CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The Acquired Immunodeficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV), a virus that progressively attacks and weakens the cells of the immune system that the body relies on to fight infection (Centers for Disease Control and Prevention [CDC], 2024). HIV remains incurable, but sustained access to antiretroviral therapy (ART) has, for many people, shifted the disease from an almost universally fatal condition to a manageable chronic one; people who start and adhere to treatment early can now approach a life expectancy similar to that of the general population (World Health Organization [WHO], 2025). This shift is far from complete or evenly distributed, however, and HIV/AIDS remains fatal for people who lack consistent access to diagnosis, treatment and care (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2025).

HIV has produced a global epidemic whose scale continues to exceed what was projected only a generation ago. The issue is not confined to medicine or clinical documentation; it is a socially and politically significant concern that continues to affect communities regardless of race, age or sexual orientation (UNAIDS, 2024). By the end of 2024, UNAIDS estimated that 40.8 million people worldwide were living with HIV, of whom 53 per cent were women and girls, and more than half resided in eastern and southern Africa (UNAIDS, 2025; WHO, 2025). Although new infections have fallen by roughly 61 per cent since their mid-1990s peak, an estimated 1.3 million people acquired HIV in 2024 alone, and someone died of an HIV-related cause every minute of that year (UNAIDS, 2025).

Caregivers and counsellors who work with people affected by HIV/AIDS require sustained, structured training if they are to respond effectively to the psychosocial and clinical needs of the people they serve, including the persistent stigma that many people living with HIV continue to encounter even where treatment is accessible (Ogunyemi, Adubiaro, Oluwole, Somefun, & Olubodun, 2022). While the family continues to provide the bulk of day-to-day care for people living with HIV in Nigeria, formal counselling and support services delivered through hospitals, schools, faith-based bodies and community organisations play an increasingly important complementary role. Individuals who provide these services, and indeed members of the wider public, benefit from continued exposure to seminars, workshops, orientation programmes and in-service training, both to strengthen the quality of care offered and to support the prevention of new infections (Elujekwute, 2022).

Nigeria's health sector continues to face structural constraints that limit the reach and consistency of its HIV response, including an uneven distribution of health personnel that leaves rural areas underserved, constrained public health financing, and persistent gaps in routine surveillance data (Frontline AIDS, 2023). Robust and current epidemiological data remain essential to a sustained, cost-effective national HIV response, since such data inform decisions about where prevention and treatment resources are most needed and help identify the behavioural, social and environmental factors that support or hinder the uptake of modern HIV prevention and care services (Onovo et al., 2023).

Nigeria has one of the largest HIV epidemics in the world in absolute numbers of people living with the virus. A Bayesian modelling analysis of national HIV testing data estimated Nigeria's adult HIV prevalence at approximately 2.1 per cent among people aged 15 to 49 years, corresponding to close to two million people living with HIV nationally, and pointing to an apparent upward trend relative to the 1.4 per cent prevalence recorded in the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (Onovo et al., 2023). The most recent Nigeria Demographic and Health Survey (2023-2024) continues to track HIV prevention knowledge, testing uptake and sexual risk behaviour among young people as a central indicator of the country's health system performance (National Population Commission [NPC] & ICF, 2024). Multinational survey evidence that included Nigerian undergraduates found that, although university students generally demonstrate a reasonably strong grasp of how HIV is transmitted, meaningful gaps remain in other areas of their knowledge, particularly among non-medical students (Terra et al., 2024).

HIV/AIDS remains one of the most persistent unresolved public health challenges of the current generation, with the capacity to erode decades of social and economic progress in the countries most affected (UNAIDS, 2024). It continues to interact with poverty, gender inequality and stigma in ways that deepen its impact on affected households, and it continues to weigh on education outcomes, workforce productivity and life expectancy in the countries most affected (UNAIDS, 2024; Frontline AIDS, 2023).

Counsellors and other caregivers involved in HIV/AIDS education occupy an important role-modelling position and need to be equipped accordingly. Effective HIV education requires more than the transmission of basic facts: it calls for the ongoing review of practitioners' own attitudes, consistent adherence to professional codes of ethics, and the acquisition of specific communication skills capable of supporting genuine behavioural change in the people they serve (Elujekwute, 2022). Theory-informed and peer-led education strategies, particularly those grounded in models such as the Health Belief Model, have been shown to strengthen young people's perceived susceptibility to HIV, their confidence in their own ability to protect themselves, and their intentions to adopt protective behaviour (Joorbonyan, Ghaffari, & Rakhshanderou, 2022; Seif, Oguma, & Joho, 2025).

Preparing teachers, counsellors and other caregivers to deliver effective HIV/AIDS education is a substantial undertaking, since it requires training a broad cross-section of personnel across sectors, a task with real implications for time, funding and materials. This depends on sustained pre-service and in-service training that allows new evidence, resources and approaches to be incorporated into practice over time (Emenike, Onukwugha, Sarki, & Smith, 2023). Approaches to HIV education that are rights-based, gender-responsive and participatory, and that actively engage learners rather than relying purely on lecture-style delivery, have consistently been found to be more effective at improving knowledge, shifting attitudes and reducing risk behaviour among young people (Yohanna, Agbaje, Ene, Ofili, & Umoke, 2023).

Effective HIV/AIDS education programmes ultimately depend on the availability of adequate human, material and financial resources. Human resources include trained HIV educators, policymakers, counsellors, health workers, community mobilisers, media practitioners, teachers and parents; material resources include curricula, teaching aids and supplementary texts; and financial resources fund the training of personnel, the production of materials, and the ongoing monitoring and evaluation of programme impact (Education Profiles, 2023; Elujekwute, 2022).

1.2 Statement of the Problem

Considerable financial, human and material resources continue to be invested by governmental and non-governmental organisations in HIV prevention, treatment and care, yet the disease continues to spread, and sub-Saharan Africa continues to carry the highest burden of HIV infection in the world (UNAIDS, 2025; WHO, 2025). By the end of 2024, UNAIDS estimated that 40.8 million people were living with HIV worldwide, with the WHO African Region alone accounting for roughly two-thirds of that total (WHO, 2025).

Although everyone is vulnerable to HIV infection, evidence continues to show that young people, including university undergraduates, remain a particularly high-risk group in both developed and developing countries. Globally, an estimated 360,000 young people aged 15 to 24 years acquired HIV in 2023, of whom about 140,000 were adolescents aged 15 to 19, and adolescent girls and young women alone accounted for close to a fifth of all new infections that year (Orji, Ifebunandu, Joe-Akunne, Chidiebere, Echefu, & Eze, 2025). Similar patterns are evident among Nigerian students specifically: many are becoming sexually active earlier and are more likely to report multiple sexual partners, and gaps in accurate knowledge about the causes, risks and severity of HIV/AIDS continue to leave a meaningful proportion of them vulnerable even where general awareness of the disease is high (Terra et al., 2024; Agu, 2020). A related concern is that many parents remain reluctant to discuss sexual health openly with their children, and comprehensive sexuality education is still not consistently delivered as part of the standard school curriculum in Nigeria, leaving many students to rely on informal, and sometimes inaccurate, sources of information about HIV/AIDS (Emenike, Onukwugha, Sarki, & Smith, 2023; Education Profiles, 2023).

Many undergraduate students in Nigerian universities continue to lack adequate and accurate knowledge of HIV/AIDS, its prevention, and the protective health services available to them. This gap in awareness has been linked to negative socio-economic outcomes for affected students, their families and the wider society, including the stigma and discrimination that continue to affect young people living with HIV even in major urban centres such as Lagos (Ogunyemi, Adubiaro, Oluwole, Somefun, & Olubodun, 2022). This suggests that improving undergraduates' awareness and knowledge of HIV/AIDS could meaningfully support the adoption of preventive behaviour and help reduce the prevalence of the disease among this population, and that undergraduates, as an educated and vocal segment of the population, have both the standing and the responsibility to be well informed in the current HIV/AIDS era. It was this problem that necessitated the present study, with the University of Lagos, Akoka, Lagos State, as its focus.

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 in 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 in 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 in 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 in 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 HIV/AIDS scourge has grown to such a magnitude that it is now a global problem. It is hoped that this study will motivate students, especially in University of Lagos, Akoka, Lagos State, their parents, guardians and the general public towards behavioural changes that will help prevent the spread of HIV/AIDS. It will also alert them to the continued existence of the disease and help create the awareness necessary to guard students against becoming victims of it.

The information gathered will be useful to students as well as lecturers, healthcare providers in schools and colleges, health educators and social workers. The findings will help students, health workers and social workers develop strategies for combating the disease through health promotion and education.

The findings derived from this study will also be of considerable help to state and local government officials in planning appropriate seminars and conferences for health workers, and in shaping counselling measures for people living with HIV/AIDS.

The study will also serve as a useful guide to the private sector, helping stakeholders proffer solutions for reducing the scourge of HIV/AIDS through symposia, workshops, talk shows, conferences, role-play and simulation exercises facilitated by resource persons.

In addition, religious groups in Lagos State, and particularly around University of Lagos, Akoka, will be able to draw on this information in organising training and counselling workshops for students, teachers and parents. The findings of the research will be useful in counselling students with or without prior HIV/AIDS knowledge. Finally, this study will, it is hoped, be a valuable contribution to knowledge and serve as reference material for future scholars.

1.7 Scope and Delimitation of the Study

The study examined the level of awareness and attitudes of undergraduate students towards HIV/AIDS at the University of Lagos, Akoka, Lagos State. The population used included both male and female undergraduate students in the University of Lagos, Akoka, Lagos State.

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