Human Immunodeficiency virus (HIV) infection produces a potentially devastating and transmissible disease of the immune system but with the introduction and strict adherence to antiretroviral therapy, it has become a chronic manageable disease, with people infected with HIV now living a long, healthy and productive life [1] [2] .

In 2012, an estimated 2.1 million adolescents worldwide were living with HIV, with about 33% of all new infections occurring in young people aged 15 - 24 years, out of which, 39% occurred in adolescents aged 15 - 19 years [3] .

In 2015, Western and Central Africa had an estimated 6.5 million people living with HIV, out of which, 500,000 were children (0 - 14 years) and 650,000 were young people (15 - 24 years). Also in that year, newly acquired infections were estimated to be 410,000 out of which, 66,000 were children, 110,000 were young people and 36,000 were adolescents (15 - 19 years) with an estimated 60% of these new infections occurring in Nigeria [4] .

Adolescence is a period of vulnerability with the onset of multiple risky behaviour such as smoking, inappropriate alcohol consumption and drug use, with the consequences of an increased risk of engaging in unprotected, multiple sexual experiences [3] [5] . This further exposes the adolescent to HIV/AIDS and other sexually transmitted diseases, and as such, they are central to the prevention and control of the HIV/AIDS epidemic with respect to the degree of their vulnerability, transmission and potential for behavioral change [6] .

In spite of the fact that in-school adolescents are still under some form of guidance from parents, caregivers or school authorities, they appear to be influenced mostly by their peers and the environment; and as a consequence, they are involved in experimenting in sexuality, sexual orientation and other new experiences [3] [7] . In Central and West African region, it has been reported that up to 16% of adolescent girls had sex before the age of 15 years and as such, it has been recognized that adolescence is a period when sexual activity begins [7] [8] . This early commencement of sex, fueled by the lack of adequate information within the context of social, cultural and economic factors, provides more opportunities over time for an increased risk of exposure to HIV [7] [8] .

Even with the knowledge of HIV/AIDS, adolescents still have several misconceptions about transmission and they do not perceive themselves to be at risk of being infected, as this could encourage the practice of unsafe sexual behavioral habits [3] [9] [10] [11] . This lack of appropriate health information coupled with limited access to reproductive health services, economic and sexual exploitation, early coerced sex and participation in other risky behaviour will also predispose the adolescent to increased risk of HIV infections [12] [13] .

The adolescents, not only have an increased risk of HIV/AIDS from behavioral transmission but also from vertical transmission (mother to child). The infection from vertical transmission could be slow, progressing from infancy into adolescence without treatment; as up to 33% of HIV infected infants not commenced on treatment, become slow progressors with a median survival of more than 10 years [14] . Vertical transmission is as significant as behavioral transmission in the spread of HIV/AIDS within the general population, as a substantial epidemic of perinatally infected adolescents appear to be emerging because their mothers were missed or not covered by prevention of maternal to child transmission (PMTCT) programmes or they were lost to follow-up. Hence, there is an increasing proportion of perinatally infected HIV children who are entering adolescence undiagnosed. Furthermore, in high prevalent areas, HIV is becoming a common cause of acute hospital admissions and death among adolescents [13] [15] [16] . Therefore, instituting the practice of adolescent HIV counselling and testing (HCT) is critical to the prevention and control of HIV/AIDS.

HCT uptake among adolescents has been low, due to factors such as perception of staff judgmental attitude, confidentiality of the process and result, stigmatization and more especially the policy regarding age of consent to testing [9] [13] . The age of consent serves as a barrier which further limits certain groups of adolescents from accessing HCT because of the requirement to inform and get consent from their parents or guardians; as adolescents are often reluctant to seek services that require parental consent [4] .

In Nigeria, the adolescents’ rights are limited, as there are several issues surrounding the age of consent especially for HCT among adolescents, as this has hampered progress in adolescent management and research of HIV/AIDS and other sexual reproductive health issues. In 2014, the Nigerian Federal Ministry of Health issued guidelines for age of consent in therapeutic and non-therapeutic research; as any person aged 16 and 13 years and above respectively [17] . Notwithstanding, this still poses an additional barrier to addressing the sexual reproductive issues of adolescents especially within the ages of 13 - 16 years who are now increasingly experimenting and engaging in unsafe sexual activities with the risk of being infected [3] [8] . So the assessment of the knowledge, attitude and prevalence of HCT among senior secondary in-school adolescents, will enable the identification of gaps in their knowledge, attitude and uptake of HCT and therefore, form the basis for the introduction of adolescent-tailored strategies which will also include, the advocacy of policies to remove age restrictions and other adolescent barriers.

Three hundred copies of the questionnaire were administered and were completely and correctly filled giving a response rate of 100%.

This study assessed the Knowledge, Attitude and the Prevalence of HIV Counselling and Testing among senior secondary in-school adolescents and it revealed that the majority of the respondents had a poor level of overall knowledge and attitude towards HCT with a very low prevalence of HCT uptake. It further revealed that the overall level of knowledge among the respondents was significantly associated with the overall level of attitude towards HCT.

In the present study, the awareness of HIV/AIDS among the respondents was high and it was observed that the school was the most important source of information followed by the media, specifically the television. This was similar to a Cameroonian study by Haddison et al. [21] among high school students, where it was observed that there was high awareness of HIV/AIDS and their source of

*Multiple responses.

*Significant.

information was mainly from the school followed by the media. Other studies also reported a high level of HIV/AIDS awareness [9] [11] [22] [23] [24] but Nubed et al. [9] a Cameroonian study, reported that, while the school was the main source of information, the television was the least source for the students. This was contrary to a Nigerian study by Bamise et al. [23] who reported that, the media specifically television was the major source of information for secondary school adolescents. Also, an Indian study by Kameshore et al. [24] , reported that books, teachers and media in that order were the main sources of information. Though, it was observed commonly across these studies that there is a high awareness of HIV/AIDS among adolescents, it was also observed that, their main sources of information varied. Hence, in order to continue to improve knowledge and maintain the high level of HIV/AIDS awareness among successive cohorts of adolescents, it is important that the multi-channel approach to information dissemination be strengthened; and continue to remain a part of the strategy in addressing adolescent health issues.

In spite of the high level of awareness observed in the present study, there is a need to improve the comprehensive knowledge of HIV among the adolescents, as a relatively sizeable proportion of the respondents still had misconceptions of HIV/AIDS transmission; for example, where some respondents reported that sharing toilet, eating with infected persons, sharing towels/ handkerchiefs and mosquito bites were the modes of HIV transmission and also, where only a small proportion of the respondents were aware of intravenous drug use as a high risk behaviour, with more than half of the respondents either not knowing or having reported that, condom use cannot prevent HIV infection. These misconceptions about HIV transmission among the respondents were also observed in other studies [9] [11] [24] [25] . Furthermore, in Nigeria, Aomreore et al. [26] also reported that, knowledge about the transmission of HIV was poor in senior high school students and this, further highlighted the existing concerns of misconception as a source that could perpetuate HIV transmission and discriminatory attitudes. Hence, it is important that the information being disseminated about HIV/AIDS is comprehensive, and it continues to emphasize on condom use as a preventive measure and also, on the various modes of transmission, as this may further help reduce transmission, stigmatization and discrimination of people living with HIV/AIDS.

HCT is one of the main strategies for reducing the transmission of HIV, providing access to preventive services and reinforcing preventive messages on HIV. It may, in addition, also reduce risky behavioral tendencies among people who have received a HCT and are HIV negative [2] . In the present study, the prevalence of HCT among the respondents was as low as 7% which appear to be consistent with the NDHS 2013 [20] that reported a prevalence of 7.7% among adolescents within the ages of 15-19 years. Similarly, a previous study by Ibrahim et al. [27] analyzing the Nigerian National HIV/AIDS and Reproductive Health Survey 2007, also reported a prevalence as low as 10% among young people within the ages of 15 - 24 years. On the contrary, some other studies [9] [21] [28] [29] appear not to be consistent, as they reported higher prevalence rates of HCT among young people as ranging from 19% - 41%.

Generally, the prevalence of HCT uptake among young people in a community or region seems to be dependent on the impact of HIV disease, public policies and the degree of public health efforts. This may explain to some extent, why there are varying degrees of HCT uptake amongst them, across regions. Nevertheless, any strategy that improves knowledge and a positive attitude towards HCT among the young people especially the adolescents within a youth friendly, non-judgmental and confidential environment, will also be fundamentally important and beneficial in improving uptake; because, any increase in HCT knowledge and positive attitude during the adolescents’ period, will definitely be facilitated by the effect of peer influence.

Furthermore, the study by Haddison et al. reported that, the uptake of HCT was significantly associated with knowledge and attitude towards HCT. Though the present study found that, the level of overall knowledge was significantly associated with the level of overall attitude, there were observed knowledge and attitudinal gaps. These gaps were further highlighted in the present study, where it was observed that, a majority of the respondents had a poor level of overall knowledge and attitude, which could also, have contributed to the low uptake of HCT observed among the respondents.

In spite of the fact that most of the respondents in the present study were aware of HCT, the gaps were obvious, for example, where a majority of the respondents did not know of any HCT location, with up to one quarter of them, having reported that HCT should be sought only before marriage and also, when more than one third of the respondents felt that, being tested for HIV is not needed since they are unlikely to be exposed. A similar attitude was observed in a study among secondary school students by Tarkang et al. [10] who reported that a majority of them did not perceive themselves to be at risk of being infected with HIV. Similar gaps in knowledge and attitude, in spite of high level of HCT awareness, were also observed in other studies which for example, reported that, up to one third to half of the respondents either did not know where to go for HCT services or did not feel that HCT was meant for students or necessary for them [21] [28] [29] . Finally, this study emphasizes on the need to improve HCT knowledge and attitude amongst in-school adolescents; because, an adequate and appropriate knowledge and attitude towards HCT is fundamentally required, in order for adolescent tailored strategies for HCT uptake to be effective.

In-school adolescents, a subgroup of different developmental levels and behavioral risks, have in common some form of parental or guardian supervision. In spite of this, they are exposed to risky behavioral tendencies within the context of inadequate knowledge and poor social values which further exposes them to the risk of HIV and other sexually transmitted diseases. The in-school adolescents are poorly equipped to handle these situations, not only because they are faced with socio-political and environmental challenges of uptake of preventive and treatment measures such as HCT, they lack comprehensive knowledge and the appropriate attitude towards these measures. So improving knowledge and attitude of adolescents towards HCT will close the knowledge and attitudinal gaps and form the basis for the implementation of adolescent tailored strategies that address their socio-political and environmental challenges and consequently encourage and improve the voluntary and confidential uptake of HCT.

We thank all the participants in this study and the research assistants who helped during the data collection.

All the authors participated in the study.

The authors hereby declare that there are no competing interests.

There was no external source of funding.

Iwu, A.C., Chineke, H.N., Diwe, K.C., Duru, C.B., Uwakwe, K.A., Azuike, E.C., Madubueze, U.C., Abejegah, C., Ndukwu, E.U. and Ohale, I. (2017) Knowledge, Attitude and the Prevalence of HIV Counselling and Testing among Secondary In-School Adolescents in Orlu Local Government Area, Imo State, Nigeria. World Journal of AIDS, 7, 77-91. https://doi.org/10.4236/wja.2017.72008