection, occurring when the immune system has been so severely damaged that the body can no longer effectively fight off opportunistic infections and certain cancers.

Awareness: The extent to which an individual is informed about, or conscious of, the existence, causes, transmission, symptoms, and prevention of HIV/AIDS.

Knowledge Level: The measurable degree of accurate information and understanding that a respondent possesses regarding a specific dimension of HIV/AIDS, as assessed through the structured questionnaire used in this study.

Attitude: An individual's evaluative disposition, whether favourable or unfavourable, towards HIV/AIDS as a disease and towards persons living with the virus, as expressed in their opinions, beliefs, and reported behavioural tendencies.

High-Risk Behaviour: Any action or practice, such as unprotected sexual intercourse, multiple sexual partnerships, or the sharing of sharp objects, that increases an individual's likelihood of contracting HIV.

Preventive Measures: Practices and strategies, such as consistent condom use, abstinence, mutual faithfulness to an uninfected partner, and avoidance of needle-sharing, that are recommended to reduce the risk of HIV transmission.

Signs and Symptoms: The observable physical indicators or clinical manifestations associated with HIV infection or its progression to AIDS.

Undergraduate Students: Students who are currently enrolled in a first-degree (bachelor's) programme at the University of Lagos, Akoka, Lagos State, and who have not yet been awarded their first degree.

Stigma: Negative attitudes, beliefs, or discriminatory behaviours directed at persons living with, or perceived to be living with, HIV/AIDS, on account of their status.

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