|BRIEF RESEARCH ARTICLE
|Year : 2013 | Volume
| Issue : 2 | Page : 96-99
Perception of personal risk of acquiring human immunodeficiency viral infection/acquired immune deficiency syndrome among people attending outpatient clinics in a teaching hospital of Nigeria
PT Adegun1, SA Adegoke2, OS Solomon3, IP Ade-Ojo4
1 Consultant Surgeon, Department of Surgery, Urology Unit, University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
2 Consultant Paediatrician, Department of Paediatrics and Child Health, University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
3 Consultant Family Physician, Department of Family Medicine, University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
4 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
|Date of Web Publication||15-Jul-2013|
S A Adegoke
Department of Paediatrics and Child Health, University Teaching Hospital, Ado-Ekiti, Ekiti State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The Human Immunodeficiency Virus (HIV) pandemic is on the increase with the highest burden in sub-Saharan Africa. This descriptive cross-sectional study was carried out in 2008 to assess the knowledge, self-perception of risk of contracting HIV infection and risky sexual practices among patients attending some out-patient clinics at the University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria. The knowledge on the modes of transmission and methods of prevention of HIV was high. Although, 53.0% of the study participants perceived themselves not to be at risk of contracting HIV infection, 80.6% were engaged in risky sexual practices within a year preceding the study. Significantly more participants with multiple sexual partners, past and present history of Sexually Transmitted Infections (STI) perceived themselves not to be at risk (P= 0.001, 0.008 and 0.001 respectively). Effective strategies must therefore be developed, to enhance risk-perception since poor risk-perception is known to mitigate behavioral change.
Keywords: Knowledge, Perception, Practices, HIV/AIDS
|How to cite this article:|
Adegun P T, Adegoke S A, Solomon O S, Ade-Ojo I P. Perception of personal risk of acquiring human immunodeficiency viral infection/acquired immune deficiency syndrome among people attending outpatient clinics in a teaching hospital of Nigeria. Indian J Public Health 2013;57:96-9
|How to cite this URL:|
Adegun P T, Adegoke S A, Solomon O S, Ade-Ojo I P. Perception of personal risk of acquiring human immunodeficiency viral infection/acquired immune deficiency syndrome among people attending outpatient clinics in a teaching hospital of Nigeria. Indian J Public Health [serial online] 2013 [cited 2017 Nov 19];57:96-9. Available from: http://www.ijph.in/text.asp?2013/57/2/96/114996
Human Immunodeficiency Virus (HIV) infection remains a global public health issue with attendant socio-economic and medical consequences.  Studies have shown that about 95% of the people living with the HIV reside in the developing countries, where the prevalence rates among adults is about 20-30%.  According to the World Health Organization, out of an estimated 33.4 million people infected with HIV globally, about 22.5 million of them are living in the sub-Saharan Africa.  Furthermore, about two-third of the newly infected resides in Africa and the likelihood of adults in sub-Sahara Africa becoming HIV infected is 10 times greater than for an adult in North America and 20 times more than an adult in Western Europe. , Nigeria alone account for about 10% of all cases of HIV/Acquired Immunodeficiency Syndrome (AIDS) in the world, with the pandemic having a serious effect on the reproductive health of women. ,
Globally, about 80% of all HIV infections are transmitted through sexual intercourse, although mother-to-child transmission (MTCT) accounts for about 95% of pediatric HIV infections. Of the several international and local efforts to curtail the spread of HIV/AIDS, behavior change appears to be the most effective way.  Among the various methods of achieving behavioral change, perceived threat of contracting the disease/condition has been reported to produce the best result.  Available data in our environment have found that knowledge about mode of transmission and prevention of HIV/AIDS infection is good. ,, Furthermore, previous studies have shown that there is a high risky sexual behavior and low service demand among many people in sub-Saharan Africa. , Unfortunately, studies have shown that many people tend to believe in their own invulnerability to AIDS, a phenomenon widely referred to as optimism bias. , The reasons for such reaction could result from misconception, ignorance, poverty, denial, shame, guilt and silence primarily as a result of stigmatization. ,
This study was conducted to examine the relationship between our patients' perceived risk of contracting HIV infection and their actual or assessed risk based on some risky sexual practices. We evaluated to what extent do people who think that they are invulnerable to contracting HIV infections engages in risky sexual practices.
This cross-sectional descriptive study was carried out between January and December, 2008 at the General Out-patients, Urology, Antenatal and Adolescent clinics of the University Teaching Hospital, Ado Ekiti, Nigeria in Nigeria. Patients aged 10 years and above who attended above clinics were enrolled for the study. They were selected by convenience sampling technique after a voluntary written informed consent. Patients who were known to have HIV infection or AIDS were not included in the study. Ethical approval was obtained from the ethical committee. Each participant was interviewed based on pretested structured questionnaire. The questionnaires were self-administered by those who were literate. However, those who were not literate were interviewed by the researchers. Data on socio-economic characteristics such as age, sex, highest level of education, occupation and marital status were recorded. Furthermore, knowledge on the mode of transmission and prevention of HIV/AIDS infection, the HIV status and factors that prompted the testing if ever carried out were documented.
For each participant, we (investigators) assessed risk of acquiring HIV/AIDS infection by assessing four main risk factors to contracting HIV/AIDS. These included the number of sexual partners; history of unprotected sex in the last 1 month preceding the study; paying or receiving money for sex; past history of Sexually Transmitted Infections (STI) and present history of STI symptoms.  Those without identifiable risk factor were categorized as having no risk while those with any one of the following: recent history of unprotected sex, paying or receiving money for sex, previous history of STI, one recent STI symptom and two sexual partners were categorized as having little risk. Those with the combination of any of the above or having two or more sexual partners or two or more recent STI symptoms were categorized as having high risk of contracting HIV infection.
Data were analyzed using Statistical Package for Social Sciences for Windows (17.0). Frequency distributions of HIV/AIDS knowledge of the participants, self-perceived and assessed risk of contracting HIV infections were computed. The relationship between the two risks of contracting HIV infection (self-perceived and assessed risk) was determined by Chi-squared test.
A total of 592 participants were interviewed comprising of 337 from the GOPD, 103 from the Antenatal clinic, 98 from the Urology clinic and 54 from the Adolescent clinic. Out of them, 40.9% were males with a male: female ratio of 1:1.4. The age of the participants ranged from 10-98 years with mean (±Standard deviation) of 37.9 (16.5) years. Majority of them were young adults i.e., 20-45 years (65%), Christian (92.2%), having secondary school education and above (74.2%) and married (64.2%). By occupation, 38.3% and 23.8% of the respondents were civil servants and students respectively. Of the married participants, 23.2% were in polygamous relationships; 11.6% lived away from their spouses. Also, 4.5% of the married had remarried at least once (ten once, six twice and one person 4 times).
Out of the total participants, 96.1% had heard about HIV/AIDS before the study and 54.1% heard it from mass media. A total of 103 pregnant women (17.4% of the total) participated in the study. Of this, 87 (84.5%) knew that MTCT of HIV infection is a major mode of transmission of the infection to their babies.
Majority of the participants, 314 (53.0%) perceived themselves to be at no risk of contracting HIV infection and significantly more males, young adults, single (non-married) and those with low educational qualification perceived themselves not to be at risk infection [Table 1].
|Table 1: The influence of socio-demographic characteristics of the participants on their level of perception to contracting human immunodefi ciency virus infection|
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In this study, 19.4% of our patients were assessed to have no risk of contracting HIV infections, 37.2% having little risk and 43.1% to have a high risk. Out of 228 participants having 2 or more sexual partners in the last 1 year before the study, 139 (61.0%) had four sexual partners [Table 2]. Considering association between self-perceived risk of contracting HIV infection and the risky sexual practices, significantly more participants with multiple sexual partners, past and present history of STI did not perceive themselves to be at risk.
|Table 2: Association between perceived and assessed risk of contracting human immunodefi ciency virus infection by the participants|
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This study agrees with previous works that knowledge on HIV/AIDS is high among the populace in the developing world.  This high knowledge may be due to continuous and effective health education on HIV/AIDS by relevant stakeholders. Mass media and health talk by medical officers were recognized as the main source of information on HIV/AIDS as documented in many local studies. , Knowledge on MTCT of HIV/AIDS is however low in this study, unlike the high-level of awareness reported among pregnant women and mothers attending pediatric HIV clinic. ,
With regards to perception, 73.9% of our patients believed that they were invulnerable or at most had little risk of contracting HIV infection. This also agrees with findings that over 70% of Nigerian youths commonly expressed optimism bias about HIV succeptibility. , In Nigeria, where stigmatization is rife and has been noted to prevent people from HIV testing or accessing treatment, this finding is not unexpected.
The finding that many participants did not perceive themselves to be at risk of contracting HIV infection, but engaged in risky sexual practices call for extensive studies on behavioral change and improvement in self-perception. In this study, significantly more participants with multiple sexual partners, past and present history of STI did not perceive themselves to be at risk. In sub-Saharan Africa, low risk perception as well as high risky sexual behavior and lack of access to HIV information have been described to account for the high vulnerability of many young people to HIV infection. , Some researchers have found a strong relationship between self-perceptions of contracting HIV infection
and risk-reduction behaviors. ,,,, Weinstein and Nicolich  reported that perceived personal susceptibility and one's risk-reducing behavior influences each other. That is, if one perceives that his or her personal susceptibility is high, the individual may change his or her behavior or engage in activities, which in turn will reduce personal susceptibility.
Health education has been shown as a key strategy to influencing or persuading people for positive behavioral change. This is usually achieved through risk-appraisal of impending danger.  Risk-appraisal involves cognitive processes that examine the severity of the threatening event and the possibility of its occurrence. In this study, perception of risk of HIV infection was influenced by some socio-demographic characteristics. Women, individuals with high education and married were more likely to perceive themselves to be at risk of contracting HIV infection while more males, adolescents, young adults, non-married (single) and those with low education were more likely not to perceive themselves to be at risk. It is therefore desirable that in-depth risk analysis or risk-appraisal be frequently carried out with a view to enhancing self-risk perception especially among the adolescents or young adults' males with low educational attainment.
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[Table 1], [Table 2]