DEPARTEMENT OF HEALTH OFFICER

A RESEARCH PROPOSAL ON RISK PERCEPTION

AND EXPOSURE TO HIV/AIDS AMONG
NIGHT SECONDARY SCHOOL STUDENTS
IN BAHIR DAR CITY

By:
1. Eistifanos Bayable 8. Simeneh
2. Desta Tesema Meknonnen
3. Netsanet Ayen 9. Tiruwork Ahmed
4. Alachew 10. Muluzewd
5. Ferede Aychiluhm
6. Nigatu 11. Kessete Delele
7. Birara Takele 12. Fasil Alemu

Submitted to: Tadess Ejigu

January, 2012
Bahir Dar
Ethiopia

1
 Table of Contents

Contents
Page
1. Introduction....................................................................................................................3
1.1. Background of the study..............................................................................................3
1.2. Statement of the problem............................................................................................5
2. Literature Review..........................................................................................................7
2.1. The Situation of HIV/AIDS in Ethiopia.......................................................................7
2.2. Vulnerability of students to HIV/AIDS........................................................................8
3. Significance of the Study.............................................................................................9
4. Objectives of the study...............................................................................................11
4.1. General Objective.......................................................................................................11
4.2. Specific Objectives.....................................................................................................11
5. Materials and methods...............................................................................................11
5.1. Delimitation of the Study............................................................................................11
5.2. Design of the Study....................................................................................................12
5.3. Population, Sample size, Sampling Techniques and Study Units ......................12
5.4. Inclusion and Exclusion Criteria...............................................................................12
5.5. Data Collection Instruments......................................................................................13
5.6. Variables of the Study................................................................................................13
5.7. Procedure of Data Collection....................................................................................13
5.8. Data Analysis.............................................................................................................. 14
5.9. Data Quality Control...................................................................................................14
5.10. Ethical Consideration...............................................................................................15
5.11. Operational Definition..............................................................................................15
5.12. Dissemination Plan.................................................................................................. 15
6. Work Plan and Budget...............................................................................................16
Reference........................................................................................................................... 17
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1. Introduction
1.1. Background of the study
Ethiopia is one of the sub Saharan countries highly affected by HIV/AIDS pandemic.
According to the 2007 Ministry of Health report, the adult prevalence of HIV infection in
Ethiopia was estimated at 2.1% where most of the burden occurring among the young
age group (Federal Ministry of Health May 2007)

Since the first serological evidence in 1984; HIV had caused significant impact on
health, human resource and overall development of Ethiopia. Currently HIV/AIDS
infected many Ethiopians and the prevalence rate has been estimated to be high. This
makes the country one of the highest level of infection in Africa. It has a big share in the
number of HIV case at global and regional level with more than a population of 77
million (CSA, 2006). As of the estimate made by MOH (2007), there were approximately
1,216,908 Ethiopians infected with HIV by the year 2010.
As of the single point estimate made by EDHS (2007) as cited in life skill manual (MOH,
2008) the most affected segment of the population by the epidemic are youth of age 15-
24. In the country, HIV transmission occurs at disproportionately higher rates in urban
settings, with estimated prevalence of 7.7%, compared with 0.9% in rural areas. The
2005 EDHS report on HIV/AIDS by socio economic characteristics shows that urban
residents are significantly at high risk of HIV infection than rural residents, 6% and 0.7%
respectively. In the same report it is indicated that the risk of HIV infection is almost
identical in rural men and women.
The pattern and distribution of HIV in the country widely varies with the existing socio
cultural diversity of Ethiopia. Within the country some regions are more affected than
others, urban areas more than rural areas as well as women more than men, (CSA,
2006). The national HIV/AIDS epidemic is showing a decreasing trend in the main urban
area, stabilizing in the rural areas, and increasing in small towns (UNAIDS, 2010).
The primary mode of HIV transmission in Ethiopia is unprotected sex with infected
person. Young women are more vulnerable to infection than young men; urban women
are three times as likely to be infected as urban men, although in rural areas the

3
difference between genders is negligible. Populations at higher risk for HIV infection
include people in prostitution, police officers, youth, secondary school students and
members of the military (MOH, 2008).
According to 2007 data in Amhara region it was estimated that a total of 384, 290
people were living with HIV/AIDS, 165,607 were living in rural areas and 218,683 in
urban areas (single point HIV prevalence estimate) .The region accounted about
32.57% of the total people living with HIV/AIDS and almost 39.69% of the newly HIV
infected people were living in this region. This indicated that the Amhara is one of the
worst regions in the country with the highest burden relative to the other regions. It was
estimated that a total of 38,491 new HIV infections including 5,184 HIV positive births
and 27,217 people die from the disease (with 4, 198 children less than 15 years). It was
also estimated that there were about 356, 539 children who lost their parents in this
region (AIDS orphic ages 0-17) (ANRS HAPCCO, 2008 as cited in life skill manual, 2008).

Gashaw et al. (2004), described that the prevalence of HIV infection is low among high
school students in Gondar. In addition they stated that, even though the majority of the
students had adequate knowledge about HIV/AIDS, their perception of risk of
acquisition and practice of protected sex is low.

Similarly Abebe (2011), showed that female secondary and preparatory school students
in Bahir Dar has reasonably high knowledge of transmission of HIV/AIDS and means of
prevention but self risk perception of infection with HIV is low regardless of continued
high risk behavior.

In several other countries, the magnitude of the problem is very high among young
adults associated with risky behaviors. The government of Ethiopia has developed a
national policy on HIV/AIDS which is designed to guide the implementation of
successful programs to prevent spread of the infection (FDRE, 1998). Studies geared
that determining the magnitude of HIV infection and assessing behavioral risk factors of
its transmission and prevention among the various segments of the population in
Ethiopia are scarce (MOH, 2004). In order to plan intervention measures it is important
to undergo studies on people’s risk perception and exposure to HIV/AIDS. Therefore,

4
this study will be conducted to shed light on such issues by involving high school night
students in Bahir Dar City Administration.

1.2. Statement of the problem

Bahir Dar town is the capital of ANRS, seat for Regional Governmental and Non
Government organizations; home for tourist attraction places that host large number of
visitors. It is estimated that its total population is about 180,094. It is reported that the
total number of students in the day program in Bahir Dar town are about 12,383 (Dr.
Girmachew, 2010).
Despite the limited number of assessments available on the risk perception and
exposure to HIV/AIDS of students, figures from schools that have night program show
that students attending the night program are dominantly daily labourers and home
maids. Even though no concrete evidence on the exact prevalence of HIV/AIDS among
home maids is found, this segment of the population are subjected to multiple kinds of
abuse and violations from their employer and/or other family members and hence
getting to HIV/AIDS infection is apparently high coupled with low level of information
about the disease. The daily labourers are also among the most at risk population
groups identified in the Amhara MARPs study who are highly exposed to HIV/AIDS
infection.

According to Melkamu (2007), Bahir Dar has a wide range of high-risk groups including
commercial sex workers, university students, high school students, and migrant
workers. A common practice is cross-generational and transactional sex between young
girls and older men, especially between university girls and civil servants. High school
girls also have sex with older men in return for gifts and money. It is noted that high
alcohol and chat abuse among youth, which leads to unplanned and possibly unsafe
sex (Melkamu, 2007).

Currently secondary school students have been identified as most at risk population
groups for the transmission of HIV/AIDS (EPHA, 2009). In response to this
implementers on HIV/AIDS prevention and control are engaged in different activities

5
towards secondary school students. However, in our personal day to day observations,
we have seen as no HIV/AIDS intervention is being undertaken regarding night
students where many house maids and daily laborers are attending their education in
the night. Personal observations also show that night students are being seen engaged
in different risk behaviors. Despite this, recent studies conducted on night students are
generally lacking and are scanty in the area. Thus exploring the issue for evidence
based interventions are paramount important. Studies conducted so far on the factors
that expose night students for HIV/AIDS as well as their knowledge and risk perception
level are very few in the area .Even when they exist they are not up-to-date to show
the present reality. Appropriate information is needed to create appropriate evidence
based interventions adapted to the night secondary school students. Bahir Dar was
selected for the study context because there are relatively high numbers of night
students and is one of the HIV/AIDS hot spot areas. The study area is also selected by
the researchers for it is convenient as it is the researchers’ place of residence, and work
place on the other hand.
The researchers were inspired by the work of the joint Amhara region HAPCCO and
EPHA study on the findings of secondary school students where HIV/AIDS prevalence
rate was found to be 11.6% (EPHA, 2009). The need to give workable suggestions and
recommendations that facilitate action oriented activities and intervention in HIV/AIDS
prevention among night students at various levels in the city was also what motivated
the researchers to make an investigation in the area. This was what initiated the
researcher to assess the current knowledge and risk perception of night students. It also
seems worthwhile to investigate the factors that made risk for HIV/AIDS. In Line with
this the study is planned to be undertaken in order to answer the following basic
research questions:
 What are the factors that expose night students to HIV/AIDS in night secondary
schools of Bahir Dar City?
 What is the level of knowledge and risk perception of night secondary school
students regarding HIV/AIDS?
 What is the level of misconception of night secondary school students related to
HIV/AIDS?

6
  Is there sex difference in the knowledge and attitude level of night secondary
school students towards HIV/AIDS?
 Is there relationship between selected socio-demographic variables with risk
perception of night secondary school students?

2. Literature Review
2.1. The Situation of HIV/AIDS in Ethiopia
Ethiopia is one of the most severely affected countries in the world with regards to
HIV/AIDS. Since the first serological evidence in 1984; HIV had caused significant impact
on health, human resource and overall development of Ethiopia. Conscious of the rapidly
expanding epidemic, the government of Ethiopia has formulated national HIV policy and
has taken some measures to control and prevent the epidemic from spreading (MOH,
1999). As of MOH (2002) HIV/AIDS is one of the key challenges for the overall
development of Ethiopia, as it has led to a seven-year decrease in life expectancy and a
greatly reduced workforce.
Currently HIV/AIDS infected many Ethiopians and the prevalence rate has been
estimated to be high. This makes the country one of the highest level of infection in
Africa. It has a big share in the number of HIV case at global and regional level with
more than a population of 77 million (CSA, 2006). As of the estimate made by MOH
(2007), there were approximately 1,216,908 Ethiopians infected with HIV by the year
2010.
As of the single point estimate made by EDHS(2007) as cited in life skill manual (MOH,
2008) the most affected segment of the population by the epidemic are females in
Ethiopia especially of commercial sex workers. In the country, HIV transmission occurs
at disproportionately higher rates in urban settings, with estimated prevalence of 7.7%,
compared with 0.9% in rural areas. The 2005 EDHS report on HIV/AIDS by socio
economic characteristics shows that urban residents are significantly at high risk of HIV
infection than rural residents, 6% and 0.7% respectively. In the same report it is
indicated that the risk of HIV infection is almost identical in rural men and women.

7
The pattern and distribution of HIV in the country widely varies with the existing socio
cultural diversity of Ethiopia. Within the country some regions are more affected than
others, urban areas more than rural areas as well as women more than men,
particularly it is sever among commercial sex workers for reasons of different types
(CSA, 2006). The national HIV/AIDS epidemic is showing a decreasing trend in the
main urban area, stabilizing in the rural areas, and increasing in small towns (UNAIDS ,
2010).
The primary mode of HIV transmission in Ethiopia is unprotected sex with infected
person. Young women are more vulnerable to infection than young men; urban women
are three times as likely to be infected as urban men, although in rural areas the
difference between genders is negligible. Populations at higher risk for HIV infection
include people in prostitution, police officers, youth and members of the military (MOH,
2008).
In 2007 data, in Amhara region it was estimated that a total of 384, 290 people were
living with HIV/AIDS, 165,607 were living in rural areas and 218,683 in urban areas
(single point HIV prevalence estimate) .The region accounted about 32.57% of the total
people living with HIV/AIDS and almost 39.69% of the newly HIV infected people were
living in this region. This indicated that the Amhara region is the worst in the country
with the highest burden relative to the other regions. It was estimated that a total of
38,491 new HIV infections including 5,184 HIV positive births and 27,217 people die
from the disease (with 4, 198 children less than 15 years). It was also estimated that
there were about 356, 539 children who lost their parents in this region (AIDS orphic
ages 0-17) (ANRS HAPCCO, 2008 as cited in life skill manual, 2008).

2.2. Vulnerability of students to HIV/AIDS

The high and increasing prevalence of HIV/AIDS among youth in South Africa suggests
that prevention efforts need to be re-examined. Condom promotion, STI programs, the
HIV and AIDS Life Skills intervention, and mass media communications have been
deficient in reducing the incidence of HIV. HIV prevalence among youth in the 15 - 24
age group was 10.3%, but has increased among females to 16.9% and decreased

8
among males to 4.4% (Shisana et al. 2005). Youth in South Africa nevertheless continue to
practise risky sexual behaviours (Leclerc-Madlala et al. 2002)
Many have had their first sexual experience by age 14 or younger, even though the
legal age of consensual sex is 16.3 The ‘fertility conundrum’, whereby girls have to
demonstrate their fertility before marriage, is evident in many African cultures, and
further perpetuates the early age of sexual activity among youth.
The 2008 MARP survey in Amhara region which was conducted in secondary schools
and TVETs in 5 of 10 HIV “hot-spot” Woredas from a Sample Size = 389 students (male
= 156, female = 233) show that:
 Percent ever sexually active: 29%
 Sexually active in the last year: 19%
 Estimated HIV prevalence in students = 11.6%
• Males = 16%, females = 8%
• 33% among all students who reported a sexual partner in the last year
In addition, from a Routine surveillance in School-based VCT campaigns revealed HIV
sero-positivity rates of 0.3% – 7.6% (Unpublished data, Amhara HAPCO, 2009 – 2010)
According to the MARPs study conducted by fhi360 and other partners, issues identified
related to Risky behaviors of students in the selected hot spot areas including Bahir Dar
were:
• Most students are from zuria Weredas and stay by themselves
• Need money for different purposes / Sex for subsistence
• Practice High risk behavior – unprotected sex, multiple sexual partners, chat and
alcohol
• Sugar daddies
• Data shows that there are lots of abortion cases ( 360 abortion cases in one
semester from one school)
• For teachers uncommon to see their former students engaged in commercial sex
work in different towns around Bahirdar (Finoteselam, Debremarkos, Gondar).

3. Significance of the Study

9
This research is going to be useful to support all actors working on the prevention and
control of HIV/AIDS at any level. Yet, lots of assessments have been done on the
exposure and risk perceptions to HIV/AIDS among students at secondary and tertiary
level. However, there are limited or no assessment on risk perception of Night
Secondary school students. Thus, this assessment is going to be helpful in giving
insight to researchers or organizations operating on HIV/AIDS prevention and control.
Proper evidence based intervention for effective HIV/AIDS prevention and control
programs targeting night secondary school students will be designed based on the
study findings. The recommendations to be given by the researcher as per the findings
of the study could highly maximize the interventions towards these students who are
currently levelled as most at risk population groups. The information obtained from the
study would have also substantial contributions for those organizations working on
HIV/AIDS prevention on students to design appropriate interventions. Thus the
significance of the study includes:
 Showing the existing knowledge and risk perception of night secondary school
students to organizations working in HIV/AIDS prevention and control with schools
such as to the town HAPCCO and NGO in the city to design appropriate
interventions to minimize the transmission of HIV/AIDS. It would also give an input
for designing appropriate curriculum that could be used for peer education and
awareness creation by implementers of HIV/AIDS prevention and control activities
with schools in the town
 Making aware of the different actors working on HIV/AIDS about the factors that
expose secondary school students to HIV/AIDS so that evidence based
interventions will be designed for implementation to prevent these students from
HIV/AIDS. The general population would be highly benefited through the
education and awareness creation to be made based on the result of the study.
Particularly it gives input for night students to know their situation related to
HIV/AIDS around them.
 Initiating other researchers to undertake further investigation on the issue in a large
scale and serving as a bench mark for literature could also be the other relevance
of the study.

10
4. Objectives of the study

4.1. General Objective

 The general objective of this study is to examine the current knowledge and risk
perception of night secondary school students on HIV/AIDS and the factors that
expose night secondary school students for HIV/AIDS.

4.2. Specific Objectives

The specific objectives of the study will be:

 Identifying the factors that expose to night secondary school students to HIV/AIDS
 Investigating the current knowledge and risk perception level of night students
regarding HIV/AIDS ways of transmission and prevention
 Examining sex difference in the knowledge and attitude level of night secondary
school students towards HIV/AIDS
 Assessing the level of misconceptions related to HIV/AIDS among night secondary
school students
 Exploring the relationship between selected socio-demographic variables with risk
perception of night secondary school students.

5. Materials and methods

5.1. Delimitation of the Study

The study will only try to examine the current knowledge, attitude and risk
perception of night students on HIV/AIDS. Besides it will also investigate the factors
that expose night students to HIV/AIDS and the relationship between selected
socio-demographic factors with perception of risk. The study will be made only with
night students in Bahir Dar City secondary schools. Factors like practice of night

11
 students towards HIV/AIDS and condom use will not be investigated in this
research.
5.2. Design of the Study
A cross-sectional study design will be used for the study purpose.
5.3. Population, Sample size, Sampling Techniques and Study Units
of the Study
The target population of the study will be all secondary school night students attending
their education during night times in Bahir Dar City Administration. Students in eleven
secondary schools of Bahir Dar city (i.e. Tana Haik, Fasilo, and Ghion…) will be the
target populations for the study. All students will be considered as target population
while selecting the sample. To select the sample systematic random sampling
technique will be used. Currently, there are about 2500 night secondary school
students in Bahir Dar city in 11 schools. Out of these a total of 672 students will be
selected as participants of the study.

 Level of confidence is 95%

 Margin of error is 5%
 As there is no any prior study on it, the value of P is considered 50%
 The result based on the above assumptions will be multiplied by 2 for design effect
 15% non response rate will be added on the above result

n=(Z/2)2P(1-P)/ d2 n=384

Finite population correction formula will be used since the total population is less
than 10,000. Hence
nf= ni n= 384 n= 292
1+ni/N 1+384/1222

5.4. Inclusion and Exclusion Criteria

12
All night students who are above the age of 15 will be included. However, students who
are not day students and willing to cooperate will be excluded from the study.

5.5. Data Collection Instruments

A pre-tested closed ended questionnaire will be used to collect quantitative data from
randomly selected night secondary school students. The items of the questionnaire will
be adapted from previously conducted similar researches in the area or else it will be
developed by the researcher with the support of the advisor .The development of the
items will be guided by study objectives, conceptual framework of related literatures and
the study issues under consideration. Only items that are related to the objectives of the
study will be included in the questionnaire. Items that measure the same variable will
also be grouped together in the questionnaire. The questionnaire will be initially
designed in English and then translated to local language (Amharic). The translation
will be made by the researcher in consultation with English language professionals
having extensive experience. For triangulation purpose qualitative data will be collected
through in-depth interview from selected night secondary school students using semi
structured interview guideline

5.6. Variables of the Study

Dependent variable

The dependent variable selected for the research will be risk perception and knowledge
of night secondary school students related to HIV/AIDS.

Independent Variables

In this study the specific independent variables employed will be age, grade level, Sex,
nature of out of school work they are engaged in, training on HIV/AIDS, etc.

5.7. Procedure of Data Collection

13
Before collection of data, the questionnaire will be pilot-tested in similar settings. The
required adjustment will be made after the pre-test. Permission will be asked from the
school. After getting permission Intensive orientation will be given for the sample
students about the objectives of the study and contents of the questionnaire before they
fill out the questionnaire by the researchers. It will be told to the participants to read the
instruction carefully and to respond to each of the items genuinely. The time of data
collection will be during class room sessions. At the end of the quantitative data
collection process, 12 night students will be selected for the in–depth interview through
lottery method. These students will be selected from those that were included in the
quantitative study. The in–depth interviews will be conducted in places where there will
be no interruptions, and privacy will also be well maintained. The in depth interviews will
then be transcribed before the data is analyzed.

5.8. Data Analysis

The recent version of SPSS 16.0 software will be used for data entry and analysis. The
data will be cleaned at two stages to maintain the quality of the data. Prior to data entry,
the entire questionnaire will be manually checked for being properly filled by students.
Then checking after data entry will be done by the researcher to ensure proper entry of
the information in to SPSS.
The result will be presented using simple frequencies, percentages and bar graphs to
put on view the descriptive part of the findings. Regression analysis will be done at 95%
confidence interval and p value less than 0.05 as significant level to show the strength
of the association between the independent and dependent variables. Crude and
adjusted odds ratios will be calculated using regression analysis. The data collected
through interviewing will be analyzed in a narrative form to support the quantitative
result.

5.9. Data Quality Control

To ensure data quality, in addition to training the research team, checklist will be
prepared starting from the sample selection to the end of interviewing the respondent.

14
A day to day basis checking of collected data will be undertaken so that problems
encountered in that specific day will not be repeated again in the next day. In addition,
the day to day checking helps to take a lesson for future work. The data collection
procedure is going to be organized in to three level hierarchies. The first level is the
data collectors and the second level is the supervisors and the third level is the research
team. Thus, at any point in time the supervisors are going to provide technical
assistance to data collectors on the spot. However, problems that might be beyond the
level of supervisors will be communicated and responded by the research team.
Finally, each questionnaire collected will have a sign and seal of the school from which
the data is collected to avoid data fabrication.

5.10. Ethical Consideration

Permission will be sought from Regional HAPCO and respective schools.
Confidentiality and privacy of study participants will be maintained. Participants will be
informed about their right not to participate, not to tell a certain information if they do not
want to or even to withdraw without being denied from any possible benefit. Data will be
collected after obtaining verbal consent from each study participant.

5.11. Operational Definition

Night students: students who are attending classes (learning) in the evening,
especially for people who are at work during the day time.
Risk perception: the information, awareness, knowledge, understanding, and attitude
of night students about the exposure to HIV/ADIS.
Exposure: the experience of night students coming in contact with HIV/AIDS that has a
potentially harmful effect.

5.12. Dissemination Plan

The findings of the study will be submitted to GCMS. In addition, the result will also be
submitted for actors who are currently working or potentially involved on HIV/AIDS
prevention and control special consideration will be given to organizations focussing on

15
students or youth. If possible, publication on journals will also be taken in to
consideration.

6. Work Plan and Budget

No Reasons Estimated
Budget in birr
1 For Internet 1,000.00
2 For Printing and Questionnaire duplication 3,800.00
3 For Binding 600.00
4 For Typist and Data entry clerk 2,000.00
5 For Transportation 1,000.00
6 For Photo copy of materials, Journals & 2,000.00
Books
7 Tea and coffee during Interview 1,000.00
8 Data collectors 4000.00
Others 1,000.00
Total Cost 16,400.00

Time Schedule
NO Main Activities Date
1 Submission of Proposal 05 – 27/05/2004 E.C
2 Questionnaires and other qualitative 27 – 30/05/2004 E.C
instruments preparation
3 Questionnaires distribution 20 – 25/06/2004 E.C
4 Analysis and discussion of results 01 – 30/07/2004 E.C
5 First draft Submission to the advisor 15 – 20/08/2004 E.C

16
 6 Second draft Submission to the advisor 10 – 15/09/2004 E.C
7 Final Thesis Submission 25 /09/2004 E.C

Reference

1. Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence,
HIV Incidence, Behaviour and Communication Survey. Pretoria: Human
Sciences Research Council, 2005)
2. Leclerc-Madlala S. Youth, HIV/AIDS and the Importance of Sexual Culture and
Context. Center for Social Science Research, Aids and Society Research Unit,
University of Cape Town, 2002).
3. Federal Ministry of Health (FMoH), National Consensus Meeting on single point
HIV prevalence estimate: Palace Hotel, Adama, Ethiopia, 11-12 May 2007
4. Dr. Girmachew Mamo, Amhara MARPS project for IAs Sub agreement
development workshop, Bahir Dar
5. Shisana South African National HIV Prevalence, HIV Incidence, Behaviour and
Communication Survey. Pretoria: Human Sciences Research O, Rehle T,
Simbayi LC, 2005)
6. Leclerc-Madlala S. Youth, HIV/AIDS and the Importance of Sexual Culture and
Context. Centerfor Social Science Research, Aids and Society Research Unit,
University of Cape Town, 2002 et al.)

17