THE RELATIONSHIP BETWEEN THE UPTAKE OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) TESTING AND STIGMA AMONG UNIVERSITY STUDENTS IN THE KLANG VALLEY
Keywords:Uptake, HIV testing, HIV Stigma, University, Students
The prevalence of Human Immunodeficiency Virus (HIV) is on the rise among adolescents and young people and these people are frequently subjected to significant levels of stigma, resulting in most of them avoiding HIV testing services. This study aimed to identify the prevalence of HIV testing uptake and its associated factors among students who were willing to undergo HIV testing. A cross-sectional study across five campuses within the Klang Valley was conducted between March to May 2020. Data were collected using an online self-administered questionnaire and the HIV Stigma Scale (HSS) was used to assess perceived stigma towards people with HIV. The results were analyzed using SPSS 26.0 and the prevalence of HIV testing uptake and its associated factors were assessed using multiple logistic regression. A total of 305 students showed a willingness to undergo HIV testing, with only 17% (95% CI; 13.0,21.0)(N=52) of the students ever undergoing an HIV test. The overall stigma associated with HIV was found to be high (93.4%) among the students. Students enrolled in non-health-related courses (AOR=0.33, 95% CI; 0.15,0.73), 5th year students (AOR=0.13, 95%CI; 0.02, 0.78), older aged people (AOR=1.35, 95% CI; 1.03,1.78), and those who had multiple sexual partners (AOR=5.28, 95% CI 1.42,19.60) were significantly associated with HIV testing uptake. Although stigma was associated with HIV testing in simple logistic regression, it was not significant in the multivariate logistic analysis and there was no correlation between HIV uptake and HIV-related stigma. The prevalence of HIV uptake among students was low, and it was discovered that variables acting as facilitators were students who engaged in risky behaviors, and that these variables should be formulated and incorporated into advanced university-based programs to harness the potential of testing and expand it to periodic HIV testing.
HIV/AIDS [Internet]. [cited 2022 Jul 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids
Global HIV & AIDS statistics — Fact sheet [Internet]. [cited 2022 Jul 13]. Available from: https://www.unaids.org/en/resources/fact-sheet.
Asia-Pacific region facing a “hidden epidemic” of HIV among adolescents, new report finds [Internet]. [cited 2022 Jul 13]. Available from: https://www.unicef.cn/en/press-releases/asia-pacific-region-facing-hidden-epidemic-hiv-among-adolescents-new-report-finds.
REPORT MALAYSIA 2015 [Internet]. Available from: https://www.moh.gov.my/index.php/file_manager/dl_item/
Anita S, Chai PT. Country Progress Report on HIV / AIDS Response 2019 Malaysia. HIV/STI/Hepatitis C Sect Minist Heal Malaysia. 2019;(March):42.
Innovative WHO HIV testing recommendations aim to expand treatment coverage [Internet]. [cited 2022 Jul 13]. Available from: https://www.who.int/news/item/27-11-2019-innovative-who-hiv-testing-recommendations-aim-to-expand-treatment-coverage.
Nkuna E, Nyazema NZ. HIV Self-Testing, Self-Stigma and Haart Treatment at the University of Limpopo: Health Sciences Students’ Opinion and Perspectives. Open AIDS J. 2016;10(1):78–82.
Dagne S, Agedew E, Misikir D, Haftu D. Voluntary Counseling and Testing Utilization and Associated Factors among Arba Minch University Students, South Ethiopia. J AIDS Clin Res.2017;08(06):6–11.
Izizag BB, Situakibanza H, Mbutiwi T, Ingwe R, Kiazayawoko F, Nkodila A, et al. Factors associated with acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC). Pan Afr Med J. 2018;31:1–9.
Woke FI. The role of socio-demographic factors in voluntary counselling and testing uptake in South Africa. Diss Abstr Int Sect B Sci Eng. 2016;77(6-B(E):Sefe.
Tade O, Adekoya AJ. Transactional sex and the “aristo” phenomenon in Nigerian universities. Hum Aff. 2012;22(2):239–55.
Hansson M, Stockfelt L, Urazalin M, Ahlm C, Andersson R. HIV/AIDS awareness and risk behavior among students in Semey, Kazakhstan: A cross-sectional survey. BMC Int Health Hum Rights. 2008;8:1–10.
Ajzen I, Joyce N, Sheikh S, Cote NG. Knowledge and the prediction of behavior: The role of information accuracy in the theory of planned behavior. Basic Appl Soc Psych. 2011;33(2):101–17.
Rénette J, Jacobs J, Vergnani T. Trends in HIV risk behaviour of incoming first-year students at a south African university: 2007–2012. Sahara J. 2015;12(1):39–50.
UNAIDS. Global partnership for action to eliminate all forms of HIV-related stigma and discrimination. 2018;20.
Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: Findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS. 2013;27(11):621–7.
Okumu E, Jolly DH, Alston L, Eley NT, Laws M, MacQueen KM. Relationship between human immunodeficiency virus (HIV) knowledge, HIV-related stigma, and HIV testing among young black adults in a southeastern city. Front Public Heal. 2017;5(MAR):1–7.
Sanga Z, Kapanda G, Msuya S, Mwangi R. Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: A cross sectional study Health behavior, health promotion and society. BMC Public Health. 2015;15(1):1–9.
Fu G, Shi Y, Yan Y, Li Y, Han J, Li G, et al. The prevalence of and factors associated with willingness to utilize HTC service among college students in China. BMC Public Health. 2018;18(1):1–10.
Nall A, Chenneville T, Rodriguez LM, O’Brien JL. Factors affecting hiv testing among youth in kenya. Int J Environ Res Public Health. 2019;16(8):1–14.
HIV/STI Sector Disease Control Division Ministry of Health Malaysia. Integrated Biological and Behavioural Surveillance Survey (IBBSS). Minist Heal Malaysia. 2014;127.
Not DO. 2015 State and Local Youth Risk Behavior Survey. 2015;1–20.
Yuan L, Li X, Li X, Shi J, Jiang L, Zhang C, et al. Factors associated with willingness to participate in free HIV test among general residents in Heilongjiang, Northeast China. BMC Infect Dis. 2012;12:2–9.
Mwangi RW, Ngure P, Thiga M, Ngure J. Factors influencing the utilization of Voluntary Counselling and Testing services among university students in Kenya. Glob J Health Sci. 2014;6(4):84–93.
Ibrahim K, Kombong R, Sriati A. The Difference of Perceived HIV Stigma between People Living with HIV Infection and Their Families. Nurse Media J Nurs. 2019;9(2):117–27.
Nobre N, Pereira M, Roine RP, Sutinen J, Sintonen H. HIV-Related Self-Stigma and Health-Related Quality of Life of People Living With HIV in Finland. J Assoc Nurses AIDS Care. 2018;29(2):254–65.
Charles B, Jeyaseelan L, Pandian AK, Sam AE, Thenmozhi M, Jayaseelan V. Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India - A community based cross sectional study. BMC Public Health. 2012;12(1).
Li Z, Sheng Y. Investigation of perceived stigma among people living with human immunodeficiency virus/acquired immune deficiency syndrome in Henan Province, China. Int J Nurs Sci. 2014;1(4):385–8.
UNAIDS Terminology Guidelines [Internet]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2118_terminology-guidelines_en.pdf.
Facts about HIV Stigma | HIV Basics | HIV/AIDS - CDC [Internet]. [cited 2022 Jul 13]. Available from: https://www.cdc.gov/hiv/basics/hiv-stigma/index.html.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Res Nurs Heal. 2001;24(6):518–29.
Toolkit Shell for Developing New Applications - OpenEpi [Internet]. [cited 2022 Jul 13]. Available from: https://www.openepi.com/SampleSize/SSPropor.htm.
Tsegay G, Edris M, Meseret S. Assessment of voluntary counseling and testing service utilization and associated factors among Debre Markos University Students, North West Ethiopia: A cross-sectional survey in 2011. BMC Public Health. 2013;13(1).
Khawcharoenporn T, Chunloy K, Apisarnthanarak A. Uptake of HIV testing and counseling, risk perception and linkage to HIV care among Thai university students. BMC Public Health. 2016;16(1):1–12.
Choi EPH, Wong JYH, Fong DYT. Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students. Vol. 56, Journal of Sex Research. 2019. p. 1023–30.
Madiba S, Mokgatle M. Students want HIV testing in schools a formative evaluation of the acceptability of HIV testing and counselling at schools in Gauteng and North West provinces in South Africa. BMC Public Health. 2015;15(1).
Abiodun O, Sotunsa J, Ani F, Jaiyesimi E. Knowledge of HIV/AIDS and predictors of uptake of HIV counseling and testing among undergraduate students of a privately owned university in Nigeria. BMC Res Notes. 2014;7(1):1–8.
Abdullah A, Ismail AH, Mooi CS. Stigma Among Patients with HIV/AIDS: A Cross Sectional Study in Malaysia. Int J Hum Heal Sci. 2019;4(1):26.
Kingori C, Adwoa Nkansah M, Haile Z, Darlington K-A, Basta T. Factors Associated with HIV Related Stigma among College Students in the Midwest. AIMS Public Heal. 2017;4(4):347–63.
Rasel Faruk S, Chowdhury MK, Kamal SB, Ahmed Shamim SM, Mohit I. STD/ AIDS Asia and world perspective. Vol. 3, Clinical and Medical Investigations. 2018.
Lieber E, Chin D, Li L, Rotheram-Borus MJ, Detels R, Wu Z, et al. Sociocultural contexts and communication about sex in China: informing HIV/STD prevention programs. AIDS Educ Prev. 2009;21(5):415–29.
Svensson, et. al SW. Knowledge of and attitudes to sexually transmitted diseases among Thai university students. Caring Sci. 2013;18–21.
Fadzil NA, Othman Z, Mustafa M. Stigma in Malay patients with HIV/AIDS in Malaysia. Int Med J. 2016;23(4):324–7.
Kim YK, Small E, Okumu M. School-based HIV/AIDS education, risky sexual behaviors, and HIV testing among high school students in the United States. Soc Work Health Care. 2019;58(3):258–73.
Xu H, Xie J, Xiao Z, Xiao H, Li X, Goldsamt L, et al. Sexual attitudes, sexual behaviors, and use of HIV prevention services among male undergraduate students in Hunan, China: A cross-sectional survey. BMC Public Health. 2019;19(1):1–9.
Sukari O. Barriers and attitudes towards HIV Voluntary Counselling and Testing (VCT) among Secondary School Pupils of Sengerema in Mwanza. Off Publ Tanzania Med Students’ Assoc [Internet]. 2007; Available from: https://www.ajol.info/index.php/dmsj/article/view/49596/35924.
Oppong Asante K. HIV/AIDS knowledge and uptake of HIV counselling and testing among undergraduate private university students in Accra, Ghana. Reprod Health. 2013;10(1):1–8.
Irmayati N, Yona S, Waluyo A. HIV-related stigma, knowledge about HIV, HIV risk behavior and HIV testing motivation among women in Lampung, Indonesia. Enferm Clin. 2019;29(xx):546–50.