HIV/AIDS is a major public health problem. Globally, almost 75 million people have been infected with the HIV virus and about 36 million people have died of HIV since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history.1 An estimated 0.8% of adults aged 15 – 49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for 71% of the people living with HIV worldwide.1

In 1981, the first set of cases of AIDS was discovered among homosexual men in the United States.2 The men had an unusual type of pneumonia called Pneumocystis carinii pneumonia and rare skin tumors called Kaposi’s sarcoma. Shortly thereafter, the disease was recognized in Western Europe and Africa.2Today it has become a global pandemic.

Since its emergence, HIV/AIDS has become a devastating challenge to human dignity and generalized threat to socioeconomic growth,34 It has hindered the achievement of Millennium Development Goals,5 reduced life expectancy,6 lessened labour productivity and increased poverty levels particularly in developing countries.7

HIV is transmitted by three main routes, which are: unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood or blood products and vertical (mother-to-child) transmission during pregnancy, childbirth and breastfeeding. HIV transmission in Nigeria is largely through unprotected heterosexual sex contributing 80% of transmission.8 Factors that encourage transmission include lack of information about sexual health and HIV, multiple sexual partners, prostitution, low levels of condom use and high levels of sexually transmitted diseases.9 Preventing HIV transmission and its attendant socio-economic sequel is an essential part of addressing the global HIV/AIDS pandemic. It has been documented that sexual behavior change and practice of safe lifestyles is the most effective way of preventing further HIV transmission.8

Although several studies have documented high level of knowledge of, perception and practices towards HIV/AIDS,1011 more information is needed about the knowledge of and practice of lifestyle preventive measures and its linkage with perception of vulnerability, especially among students of tertiary institutions. Hence the main objective of this study is to evaluate the level of knowledge of HIV transmission and prevention, perception and practice of safe lifestyles towards prevention of HIV infection among students of a tertiary educational institution. The information obtained may portray the need to refocus education program so as to impact sufficient comprehensive knowledge to change perception of self-vulnerability, and encourage practice of safe lifestyle to prevent further HIV transmission.

The study procedure was approved by joint Ethics Committee of Federal Teaching Hospital Abakaliki and the Management of Ebonyi State University, Abakaliki. Questionnaires were administered only to students who gave their consent.

A total of 387 participants were surveyed and were made up of 199 (51.4%) males and 188 (48.6%) females with male to female ratio of 1.1:1 The ages of the participants ranged between 19 and 35years with mean age of 23.6±2years. All (100%) the participants were Christians, with most, 374 (96.6%) of them single while 13 (3.4%) were married (Table 1).

This study revealed that the students were between the ages of 19 to 35 years with equal sex distribution. The age of the students were within the most vulnerable age group for HIV epidemic, with most of them unmarried, making them ideal for the study of knowledge on issues regarding HIV/AIDS. This age group, the most economically productive age group in the society, has been most implicated in other studies within and outside Nigeria.1314

The study also revealed that all the students had heard about HIV/AIDS. This is similar to the findings of the studies conducted by Unadike et al15 and Onah et al16 who also reported awareness of HIV/AIDS among all the university students studied. Radio and television were found to rank highest as the source of information on HIV/AIDS. This corroborates with previous study conducted by Makwe et al,17 who also reported radio and television as the main source of awareness and other information about HIV/AIDS. This is important in view of the fact that mass media can reach most people in Nigeria, and so there is need for more media-driven health education campaigns.

Most of the participants were found to have very high level of knowledge about the various routes of HIV transmission, however, few of the participants had some misconceptions. They reported that sharing toilet with an infected person, mosquito and other insect bite, sharing the same bed with an infected person, handshake and eating with an infected person are also routes of transmitting HIV. Similar misconceptions have been reported by previous study.18 Furthermore, participants exhibited very high level of knowledge about ways of prevention of HIV infection and general knowledge about HIV/AIDS. Few participants also had some misconceptions about preventive measures. Such misconceptions include isolation of infected person from others, use of insecticides among others. These knowledge gaps were consistent with findings of similar study carried out on HIV/AIDS.11 The high level of knowledge about HIV transmission and preventive measures among Nigerian university students as shown in this study may be connected with the aggressive campaigns that have over the years been championed by relevant health and community based institutions. In addition, the efforts of relevant organs of the United Nations, several non-governmental organizations and relevant government institutions have been aimed at educating the students on the causation, routes of transmission and preventive measures. This trend of findings has a very bright future for the prevention and control of HIV/AIDS pandemic among the youths.

Another finding of this study is that both male and female students have very good knowledge about HIV/AIDS. There was no significant difference in the knowledge about HIV/AIDS between male and female students. The finding is probably as a result of the readily accessible sources of HIV/AIDS information, which are made equally available to both sexes. The finding is in contrast to those of Aluede et al19 and Chang et al20 who reported a higher knowledge among male students and female students respectively.

The study showed a high level of risky sexual behavior among the participants. Over half of the participants practice pre-marital sex, have multiple sexual partners and do not use condom consistently during sexual intercourse. In addition, about half of the participants share sharp objects with people and about a third of the few married ones among them practice extramarital sex. The practice of these high risk behaviours is not compatible with high knowledge of HIV transmission and prevention exhibited by all the participants. This shows that the participants’ practice of preventive measures is still poor despite very high knowledge about HIV transmission and prevention. Although knowledge about a disease is a prerequisite for change, it has however been demonstrated that high knowledge about AIDS is not a predictor for behavioural change2122

Since there is no cure for HIV/AIDS at present, most activities are aimed at reducing HIV transmission. Apart from abstinence, the next most effective preventive measure against HIV/AIDS is use of condom during sexual intercourse. Thus the proportion of sexually active students who do not use condom during sexual intercourse suggest that current strategies are inadequate. Among the students that use condom, a significantly higher percentage of males use condom during sexual intercourse compared to females. This may be because some people especially females are not assertive enough to negotiate condom use with their sexual partners.23

Low risk perception of self-vulnerability was observed among the participants as over half of them think they are not at risk of contracting HIV infection. The acceptance of preventive measures depend largely on the degree to which the target population actually feels that HIV/AIDS is a real threat to them. Majority of those who have low risk perception of self-vulnerability practice risky sexual behaviours such as having multiple sexual partners, not practicing abstinence, not using condom during sexual intercourse than those who have high risk perception of self-vulnerability. Similar findings have been reported by other studies.141724 This low risk perception of self-vulnerability to HIV infection is important as it may likely influence the attitude of the participants towards risky sexual behavior and practice of preventive measures.

Awareness and knowledge on certain aspects of HIV/AIDS is very high among the students of Ebonyi state University, south eastern Nigeria. However, despite high knowledge about HIV transmission and prevention, students still engage in high risk sexual behavior such as practicing pre-marital sex, having multiple sexual partners, non use or inconsistent use of condom during sexual intercourse and sharing unsterilized sharp objects. This is probably due to low perception of self-vulnerability to HIV infection among the students.

Failure to perceive HIV infection as a personal risk has prevented majority of the students from making commitment to sexual behavior change. Health education should therefore be refocused in such a way as to fortify the very high knowledge about HIV transmission and prevention, as well as to change the low perception of self-vulnerability to HIV infection observed among the students. This will help to improve their practice of safe lifestyles and reduce the incidence of HIV infection and death recorded among the youth.