Project – Assessment of HIV/AIDS Prevention Knowledge and Risky Sexual Behaviours among Undergraduate Students

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Human Immunodeficiency Virus (HIV) infection remains a significant global public health concern despite major advances in prevention, testing and antiretroviral treatment. HIV attacks the body’s immune system and, if untreated, can progress to acquired immunodeficiency syndrome (AIDS). Although HIV has no cure, effective antiretroviral therapy has transformed HIV infection into a manageable chronic condition, while people receiving effective treatment with an undetectable viral load do not transmit HIV sexually. Nevertheless, HIV transmission continues globally, with the World Health Organization estimating that 41.0 million people were living with HIV at the end of 2025, approximately 1.2 million people acquired HIV during 2025, and about 570,000 people died from HIV-related causes. The continuing incidence of infection demonstrates that prevention remains essential, particularly among populations whose social and sexual circumstances may increase exposure to HIV (World Health Organization [WHO], 2026).

Young people and young adults constitute an important population in HIV prevention because the transition into adulthood is often accompanied by changes in social relationships, sexual relationships, independence and decision-making. University students fall predominantly within the age group in which sexual experimentation and formation of intimate relationships may occur, making accurate HIV knowledge and responsible sexual practices important components of health protection. WHO identifies adolescents and young adults aged 10–24 years as underserved in the global HIV response and emphasizes combination prevention approaches that include HIV testing, condoms, pre-exposure prophylaxis, treatment and appropriate sexual-health information. Comprehensive sexuality education is also recognized as an important means of correcting misconceptions, developing informed attitudes and supporting protective behaviours such as condom use and reduction of sexual risk-taking (WHO, 2024, 2026).

Nigeria continues to carry a substantial HIV burden, although the country has achieved important progress in reducing new HIV infections. UNAIDS data indicate that Nigeria recorded an estimated 75,000 new HIV infections in 2023, including approximately 18,000 among people aged 15–24 years. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey also showed that sexual activity begins relatively early among a proportion of young Nigerians, with 18.1% of older adolescents and young adults reporting sexual intercourse before age 15. In addition, the survey identified gaps in comprehensive HIV knowledge and awareness of HIV status among young people. More recent national prevention planning acknowledges that although Nigeria achieved a substantial decline in new infections between 2010 and 2024, the pace of prevention remains insufficient to meet national targets. These circumstances make young adults, including university students, an important population for continued HIV prevention research and intervention (UNAIDS, 2024; National Agency for the Control of AIDS [NACA], 2021, 2026).

Knowledge of HIV transmission and prevention is an important foundation for reducing risky sexual behaviours, but evidence suggests that awareness alone does not necessarily translate into safer sexual practices. Harding et al. (1999), in their study of Nigerian university students, found that students demonstrated substantial knowledge about HIV transmission and symptoms, yet misconceptions remained and many students did not perceive themselves to be at high risk despite considerable sexual experience. Similarly, Odu et al. (2008), in a study among students in a tertiary institution in south-western Nigeria, found that most respondents were aware of HIV/AIDS and knew several methods of transmission and prevention, but almost half of currently sexually active respondents reported having multiple sexual partners. These findings demonstrate the important distinction between simply knowing about HIV and applying that knowledge through consistent protective behaviour (Harding et al., 1999; Odu et al., 2008).

Risky sexual behaviour is particularly important in the context of HIV prevention because sexual transmission remains one of the major routes through which HIV is acquired. WHO identifies vaginal or anal sex without a condom, having another sexually transmitted infection and certain patterns of substance use associated with sexual behaviour among factors that increase HIV acquisition risk. Consistent and correct condom use is an effective method of reducing HIV and other sexually transmitted infections, while HIV testing enables individuals to know their status and make informed decisions concerning prevention and treatment. However, Nigerian studies among tertiary students have documented discrepancies between knowledge and practice. Odusanya and Alakija (2004), studying students in Lagos, reported that 72% of respondents were sexually active, 48% had engaged in casual sex and only 29% of students with a primary sexual partner reported consistent condom use. Such evidence indicates that knowledge must be considered alongside actual sexual behaviour when assessing HIV prevention among university students (WHO, 2026; Odusanya & Alakija, 2004).

The Nigerian university environment therefore represents an important setting for HIV prevention interventions because students may experience social and environmental factors that influence sexual decision-making. Osagiede et al. (2016), in a study of undergraduates in a Nigerian tertiary institution, reported high awareness of condoms and recognition of abstinence and condom use as appropriate methods for preventing HIV and sexually transmitted infections, yet 93.6% of sexually active respondents reported that they did not routinely use condoms. Likewise, Abiodun et al. (2014), in a study of 1,250 students at a Nigerian private university, found universal awareness of HIV and very high HIV knowledge, but only 30.4% of participants had undergone HIV testing during the six months preceding the study. These findings suggest that having information about HIV does not automatically lead to testing, consistent condom use or other preventive actions. Consequently, studies of undergraduate students need to assess both knowledge and actual behavioural practices rather than assuming that high awareness necessarily indicates low HIV risk (Osagiede et al., 2016; Abiodun et al., 2014).

The Lagos context further strengthens the need for the present study because previous research among undergraduates in Lagos has demonstrated that HIV-related interventions can influence sexual behaviour. Wusu and Okoukoni (2011), in a study involving 625 undergraduates in Lagos Metropolis, found that participation in HIV counselling and testing was associated with reductions in the average number of sexual partners and the frequency of sexual activity among respondents. However, the relatively low proportion of students who had participated in HIV counselling and testing highlighted an important gap between the availability or potential usefulness of HIV prevention services and their actual utilization by students. In addition, research in Lagos has shown that students may possess satisfactory HIV knowledge while continuing to engage in behaviours that increase their exposure to HIV. Therefore, assessing the current level of HIV prevention knowledge and risky sexual behaviours among students in selected universities in Lagos State is necessary to identify existing knowledge-behaviour gaps and provide evidence for strengthening campus-based HIV prevention programmes (Wusu & Okoukoni, 2011; Odusanya & Alakija, 2004).

1.2 Statement of the Problem

HIV/AIDS remains an important public health problem despite substantial progress in prevention and treatment. Globally, 41.0 million people were living with HIV in 2025, while approximately 1.2 million people acquired HIV during the same year. Although Nigeria has experienced a significant reduction in new HIV infections over the past decade, the country still recorded an estimated 75,000 new infections in 2023, including about 18,000 among people aged 15–24 years. The continued occurrence of new infections among young people is particularly concerning because many infections acquired during young adulthood can have lifelong consequences for health, relationships, education, employment and future family life. This situation underscores the importance of strengthening HIV prevention among young adults, including students in tertiary institutions (WHO, 2026; UNAIDS, 2024).

A major problem is the persistent gap between HIV knowledge and actual preventive sexual behaviour among university students. Nigerian studies have repeatedly demonstrated that students may be highly aware of HIV while continuing to engage in behaviours that expose them to infection. Harding et al. (1999) found that Nigerian university students had substantial knowledge about HIV but that knowledge did not prevent unprotected sexual intercourse. Similarly, Odu et al. (2008) reported that nearly half of currently sexually active students in their south-western Nigerian study had multiple sexual partners, while Osagiede et al. (2016) found that 93.6% of sexually active undergraduates did not routinely use condoms. These findings raise concerns about the effectiveness of HIV information when it is not accompanied by behavioural skills, realistic risk perception, access to preventive services and the ability to negotiate safer sexual practices (Harding et al., 1999; Odu et al., 2008; Osagiede et al., 2016).

Another concern is that HIV prevention involves more than knowledge of transmission routes. Students’ perceptions of their own vulnerability, attitudes towards condoms and HIV testing, number of sexual partners, consistency of condom use and willingness to access HIV counselling and testing can influence their level of risk. In Lagos Metropolis, Wusu and Okoukoni (2011) found that students who participated in HIV counselling and testing demonstrated reductions in reported numbers of sexual partners and frequency of sexual activity, yet participation in counselling and testing was relatively low. Earlier research among students in Lagos also found that many sexually active respondents did not consistently use condoms despite satisfactory levels of HIV knowledge. These findings suggest that there may be important behavioural and service-utilization barriers that cannot be addressed through information provision alone. Without a clear understanding of these factors among current university students, HIV prevention programmes may fail to address the reasons students continue to engage in risky sexual behaviours (Wusu & Okoukoni, 2011; Odusanya & Alakija, 2004).

Although previous studies have examined HIV knowledge and sexual behaviour among Nigerian undergraduates and some have specifically considered students in Lagos, there is a need for current evidence across selected universities in Lagos State. Changes in students’ social environments, digital communication, access to sexual-health information, HIV prevention services and patterns of sexual relationships make continuous assessment necessary. Furthermore, evidence from Nigeria indicates that high HIV awareness may coexist with low uptake of HIV testing and inconsistent preventive behaviour. The central problem addressed by this study, therefore, is the possible gap between what undergraduate students know about HIV/AIDS prevention and how they actually behave in relation to sexual risk. Assessing students’ HIV/AIDS prevention knowledge alongside their risky sexual behaviours will provide evidence that can assist universities, health educators, policymakers and public health practitioners in developing more targeted and effective campus-based HIV prevention strategies (Abiodun et al., 2014; WHO, 2024; NACA, 2026).

1.3 Purpose of the Study

The main purpose of this study is to assess HIV/AIDS prevention knowledge and risky sexual behaviours among undergraduate students in selected universities in Lagos State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of HIV/AIDS prevention knowledge among undergraduate students in selected universities in Lagos State;
2. determine the level of awareness of HIV transmission and prevention methods among the students;
3. assess the prevalence and patterns of risky sexual behaviours among undergraduate students;
4. examine students’ attitudes towards HIV/AIDS prevention, condom use and HIV counselling and testing;
5. determine the relationship between HIV/AIDS prevention knowledge and risky sexual behaviours among undergraduate students; and
6. identify selected socio-demographic and behavioural factors associated with risky sexual behaviours among the students.

1.5 Research Questions

The following research questions will guide the study:

1. What is the level of HIV/AIDS prevention knowledge among undergraduate students in selected universities in Lagos State?
2. What is the level of awareness of HIV transmission and prevention methods among the students?
3. What are the prevalent patterns of risky sexual behaviours among undergraduate students?
4. What are the attitudes of undergraduate students towards HIV/AIDS prevention, condom use and HIV counselling and testing?
5. Is there a relationship between HIV/AIDS prevention knowledge and risky sexual behaviours among undergraduate students?
6. What socio-demographic and behavioural factors are associated with risky sexual behaviours among the students?

1.6 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between HIV/AIDS prevention knowledge and risky sexual behaviours among undergraduate students in selected universities in Lagos State.

1.7 Significance of the Study

The findings of this study will be beneficial to undergraduate students because they will provide a clearer understanding of the relationship between HIV/AIDS knowledge and sexual decision-making. The study may help students identify misconceptions about HIV transmission and recognize behaviours that can increase their vulnerability to HIV infection. It may also encourage responsible sexual practices, including consistent and correct condom use, reduction of multiple sexual partnerships, HIV testing and utilization of appropriate sexual and reproductive health services.

The study will be useful to university health personnel, medical centres, nurses, counsellors, health educators and other professionals responsible for student welfare. The findings may help these professionals design health education and counselling programmes that address the actual behavioural patterns and knowledge gaps identified among students. WHO emphasizes combination HIV prevention approaches that include testing, condoms, PrEP, STI prevention and treatment, and appropriate information for adolescents and young adults (WHO, 2024, 2026).

The study will also be useful to university administrators and student-affairs departments. Evidence generated from the study may assist institutions in strengthening campus HIV/AIDS programmes, organizing health campaigns, improving access to confidential HIV counselling and testing, and supporting student-friendly reproductive health services. The findings may also assist universities in determining whether existing HIV/AIDS education programmes are adequately translating knowledge into protective behaviour.

The findings will be valuable to the Lagos State Ministry of Health, Lagos State AIDS Control Agency, NACA and other organizations involved in HIV prevention. Since Nigeria’s current HIV prevention strategy emphasizes young people and community-level prevention, evidence from university populations can contribute to the design and targeting of interventions for young adults. Current national planning also recognizes the need to sustain prevention gains and strengthen youth engagement in HIV prevention (NACA, 2026).

Finally, the study will contribute to existing academic literature on HIV/AIDS prevention, knowledge and sexual behaviour among young adults in Nigeria. It may serve as a reference for students, researchers and public health practitioners conducting further studies on HIV prevention in tertiary institutions. The study may also provide baseline information for future intervention studies examining the effectiveness of comprehensive sexuality education, peer education, HIV counselling and testing, condom promotion and other campus-based HIV prevention programmes.

1.8 Scope of the Study

The study will focus on HIV/AIDS prevention knowledge and risky sexual behaviours among undergraduate students in selected universities in Nigeria. The study will examine students’ knowledge of HIV/AIDS, including the meaning of HIV and AIDS, modes of transmission, symptoms, prevention methods, HIV testing, condoms, PrEP and other relevant preventive measures. It will also examine risky sexual behaviours, including early sexual initiation, multiple sexual partnerships, inconsistent condom use, casual or non-regular sexual relationships, sex under the influence of alcohol or other substances, and other behaviours relevant to HIV transmission.

The study will also consider selected socio-demographic characteristics of respondents, such as age, sex, level of study, marital status, religious affiliation and other characteristics considered relevant to the research. The study will be restricted to undergraduate students enrolled in the selected universities in Lagos State.

The study will not clinically test respondents for HIV infection. Rather, it will assess HIV/AIDS prevention knowledge and self-reported sexual behaviours through a structured research instrument. The study will focus on behavioural and preventive dimensions of HIV/AIDS rather than the clinical management of people living with HIV.

1.9 Operational Definition of Terms

Acquired Immunodeficiency Syndrome (AIDS): The most advanced stage of HIV infection in which the immune system has been severely weakened, making the affected person vulnerable to serious infections and other health conditions.

HIV/AIDS Prevention: Measures and behaviours designed to reduce the risk of acquiring or transmitting HIV, including safer sexual practices, condom use, HIV testing, PrEP, treatment of sexually transmitted infections and effective antiretroviral treatment.

HIV Prevention Knowledge: The accurate information possessed by undergraduate students concerning HIV/AIDS, including its causes, modes of transmission, risk factors, prevention methods, testing and treatment.

Human Immunodeficiency Virus (HIV): A virus that attacks cells of the human immune system and can progressively weaken the body’s ability to fight infections and diseases (WHO, 2026).

Undergraduate Students: Students formally enrolled in bachelor’s degree or other first-degree programmes in the selected universities in Lagos State.

Risky Sexual Behaviour: Sexual practices that increase an individual’s likelihood of acquiring or transmitting HIV or other sexually transmitted infections, including unprotected sexual intercourse, inconsistent condom use and multiple sexual partnerships.

Condom Use: The use of male or female condoms during sexual intercourse as a method of reducing the risk of HIV, other sexually transmitted infections and unintended pregnancy. Correct and consistent condom use is recognized as an effective HIV prevention method (WHO, 2025).

HIV Counselling and Testing (HCT): A voluntary health service through which individuals receive information and counselling concerning HIV and undergo testing to determine their HIV status.

Multiple Sexual Partners: Having sexual relationships with more than one sexual partner within a specified period.

Sexual Risk Perception: An individual’s assessment or perception of their likelihood of acquiring HIV or another sexually transmitted infection as a result of their sexual behaviour.

HIV/AIDS Awareness: The extent to which an individual has heard about or is generally familiar with HIV/AIDS and its existence, transmission or prevention.

Preventive Sexual Behaviour: Sexual practices adopted to reduce the possibility of HIV or STI transmission, including consistent condom use, reduction of multiple partnerships, HIV testing and informed partner communication.

Project – Assessment of HIV/AIDS Prevention Knowledge and Risky Sexual Behaviours among Undergraduate Students.