Knowledge, behaviour, perceptions and attitudes of university of Ghana students towards HIV/AIDS: what does behavioural surveillance survey tell us?
Abstract: This study assesses knowledge, attitudes and behaviour in respect of risk of HIV infection of students through behavioral surveillance survey. The study used the systematic sampling approach to select 375 students. Interviews and focus group discussions were conducted to solicit information from respondents. The study found out that the students engaged in pre-marital sex, although this was more common among the male than female students. Students did not use condoms consistently and were not likely to use condoms when the relationship was considered as stable because of trust. Students revealed that they were all at risk of infection; however, a significant number of them did not know their HIV status and were not ready to take the test for fear of stigmatization. There low level knowledge among female students of the different types of STI. The results suggest that there is need for an appropriate education program for students. Peer education clubs need to be established to provide education on condom management. In addition, edutainment-education through entertainment program on HIV/AIDS - needs to be an integral part of the university's curriculum. More recreational centers need to be established to allow students to channel their energies towards sports.
Article Type: Survey
Subject: Condoms (Health aspects)
Condoms (Usage)
AIDS (Disease) (Risk factors)
AIDS (Disease) (Demographic aspects)
AIDS (Disease) (Surveys)
Medical students (Health aspects)
Medical students (Sexual behavior)
Medical students (Surveys)
Authors: Tagoe, Michael
Aggor, R.A.
Pub Date: 06/22/2009
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2009 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Summer, 2009 Source Volume: 32 Source Issue: 1
Product: Product Code: 3069770 Prophylactics & Diaphragms NAICS Code: 326299 All Other Rubber Product Manufacturing SIC Code: 3069 Fabricated rubber products, not elsewhere classified
Geographic: Geographic Scope: Ghana Geographic Code: 6GHAN Ghana
Accession Number: 250034403
Full Text: INTRODUCTION

One of the challenges facing many sub-Saharan African countries is the spread of Human Immunodefiency Virus (HIV) which causes the AIDS disease. Initially, the disease was associated with homosexuals and later with commercial sex workers. In the last decade, the virus has spread among different categories of people. Data from UNAIDS on the spread of the virus globally from 36.1 million in 2000 to 40 million in 2001, dropped to 38.6 million in 2002 and 37.2 million in 2003 and 2004 (UNAIDS/WHO 2005) shows that there should be concerted effort to mitigate its spread. For sub-Saharan Africa, the impact of the virus and the disease has caused much consternation among policy-makers as it threatens to erode socio-economic through its associated increase in morbidity and mortality of people in the productive age group (Barnett and Whiteside, 1999 and World Bank, 2003). Although there is an apparent 'stabilization' of the epidemic in sub-Saharan Africa as countries in West Africa experience reduction in the prevalence rate of the virus, the threat of the disease is still real, the world continues to find a cure and 64% of all people living with HIV are found in sub-Saharan Africa.

Even a more serious challenge today, is the growing infection rates among the young people in sub-Saharan Africa. Studies have shown that the highest group found to be infected with the virus is the age-group 15 to 24. This adolescent high-risk group accounts for 60 percent of all new infections in many countries (World Bank, 2002). Studies have shown that transactional sex is very common among the youth of Africa and has been identified as one of the critical pathways for the transfer of the virus in Africa (Cote et al., 2004; Alary and Lowndes, 2004). Studies from Cameroon, Kenya, Nigeria, and South Africa revealed that young women exchange sex to get funds to cover education-related expenses and gain connections in social networks (Calves et al., 1996; Barker and Rich, 1992; Kaufman et al., 2001; Meekers and Calves, 1997; Mensch et al., 1998; cited in Chatterji, Murray, London and Anglewicz, 2004). Other qualitative studies conducted in Cameroon, Ghana, Kenya, Nigeria, Sierra Leone, Uganda, and Zimbabwe suggested that peer pressure to obtain luxury items, such as expensive clothing, cars, jewelry, fashionable hairstyles, accessories, and makeup, motivates young women to engage in transactional sex (Ankomah, 1998; Longfield, 2002; Temin et al., 1999; Bledsoe, 1990; Calves et al., 1996; Hulton et al., 2000; Nyanzi, 2001; Gregson et al., 2002; Meekers and Calves, 1997; cited in Chatterji et al., 2004).

One category of youth which has recently become a focus of study in the last few years as we discuss HIV/AIDS in Africa are university students. In 1999, a number of studies were commissioned by the Association for the Development of Education in Africa (ADEA) on university campuses in Benin, Ghana, Kenya, Namibia, South Africa and Zambia to generate understanding of the way HIV/AIDS was affecting universities and to develop the appropriate responses to mitigate the spread of the virus (cited in Anarfi, 2000 and Katjavivi and Otaala, 2003). The case studies showed that very little was known about the HIV/AIDS situation on the respective campuses. The studies painted a disquieting picture, that there was a thick cloak of ignorance surrounding the disease in the Universities (Kelly, 2001).

Although, universities in Eastern and Southern Africa have experienced a high toll of the disease on students, lecturers and administrators in higher institutions, universities in West Africa have recorded fewer cases of HIV/AIDS. Most of the reported cases have been anecdotal rather than through empirical research. It was easier to report cases of HIV/AIDS among lecturers and administrative staff than among students because of the number of years they spent at the university. This notwithstanding, there is ample evidence to show that the lifestyles of students on university campuses cannot insulate them any longer from the threat of the virus. Anarfi (2000) has noted that universities offer conditions ideal for the spread of HIV. Today, there are several predisposing factors which may engender risky behaviour on university campuses. These factors include:

* A large number of young students entering the university fall within the age cohort (19-49 years) which is regarded as the cohort most infected with the virus in Ghana (Figure 1).

* Lack of adequate facilities for students.

* Steady rise in the number of international and African students.

* Multiple sexual partners.

* Transactional sex among female and male students.

* Partner mixing as both female and male students alternate between different sets of sexual partners during vacation and during academic sessions. (1)

* excessive alcohol consumption and drug abuse.

* The relaxed atmosphere which offers students the liberty to engage in liberal sex at obscure places is on the increase (2).

The above factors show that if the University is to continue its mission of developing world-class human resource to meet socio-economic needs of the country, then it behoves the leadership of the University to ensure that the young male and female students who enter the University are equipped with the requisite competencies to be able to protect themselves from being infected with the virus. This means that the University need not focus only on its core competence of teaching, research and knowledge dissemination (University of Ghana, 2003), but should be able to put in place an effective educational program on HIVAIDS prevention and management. However, studies by Anarfi (2000) and Schierhout, Johnson, Dzokoto and Bosu (2003) have shown that information on the risk behaviour is limited, although they are a strategic group for HIV-prevention interventions. This means that for the University to develop this educational program, the authorities need to understand perceptions, attitudes, and knowledge of students through behavioral surveillance studies.

Behavioral surveillance is a monitoring and evaluation tool designed to track trends in HIV and AIDS-related knowledge, attitudes and behaviours in subpopulations that may be prone to infection (Family Health International, 2000; Thwe, Soe and Aung, 2005; World Health Organisation, 2001; Lansky, Sullivan, Gallagher, and Fleming, 2007). Behavioral surveillance surveys consist of repeated cross-sectional surveys conducted systematically to monitor changes in HIV/STI risk behaviors. The findings from behavior surveillance surveys serve many purposes. These include:

* Functions as an early warning system, alerting policy makers and program managers to emerging risks or changes in existing risk behaviour and encourage investment in prevention before HIV levels begin to spread rapidly.

* Reveals gaps in knowledge and understanding of HIV/AIDS that interventions can address.

* Helps identify population segments whose behaviour makes them particularly vulnerable to HIV infection.

* Provides data on specific target groups that complement information from general population surveys (FHI, 2000 and WHO, 2001).

This study which was a collaborative work between the Institute of Adult Education (IAE) in partnership with the United Nations Population Fund (UNFPA) was undertaken as part of a campus-wide behaviour surveillance survey at the University of Ghana. The objectives of the research were threefold:

1) To determine those behaviours that put students at risk of HIV infection.

2) To disseminate the findings of the research, translating them into an advocacy tool to mainstream HIV/AIDS into every level of university operations, and mobilise the leadership of the university to play a catalytic role in the fight against the disease.

3) To develop culturally acceptable Information, Communication and Education (IEC) program for students.

METHOD

The target population for the survey comprised students resident in the following halls: Akuafo, Commonwealth, Mensah-Sarbah, Legon, Volta, Jubilee, and Valco. Non-resident students were not included in the target population because they were not resident on campus and it was difficult to get them. The sampling frame consisted of the lists of students at the various halls of residence. First, the stratified sampling was used to categorize the halls of residence into sub-groupings. A sample of three hundred and seventy-five (375) students was determined through the computer using a proportionate method, a confidence level of 95 per cent (CL [approximately equal to] 1.96) and a tolerance for sampling error of [+ or -] 2.5 percentage points (Table 1). The systematic random sampling method was used to select the rooms. The room numbers of the various halls were prepared, whilst the skip interval was calculated to identify which rooms to be selected. Having determined that, an occupant of the room was selected to be interviewed.

Instrument

The study made use of both quantitative and qualitative methods of data collection. A questionnaire which was based on a modification of the commonly used knowledge, attitude and practice items in the field of HIV/AIDS (Koopman et al, 1990; Shrum et al, 1989; cited in Richter, 1999; Family Health International 2003) and the 1999 Youth Risk Behavior Survey developed by the Center for Disease Control (CDC) was used to gather data. The instrument had questions on demographic characteristics to measure age, level, gender sex, religion, and marital status.

To measure students' perception of sex and sexuality, questions focused on first sexual experience, number of sexual partners, person with whom the sexual act was engaged, and conditions under which sexual experience occur between partners. Questions on the use of condom measured students' knowledge of sexually transmitted infections and management of STIs, frequency of condom during sex, availability of condoms, and negotiation skills for use of condoms with partners for safer sex, knowledge of types of STIs and STD treatment seeking-behavior. Questions were asked to assess respondents' knowledge about the HIV and AIDS. Questions were also asked on the respondents' perceptions, feelings, ideas, judgment of People Living with HIV and AIDS.

The survey was administered with the assistance of twenty research assistants drawn from the Diploma and Master's students in the Institute of Adult Education, University of Ghana. A training session was organized for them which took them through the objectives of the study, sample, selection of students and the instrument. After the training, the research assistants pre-tested the questionnaire to determine the suitability of questions. The pre-testing provided the research assistants with the opportunity to become familiar with the instrument and also to practise research in real situations. It was during the pre-testing that we realized it was going to be difficult to elicit responses easily from students because questions on sex, sexuality and HIV/AIDS where identified by the students as sensitive issues (Kitzinger and Barbour, 1999).

In order to ensure credibility, data triangulation became a key strategy in the research. Focus group discussions were held in all the halls of residence for students. Focus group discussions were held with students in the various halls of residence. Before the discussions were held in December, 2003 and January, 2004, consultations were held with Hall representatives. This paved the way for the selection of participants in groups of between 10-15 students. The use of focus group discussions was to add depth to the study. It also provided opportunity to the researchers to follow interesting leads (Fielding and Fielding; cited in Moris and Copestake, 1993), which resulted from the questions. A cassette recorder was used during the discussion after the group had been told in advance and adequate assurances given about confidentiality (Hoinville and Jowell, 1978).

DATA ANALYSIS

Two approaches were adopted for the data analysis. For the quantitative data, the questionnaire was entered into Excel version 6 and later imported into SPSS as a file, from which descriptive statistics were produced in the form of frequency distributions. In the case of qualitative data, the focus group discussions, which were captured on tapes, were transcribed. The data was analysed through content analysis, whilst the phenomenological analysis was used to understand the experience of students (Merriam, 2000). The sensitive nature of the study, particularly as it affects students' sexual behaviours made it difficult for students to reveal all the information on their sexual behaviours; they had a strong inclination to conceal some facts.

FINDINGS

This section deals with the findings of the study. Table 2 shows that a significant percentage of respondents were females. In terms of level, this was fairly distributed. On age distribution, a higher percentage of students came from 17 to 24 age-groups. With religion and marital status, a significant percentage of students indicated they were Christians and single.

Table 3 shows that about equal proportions of females and males were in a relationship of some sort. However, the data showed that there were more male students (62%) in sexual relationships than female students. On sexual experience, 62% of male students indicated that they had had sexual intercourse, whilst 63% of female reported being sexually abstinent.

For students who have not had sex before, some of the reasons offered for abstaining included religion, not ready for a sexual relationship, and fear of pregnancy. For those who had had sex before, the study found that the first sexual experience was 19.3 years for female students and 18.8 years for male students. This is an indication that more male students than female students had had sex at an earlier age.

About 79% of female students who had sex in the last twelve months indicated that they had had sex with their regular sexual partners, whilst 6.1% had sex with casual partners. For the male students, the study found out that whilst 50% of them reported having had sex with casual partners, only 34.5 % had sex with their regular partners. The study found out that fewer students had engaged in anal compared with oral sex.

Of the sexually active students who had sexual intercourse in the last twelve months, both male and female students reported using condoms with their partners, with males reported a slightly higher percentage of condoms than females. With the regularity of use, the females had a higher percentage than the males. On who suggested the use of condoms, a higher percentage of both male and female students reported that it came from both partners. Twenty-eight percent of male students indicated that they made the suggestion to use of condom as against 18.5% of female students. Equal proportion of male and female students (72% vs. 73%) disagreed with the statement that condoms were only needed when one did not trust the partner. Although the study did not come across any student who disclosed that she/he had sold sex for money, an equal percentage of male and female students (68% vs. 63%) indicated that some students offered sex for money.

The study found out that a significant number of male and female (91.0% vs. 90.9%) had had no sexually transmitted infection in the last twelve months. Both male and female students had inadequate knowledge of sexually transmitted disease (74% vs. 81%). The most popular STIs the students could mention were gonorrhoea and syphilis. The male students had a higher knowledge of infections such as Chlamydia, genital warts and herpes. Equal proportion of males and females students would tell their partners if they contracted STIs.

The study indicated that students had adequate knowledge about HIV and AIDS (Table 6). Indeed, the students knew how the virus was spread (i.e. through blood transfusion (female- 90.8% vs. male-87.3%), sharing sharp instruments (87.2% vs. 81.3%, sex with an infected person (94.5% vs. 94.0%), and the means of prevention such as the use of condom (female-77.1% vs. 83.3%), being abstinent (84.4% vs. 85.3%), and having sex with a faithful partner (75.2% vs. 64.7%).

On the age-range for women most infected with the virus in Ghana, about 55% of female mentioned 15-24 yrs as against 56% by male students. The study found out that there was no significant difference between females and male students on the accurate knowledge of the age-range for women most infected with the virus in Ghana (44% vs. 42%). For age-range of men most affected by the virus, although a higher percentage (56.9% vs. 45.3%) for female and male students mentioned 25-29 years instead of 30-34 years, the male students were more likely to know the age-range (14.1% vs. 9.7%) than their female counterparts.

Equal proportion of male and female students indicated they were likely to contract HIV through sexual activity, and the reasons offered were that anyone is susceptible (75% vs. 78%), partner may be unfaithful (8% v.12%); and don't know who partner goes out with (5.6 vs. 6.2%). Four percent of female students reported they could be raped by someone.

On the reasons why students thought they were unlikely to contract the virus, more female students than male (54% vs. 32%) reported having faithful partners, whilst 28% of female and 23% of male students reported having no boy/girl friends or being abstinent. Thirty-two percent of male students reported practicing safe sex.

Over 90% of students reported never having had an HIV test (Table 7). However, 65.7% of female students indicated their readiness to go for a test in future than their male students (8.3%). The study reported that both male and female students (58% vs. 63%) would keep it secret should a close friend be diagnosed as HIV-positive.

Asked what should be done to people living with the disease, a significant percentage of both male and female students (91% vs. 88%) reported that they should be shown love. More males than females (45.0% vs. 38.0%) indicated that they would warn others about the disease. Female students were more likely to isolate or kill themselves should they be diagnosed as HIV-positive than male students. Over 90% of students indicated that people living with AIDS should not be seen as bad or as promiscuous people.

DISCUSSION

Sex and sexuality

Studies have shown that students' behaviour is influenced by their attitudes. Our attitudes are shaped by the values we imbibed during our childhood and preadolescence stages. These values determine our sexuality in the future (Apoola, 2004). Thus, the study found that sexual practices of students were influenced by attitudinal differences across genders. For students who had not had sex yet, it was found that most of them had stayed away because of religious reasons. Other reasons offered bordered on personal safety such as problems of pregnancy, being too young, and the need to concentrate on one's studies.

The study found out that the mean age of students' first sexual experience was 19.3 years for females and 18.8 years for males. The result confirmed earlier study by Anaafi (2002) that that males students are more likely to engage in sex earlier than their female counterparts. Also studies conducted by the Health Reproductive Progress (HRP) in 1996 in nine countries supports the findings that the male students usually experienced sex earlier than their female counterparts. Among tertiary students in Illorin in Nigeria, the mean age of first sexual intercourse was 17 years for males and 19 years for females. Other studies among university students at the University of Ibadan and urban university students in the Philippines by Iwuagwu and Ajuwon (2000) and Romel et al (1997) both support the evidence that male students have sex earlier than their female counterparts.

For students who engaged in sex whilst on campus, several predisposing factors were identified as contributory to their action. These were: peer influence, financial constraints, the culture of 'being with the crowd', and the lack of restrictions on campus. With regard to lack of restrictions, the study revealed that the university campus offered students the freedom to do whatever they wanted:

The study found out that it was difficult for female students to openly discuss their sexual experiences. Only a few were willing to disclose their sexual history to fellow students. Even, those who said they had had sex before noted that it happened without any prior planning. According to one female student:

Condom Use and Sexually Transmitted Infections

One of the ways of preventing the spread of STIs and HIV/AIDS is through the use of condoms. Of the sexually active students who had had sexual intercourse in the last twelve months, both male and female students reported using condoms with their partners, with males reporting a slightly higher percentage of condom use than females. This means that females may be at a higher risk of STI's than their male counterparts. However, an equal proportion of male and female students (72% vs. 73%) disagreed with the statement that condoms were only needed when one did not trust the partner. When it came to use of condoms, the study found out that there was a gap between knowledge and practice. The study discovered that students did not use condoms consistently. Students would discontinue the use of condoms when they perceived the relationship to be stable. Others also used them when they were available. In situations where they did not have the condom they were more likely to have sex without condoms. Female students were less likely to walk to pharmacy shops to buy or carry condoms around because of cultural factors associated with sex. In addition, many of the female students indicated they had not seen the female condom before, nor used one before. According to one female student:

Another female student also added that:

Consistent with this findings, Svenson, Carmel & Varnhagen (1997) have argued that purchase of condoms is embarrassing to almost everybody, particularly, females. Awusabo-Asare, Abane, Badasu & Anarfi (1999) have noted that this is so because of negative views about females who carry condoms or go to pharmacy shops to buy.

On the issue of offering sex for money, although the study did not come across any student who disclosed that she/he had sold sex for money, an equal percentage of male and female students (68% vs. 63%) indicated that some students offered sex for money. Anecdotal evidence showed that transactional sex was common among female students. Some students observed that these days the male students have also been going after older women (or "sugar mummies") for monetary rewards. From Focus Group Discussions (FGD) some students noted that:

On knowledge of Sexually Transmitted Infections, the study revealed that both male and female students had a very low level of knowledge of STIs. The most popular STIs the students mentioned were gonorrhoea and syphilis. One student noted that:

Both female and male students indicated they could tell their sexual partners, if they had STIs. Whilst female students noted that could bring their relationship to an end, the male students were more likely to disclose this to their stable girlfriends than to casual sexual partners.

Knowledge of HIV and AIDS and Risk Perception

Almost all the students knew the nature of HIV and AIDS and also the modes of transmission. Some of the female students were not too sure if one could contract the virus through kissing. The students were worried that they used salons and barbers shops where instruments were not improperly sterilized. On the sources of contracting the virus, the students mentioned sexual intercourse, without the use of condom, anal and oral sex, use of sharp objects, and blood transfusion. There were a few misconceptions when a few students noted that one could be infected with the virus through the use of same toilet seats and toothbrush.

On risk perception, the study found divergent views among the students by gender. The study indicated that students had adequate knowledge about HIV and AIDS. Indeed, the students knew how the virus was spread (i.e. through blood transfusion; sharing sharp instruments; and sex with an infected person. On prevention, the students mentioned use of condom; abstinence; and having sex with a faithful partner. On susceptibility to the virus, students noted that both female and male students were at great risk. However, female students were more at risk than their male counterparts.

For male and female students who thought they were unlikely to contract the virus, they offered reasons such as having faithful partners, no boy/girl friends or being abstinent.

Voluntary Counselling Testing

Over 90% of students reported never having had an HIV test. This supports findings of Gordon & Inusah (2003) who also indicated that the majority of University of Ghana students had not done voluntary HIV testing. Female students indicated they would offer themselves to a test in future than their male counterparts. The study found out that the unlikelihood of students going through HIV testing was attributed to anxiety and fear associated with testing. However, a major barrier to knowing one's HIV status is the stigma and discrimination associated with the disease. This was revealed in the responses of students when both male and female students (58% vs. 63%) indicated they would keep it secret should a close friend be diagnosed as HIV-positive. The differences in response show that female students are more likely to sympathize with their friend and therefore keep it a secret than their male counterparts. On the possibility of having a test for HIV, the majority of the students reported they were not ready.

CONCLUSION

Three main conclusions can be drawn from the study. First, there was enough evidence to show that such factors as peer influence, financial constraints, the culture of 'being with the Jones', and the lack of restrictions at the university contribute to risky behaviours by the students. Anecdotal evidence has it that when students come to Level 100, they look innocent, but by the time they get to Level 200, they have been through the socialization process on campus and begin to compete with the older students in terms of the latest fashion, cars and mobile phones.

Although the students were aware that abstinence was the best strategy to HIV/AIDS prevention, condom use was not popular among the male students. Many of the female students had not used the female condom. Those who have been sexually active have to negotiate condom use with their sexual partners. Male discussants in the focus groups discussions revealed that condom use became less regular when their relationship with the female students became steady and long-lasting. The male students were more likely to carry condoms on themselves than their female counterparts. The female students were less likely to walk into pharmacy shops to purchase condoms. Major efforts should therefore be made to encourage the use of female condoms by female students.

Second, the lack of knowledge of sexually transmitted infections among the students of other STIs apart the popular ones such as gonorrhoea and syphilis call for more sustained condom management programs. Awareness of HIV/AIDS is high, in conformity with general trend in the country. However, a significant number of the students do not know their HIV-status and did not take opportunity of the free VCT offered to Ghanaians in the month of November. The fear of being stigmatized and discriminated against is the underlying factor why most students have not volunteered to be tested. HIV/AIDS stigma interferes with effective prevention efforts. Although the students had positive views about those infected with HIV that they should be showed love instead of being seen as promiscuous or bad people, the students triggered high levels of feelings of stigmatization and discrimination when it came to the use of drinking glasses, plates and buying from somebody perceived to be HIV-positive.

Thirdly, there are cultural norms associated with sex which affect the autonomy of female students. Whilst male students are able to openly talk about sex and condoms, female students are inhibited because of the perception that when girls are open about sex and condoms then there are bad or promiscuous. These inhibitions expose female students to high risk of infection.

To reduce the risky behaviours of students, programs must be targeted at the micro- and macro-level of the university. At the micro-level which should focus on how to change behaviour of students; there is the need for an effective and sustained health education and health promotion interventions. Glanz at al (1990:9) describe the ultimate aims of health education as "positive changes in behavior." Green and Kreuter (1991) define health promotions as "...the combination of educational and environmental supports for actions and conditions of living conducive to health" (Green and Kreuter, 1991). For these educational programs to achieve their aim, it is important that the students are involved in the planning of HIV/STD education interventions. Their involvement would ensure that decisions that are made, purposes defined, intervention messages designed and developed, are based on the real issues or challenges which students face. The first strategy to reducing risk of HIV infection is the introduction of peer education programs to provide students with interpersonal skills in condom management and stigma reduction. Svenson, Carmel & Varnhagen (1997) have noted that the purpose of instituting a program in condom management is to change campus norms regarding sexual behavior and for students to use condoms consistently. Effort must be made to support this program by making condoms available and accessible including information about how to get them and how to use them.

There should also be opportunities where students can use theatre and dance as tools for behavioral change. We recommend introduction of Edutainment as an extra-curricula activity. Edutainment is the process of designing and implementing an entertainment program to increase audience members' knowledge about a social issue, create more favorable attitudes, and change their overt behaviors regarding the social issue (Vaughan, Rogers Singhal & Swalehe, 2000). The School of Performing, the School of Communications and the Institute of Adult Education could collaborate to develop appropriate and culturally relevant material for students at all levels to form the basis of edutainment at the University.

More recreational centers need to be created so that students would spend more time in these rather than stay out drinking and thinking about other social vices. There should the development of a policy and activities for anonymous testing to be in place to inform the University of the HIV prevalence among students, workers and service providers and a course of action to manage the spread of the virus among the university community. At the macrolevel, there is the need for a strong leadership in the fight against the spread of the disease on the university campus.

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MICHAEL TAGOE

R.A. AGGOR

University of Ghana

(1) This has been described as sexual networking. A student may have a girlfriend on campus and have another in his town or village. When he is on campus he spends most of his time with the campus girl. Once the university vacates he moves to his town or village and to his other girlfriend. The university term for this activity is 'inter' (or internal) and 'exter' (external).

(2) People and Places (P&P), January 23-26, 2003, p.3
I for one have lived with my parents and my
   chances of going out have been very slim.
   Whenever I am going out I have to ask for
   permission before I can go out but when I
   came here I am free to go anywhere,
   anytime (Female student).


It is a very sensitive question and even if
   one person is here and has done it, it
   would be very difficult to say it openly
   like this. If you have a friend you trust,
   you can tell her but to say it openly like
   this, is very difficult.

   For me, it was not my own desire. I was in
   a relationship for two years and nothing
   happened but I just realized that it happened
   all of a sudden (Female student).

   I for one, I never thought of it but I just
   realized it happened. I happened to be 23
   years old and it was very unfortunate and
   so I won't try it till I get married (Female
   student).


One of the reasons why female students are
   more at risk is that we are very shy when it
   comes to sex. Men are very "cool" with
   buying condoms or they would simply go to
   their friends for one. But a lady would just
   not because she feels someone would know
   that she was going to have sex, and it puts
   us more at risk.


I remember one time when these female
   condoms came, I went to a pharmacy shop
   and the pharmacist just looked at me and he
   was like "You too." And I said to him, 'me
   too what, am I an angel', and then he said he
   was shocked. I told him I don't need it. I
   only wanted to see how it looked like.


Talking about the number of students on
   campus right now, with the accommodation
   problem, a lot of students have to find
   somewhere to stay. Many may not have the
   money, so they end up sleeping with men to
   get the money. (Female student).

   One other thing is talking about the pressure
   on campus, everybody wants to dress well.

   This causes you to go out looking for money
   and the guys. Once you are able to give them
   what they want, they would also give you
   money for dresses, shoes, mobile phones and
   the rest. They definitely will hop from one
   man to the other to just get what they want.
   (Female student).


I had gonorrhoea when I was in SSS. I
   consulted a native doctor, who gave palm
   wine mixed with cotton leaves which I
   drunk for three days and I was cured (Male
   student).


Most of us are sexually active and students
   do not know the right person he or she will
   meet at a particular point in time, so we are
   all trying the opposite sex as to how best we
   can acquaint ourselves in terms of
   relationships. Today, it is this girl,
   tomorrow it is that girl till you find a
   compatible lady (Male student).

   I am at risk, because I do not normally use
   condom during sex (Male student).

   Once AIDS is not written on anybody's
   forehead we are all likely to contract the
   virus (Male student).

   I want to say that women are more prone to
   HIV. I have heard that when a male who is
   HIV-positive sleeps with a woman, she easily
   contracts the disease more than when a man
   who does not have the virus sleeps with a
   woman who has it. This is because we take the
   fluid from the men (Female student).

   When you go out with a girl today you use a
   condom for the first time, second time you
   use a condom. Now you are sure it is your
   girlfriend and therefore nobody sleeps with
   her, so the next time you have sex you tell
   her you want to try without a condom.
   However, on campus where most
   relationships are for frivolous reasons, the
   relationship will break up and both will go
   for new boy and girl friends and the cycle
   continues. A campus lady may have
   someone outside and at the same time a
   campus boy. If any of the parties involved
   has the virus and they engage in unprotected
   sex, automatically they will be infected
   (Male student).


As for me, I know I don't have it but to save
   myself from the agony, depression and
   thinking, I won't go, unless I am convinced to
   go but it is likely I won't go voluntarily
   (Female Student).

   I know someone who went for the test. She
   also knew she did not have it but was afraid
   during the waiting period. She was always
   like "these days when I wake up in the
   morning, all I sing is gospel songs, I don't
   eat." They were about to marry and she
   prayed to God. You know, it is frightening so
   I would not do it voluntarily (Female
   Student).


Table 1:
Distribution of halls of residence and number of students
selected

Halls of Residence         Sample Size

Mensah-Sarbah                  60
Akuafo                         60
Legon                          60
Commonwealth                   75
Volta                          55
Jubilee                        45
Valco                          20
Total                         375

Table 2
Students' characteristics

                  Demographic Characteristics

                  Number   Percentage
Sex
Male              191      57.4
Female            142      42.6

Age:
17-24             205      60.3
25-34              93      27.4
35-44              31       9.1
45-54              11       3.2

Marital status:
Single Male       150      45.0
Single Female     111      33.3
Married Male       31       9.3
Married Female     41      12.3

Table 3
Views on sex and sexuality

                                        Percentage

Are you in a relationship?     Single Female   Single Male

Yes                                64.2           61.1
No                                 35.8           38.9

Is this relationship sexual?

Yes                                37.8           62.2
No                                 63.4           36.6

Have you ever had sexual
intercourse?

Yes                                36.8           62.3
No                                 63.3           36.7

Have you had sex in the last
twelve months?

Yes                                38.5           61.5
No                                 54.2           45.8

Table 4
Condom use

                                     Percentage

                                    Female   Male
Do you and your partner use
condom?
Yes                                   62.8   71.4
No                                    37.2   28.6

If yes, how often do you use a
condom?
Always                                52.0   64.2
Sometimes                             48.0   35.8

Who suggests condom use?
Self                                  18.5   28.2
Partner                                0.0    2.8
Both                                  81.5   69.0

Are condoms needed only if you
do not trust your partner?
Agree                                 22.8   24.1
Disagree                              72.3   73.0
Undecided                              5.0    3.0

Do you agree that female students
offer sex for money or gifts?
Agree                                 53.2   67.6
Disagree                              26.4   19.6
Undecided                             10.4   12.8

Table 5
Knowledge of STIs

                                         Percentage

                                       Female   Male

Have you had a sexually transmitted
infection in the last twelve months?
Yes                                       8.0    8.1
No                                       91.9   90.9

STIs Knowledge
Inadequate                               74.1   81.1
Adequate                                 25.9   18.9

Mention the STIs that you know
Gonorrhoea
Yes                                      98.1   97.9
No                                        1.9    2.1
Syphilis
Yes                                      94.2   92.4
No                                        5.8    7.6
Genital warts
Yes                                      32.7   28.3
No                                       67.3   71.7
Chlamydia
Yes                                      24.0   16.6
No                                       76.0   83.4
Genital herpes
Yes                                      37.5   31.0
No                                       62.5   69.0

If you  have  sexually transmitted
infection, can you tell your partner
about it?
Yes                                      75.6   78.0
No                                        5.6   12.1
Undecided                                18.8    9.9

Table 6
Knowledge of HIV and AIDS and level of risk perception of
students

                                            Percentage

HIV knowledge                             Female   Male

Adequate                                    55.7   63.9
Inadequate                                  44.3   36.1

AIDS knowledge
Adequate                                    50.7   56.3
Inadequate                                  49.3   43.7

How likely do you think you could
contract HIV/AIDS through sexual
activity?
Likely                                      55.7   67.1
Unlikely                                    36.1   25.0
Not certain                                  8.2    7.9

Reasons why you think you are likely to
contract HIV/AIDS
Anyone is susceptible                       75.0   78.1
Partner may be unfaithful                    8.3   12.5
If I had to get a blood transfusion          5.6    0.0
Because I do not use condoms                 1.4    3.1
You could be raped by someone who has        4.2    0.0
  HIV
Don't know who my partner goes out with      5.6    6.2

Reasons why you think you are unlikely
to contract HIV/AIDS
I have a faithful partner                   54.1   32.2
I practise safe sex                         10.8   32.5
I have one partner                           5.4    9.4
Don't have a boy/girl friend                28.4   23.1
Too old for sex                              1.4    0.0

Table 7:
Perception and knowledge of voluntary counselling testing

                                         Percentage

Have you ever had an HIV test?         Female   Male

Yes                                       7.5    8.3
No                                       92.5   91.7
Will you be ready to test?
Yes                                      65.7    8.3
No                                       34.3   91.7

Is it possible for someone on
campus to get a confidential test
to find out if he/she is positive?
Yes                                      44.2   59.3
No                                       10.6    6.9
Don't know                               45.2   33.8

If a close friend  on campus
became ill with HIV, will you
want it to remain secret?
Yes                                      55.2   63.0
No                                       19.0   19.9
Don't know                               25.7   17.1

Figure 1: Age of SSS Students admitted to the University

Year      15-19     20-24     25-29

2001       322      1747       43
2002       875      3225      112
2003      1614      3130      216

Source: Public Affairs Directorate, 2004

Note: Table made from bar graph.
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