Willingness to Test for Human Immunodeficiency Virus (HIV) Infection among First-Year Students of a Public University in the Volta Region of Ghana

1. Introduction Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) remain issues of significant public health importance with a high burden of morbidity and mortality [1,2]. Globally, over 39 million AIDS-related deaths had occurred by 2019 and there are close to 2 million new infections every year [1,2]. In 2019 and 2020, AIDS-related deaths averaged 690,000 per year and though appreciable, this was a 39% reduction compared to estimates for 2010 figures [3,4]. An estimated 37.7 million people were living with HIV in 2020 and 84% knew their status compared to 81% in 2019 [3,4]. Voluntary counselling and testing (VCT) to know one’s status is a key prevention intervention which also promotes early treatment and care [5]. However, getting people to test of their own free will remains a major challenge [6]. This challenge is even more pronounced in young people aged 15–24 years as the proportion of people living with HIV who know their status is believed to be significantly lower in this population although they harbour about a third of all new infections globally [7,8]. Close to 50% of young people living with HIV, including those aged 15–24 years, are not diagnosed and linked to treatment to achieve viral suppression [7,9]. This situation stems from a low uptake of HIV testing services among them and threatens prevention and control efforts. The Joint United Nations Programme for HIV/AIDS’ target of having 95% Venereology 2022, 1, 212–222. Venereology 2022, 1 213 of people living with HIV know their status by 2030 [3] is likely to be threatened by such low uptake or willingness to test. Sub-Saharan Africa is home to two-thirds of global HIV infections with about 26 million people living with HIV/AIDS and 70% of AIDS-related deaths [10]. About 33% of new infections in this region in 2019 [3,10] occurred in the 15–24 age group in 2019. Low uptake of HIV testing has also been observed in this region and only about 35% of Ethiopian youth were found to have ever tested for HIV [11]. In Ghana and Kenya, 80–95% of young people aged 15–24 years, including university students, knew where to access HIV testing services but only about 45% had previously tested for HIV [12–14]. This suggests that access to testing services may not directly translate into uptake [12,13] and reinforces the observation of low willingness to test for HIV in this age group [5]. In contrast, other studies have also reported high uptake of HIV testing among university students [13,15,16] and the dynamics contributing to the variations need to be understood. Higher educational levels, moderate-to-comprehensive knowledge of HIV/AIDS, and risky sexual behaviour are positively associated with voluntary testing uptake [11], while stigma, perceived low risk of HIV infection, perceived lack of confidentiality on the part of health workers, fear of test outcomes, and the perceived psych