Knowledge, Practices and Challenges on HIV/AIDS Among High School Students in Wombera District, Benishangul Gumuz, Ethiopia

Human Immunodeficiency virus, commonly known as HIV infects the cells of human immune system and destroys them which later develop into an advanced condition called Acquired Immunodeficiency Syndrome. The aim of this study is to assess the knowledge, practices and challenges of HIV/AIDS infection and prevention among some selected high school students of Wombera district, Benishangul Gumuz, Ethiopia. Simple random sampling method was used to select the representative population. The data were collected through the multistage based close-ended and, open ended questionnaires. In addition, secondary data were collected through document observation. Among the total respondents, 46(38%) males and 45(37.2%) females know as HIV/AIDS is sexually transmitted disease. Generally, the results indicated that most of the students were aware of about the methods of transmission and prevention of HIV/AIDS infection. In spite of the high level of knowledge, there were also misconception and assumption toward the transmission methods of HIV/ AIDS infection.


INTRODUCTION
Human Immunodeficiency virus, commonly known as HIV, is a retrovirus that infects cells of the immune system by destroying or impairing their function leading to increased susceptibility to infections and which later develops into an advanced condition called Acquired Immunodeficiency Syndrome (AIDS) (Kline, 2014). AIDS is the final stage of HIV infection, and at this stage, it is necessary for victims to seek medical attention in order to prevent death and this condition declines the capacity of human body to fight against the diseases make the person vulnerable to all kind of infections which may eventually lead to death (Taher & Abdelhai, 2011). Since the first HIV case was recognized in the United States in 1981, it has spread rapidly throughout the world (Shiferaw et al., 2011). The first case of HIV in Ethiopia was reported in 1984. HIV prevalence varies with age, sex, and geographical location (Shiferaw et al., 2011).
Viewing adolescents as a specific group with their own needs is relatively a recent practice, especially in developing countries. Similarly, adolescents aged 10 to 20 years constitute 25 % of the population in Ethiopia (Okonkwo et al., 2005). According to the study of Agajie et al., 2015, young people are a significant part of the labor force and form the backbone of any country's economy. These groups are at high risk of HIV for a variety of reasons, such as lack of knowledge about HIV, not perceiving themselves to be at risk, lake of access to or inconsistent use of condom, increased number of sexual partners increased risk of exposure, biological factors (their cervical epithelium is more susceptible to infection), economic factors, social factors, being forced in to asexual relationship, lacking the skills and power to negotiate condom use and encountering gender norms. The health of young people is thus a key element for social and economic progress. Neglecting the sexual and reproductive health of young people can lead to high social and economic costs, both immediately and in the years ahead (WHO, 2002). According to Wombera woreda Healthy Office HIV/AIDS Prevention and control Case Team report 2017, the prevalence of HIV/AIDS in Benshangul Gumuz Region is about 0.61%. This shows that the prevalence of HIV/AIDS in the region is decreasing as compared to the 2011 EHDS report. High school students' knowledge about HIV/ AIDS might be varies by their socio-demographic characteristics such as age, gender, school type, family head income, and source of information. The study of knowledge of HIV/AIDS is considered a basic first step in the education process and prevention of the disease (Huda & Amanullah, 2013).Secondary school students' knowledge and practice (KP) on HIV/AIDS can be an indicator of the magnitude of the problem among youths. However, the knowledge and practice toward HIV/AIDS infection and prevention in Wombera secondary school students has not been studied so far. So, it is prudent to conduct this study among three selected secondary school students in this district in order to ascertain their knowledge and practice regarding HIV/AIDS. The study is also used to identify the extent of risk behavior and practice exposed to HIV/AIDS among students and to describe the relationship between the socio-demographic and economic characteristics with risk behavior related to HIV/AIDS.

Study design
A descriptive cross sectional survey method was used to collect the data. Quantitative data approach was applied to collect data from questionnaire and analyzed those collected data survey using descriptive approach. A qualitative method was also applied to collect data from key informants such as Kebele administrators and other members and youth representatives.

Sample size determination and sampling techniques
The populations of this study were students in three different high schools of Wombera District. Thus groups were used with the assumption that, they are sexually active and highly engaged in heterosexual activity, which is the main reason for HIV transmission among sexually active Ethiopian population (Negash et al, 2003). So the population number were 593 in Wombera high school, 204 in Senkora high school, and 154 in Sanki high school. So the total population was 951.For primary data collection, the representative samples of students were taken using Kothari (2004) formula: Based on the calculation, the population number of sample size selected were 593, 204 and 154from Wombera, Senkora, and Sanki high Schools, respectively. www.iiste.org ISSN 2224-7181 (Paper) ISSN 2225-062X (Online) Vol.79, 2020

Data collection method
Both primary and secondary data sources were used for the study. The sources of primary data of this study were students from secondary schools. The data gathering tools were close-ended, open ended questionnaires. Before the starting of data collection, the questionnaires were pretest on 10% of the students that did not included in main sampling population. Pilot test or pretest is a feasibility study which are "small scale version, trial run, done in preparation for the major study" (LoBiondo & Haber, 2017).This is important to check the validity of the questions used to remove or exclude vague or ambiguous questions which were not easily answered by students. The questionnaire was prepared based on the available literature reviewed to elicit HIV/AIDS knowledge and sexual practices. Questions that access the knowledge and challenge in prevention of HIV/AIDS in the study areas were prepared. The questions were prepared by English language and translated in to Amharic language by language experts in order to make more understandable for the respondents.

Socio demographic characteristics
Of the total respondents 47.9% (n=58) were male and 52.1% (n=63) were female. Of these, were 62% (n=75) were from Wombera high school, 21.5% (n=26) were from Senkora high school and 16.5% (n=20) were from Sanki high school. Of the total respondents, majority of the males 28.9% (n=35) involved in the study were found in the age group between 15-17 years old followed by the age group between 18-20 year old. Similarly, majority of the females 37.2% (n=45) were found in the age group between 15-17 years old.
The result indicated that about 66.1% (n=80) of the students in the study area were found in the age range of 15-17 year old (Table-1). 0 3(2.5%) 3(2.5%) Of the total respondents, about (63% (n=76), 29% (n=35), 7% (n=9) and 0.8%(n=1) of them live with their families, friends, alone and partner, respectively ( Figure.3).   As the result indicates, there is no significant difference on knowledge of HIV/AIDS transmission methods, but it also shows as there is significant difference in HIV/AIDS transmission through mosquito bite in both male and female students which indicates (X 2 =8.292, p>0.016) ( Table-6). Respondents' knowledge on the methods of prevention of HIV/AIDS indicated that about 63.6%(n=77) of the respondents has a knowledge on using condom every time they have sex., Of these, 33% (n=40) were females and 30.6% (n=37) were males, But still now about 36.4%(n=44) of the students don't know as condom is used to prevent transmission of HIV AIDS. About 5.8% (n=7) males and 8.3%(n=10) females respondents don't know the importance of abstain in HIV prevention. In general the chi square result about knowledge of using condom and faith full to one sexual partner for HIV prevention of both sex indicate that (X 2 =2.200, p<0.333) and( X 2 = 1.721, p <0.423) respectively. This shows that, there is no significant difference among both sexes in the study areas (

DISCUSSIONS
This study revealed that, only 37.2% of them were a habit of discussion about HIV/AIDS with their parents and about 62.8% of study participants were not discussed with their friends. This shows there is a gap in free discussion about HIV/AIDS infection with in the parents as well as with friends. The main modes of transmission of HIV known by the students were sexual intercourse (75.2%) followed by contaminated injection needles (79.3%) which is on similar line with study done in secondary school students in Northern Ethiopia (Melaku et al., 2014). While mosquitoes bite (35.5%), touch saliva of HIV infected person (52%) were the least. 59.5% of the respondents were answered as HIV can transmit from infected pregnant mother to child. This study shows that, even though the majority of respondents have knowledge about the transmission of HIV/AIDS from infected to uninfected, there is also knowledge gap in high school students that must be given attention to increase their knowledge, perception to avoid their misconception on transmission of HIV/AIDS from infected to uninfected. The study point out that, 72.7% of respondents agree on abstain from sexual intercourse is best way for prevention of HIV/AIDS. According to this study 62% of the study participants describe there are risk areas and conditions that increase their chance of vulnerability to HIV/AIDS infection. About 9.1% of respondents explains lack of giving more attention for HIV issues at high schools, is one factor.

CONCLUSION
The results indicate that most of the students were aware of about the methods of transmission and prevention of HIV/AIDS infection. Thus, 79.3% and 72.5% were aware of transmission through sharing unsterilized sharp material and sexual intercourse respectively. 63.6% and 72.7% of them were aware of using condom during intercourse and abstain from sexual intercourse before marriage are best mode of prevention of HIV/ AIDS infection. In spite of the high level of knowledge, there were also misconception and assumption toward the transmission methods of HIV/ AIDS infection. Among those assumed wrongly or miss conceptualized respondents, Mosquito bite 52.1%, eating raw meat prepared by HIV infected person 48.8% and touching saliva or sweat of infected person are mode of transmission.