Study instruments

Modified, standardized Interviewer administered questionnaires adapted from the Joint United Nations program on HIV/AIDS (UNAIDS) , Measure evaluation (MEASURE) and Family Health

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International (FHI) survey tool for accessing behavioural factors that influence HIV testing and health seeking behaviours were used. These modified questionnaires were pre-tested for clarity and appropriateness of the questions asked in Igbo- Etche community in the Etche LGA of the State which had not been selected for this study. During the pre-tesing, it was observed that respondents did not give consistent answers when their responses were graded as in a traditional Likert scale.

They were more specific when they were required to choose from one of two options. So in all sections where graded responses where required, a dichotomous grading system was used. Eight research assistants were trained over a three day period to administer the questionnaires and were transported to the study sites daily. A total of 76, 68 and 71 households were visited in Degema, Khana and Ahoada-East LGAs respectively.

Questionnaire themes were centred on study objectives and categorized into the following sections:

Section 1: Demographic data and history of testing Part A

Information on age, sex, marital status, educational history and occupation was recorded. Prospective recruits were also assessed for eligibility based on their age and the duration of residency within the community.

Part B

Participants were asked if they had tested for HIV or not.

Those who had tested were asked to select one option from a list of options that describes the reasons why they tested

Section 2: Knowledge

Respondents were asked a series of questions about their knowledge of HIV/AIDS transmission.

They were then assigned a score based on the number of question they answered correctly. A correct

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answer attracted a score of one (1) and a wrong answer, zero (0). The maximum score was nine (9).

Respondents were then classified as having good knowledge if their total score was greater than or equal to five (5) or poor knowledge if their total score was less than five (5).

Respondents were also asked to select one option that best describes their source of information about HIV.

Section 3: Risk perception and risk assessment

Respondents were asked to classify themselves into, ‘low chance’ and ‘high chance’ based on their perceived risk of getting infected with HIV. They were then asked questions regarding their sexual activities and history of blood transfusion to assess their risk for infection. Those who did not answer questions completely were excluded. Questions were weighted and assigned scores to determine actual risks. The maximum score was ten (10). Those with total scores greater than or equal to five (5) were classified as ‘high risk’, those with scores less than five were classified as ‘low risk’.

Section 4: Stigma

Both the respondents’ tendency to stigmatize and fear of stigma were assessed.

Part A: Stigmatizing Attitudes:

Respondents were required to express their agreement or disagreement to series of questions that qualified as stigmatizing statements against HIV positive persons. The questions were aimed at assessing their attitude towards HIV positive person. Each question was given a score (agree 2, disagree1, indifferent 0). Those who did not respond or who were indifferent were excluded. The maximum score was ten (10). Those who had total scores greater than five (5) were classified as

‘High stigmatizing tendencies’ whilst those with scores less than 5 were classified as ‘Low stigmatizing’.

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Part B: Observed Enacted Stigma

Respondents were asked a series of questions that assessed if they had ever observed how positive persons were treated in their community as a measure of their level of awareness of the existence of stigma within the communities. Each question was given a score (Yes- 2, No-1, indifferent- 0).

Those who did not respond or who were indifferent were excluded. The maximum score was ten (10). Those who had total scores greater than or equal to five (5) were classified as having a ‘High awareness’ whilst those with scores less than 5 were classified as having a ‘Low awareness’.

Section 4: Choice of Care for STI treatment

Respondents were asked if they had symptoms of any sexually transmitted infection within a given period of time and where they sort treatment. Choice of treatment provider for those who had a history of symptoms was recorded. Respondents were also asked about their preferred choice of provider based on severity of STI symptoms.

Qualitative data:

A total of six focus group discussions were carried out, three each for both men and women. The aim was to get more details on the following:

i. Concerns about HIV positive test result.

ii. Socio-cultural determinants of risky sexual behaviour.

iii. Factors that influence choice of care provider for treatment of STI.

(See appendix 7 for FGD Guide).

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Each group consisted of 10 persons (one man and one woman from each of the enumeration areas were selected using convenience sampling). All participants were within the required age range. Two of the groups (one for men and the other for women) were made up of persons who were married whilst the other four groups consisted of persons who were single.

Discussions took place at the health facilities in both communities and were moderated by the researcher. Health workers who were indigenes of the community or neighbouring communities were used as interpreters where necessary. The program started off with an opening prayer and a welcome address by the researcher. We all introduced ourselves by name and occupation, established some ground rules and then the researcher gave an overview of the research including some information on the epidemiology of HIV/AIDS infection in Rivers State and the purpose of the study. Participants were allowed to seek clarification on aspects they did not understand and then the discussion began in earnest. Light refreshments were served at the end of the deliberations and the program ended with a closing prayer.

All sessions were recorded except Female participants from the Gokana community who did not want sessions recorded. To ensure that correct information was recorded and no vital information was left out four research assistants took notes in each session. Sessions lasted for about one and a half hours each on the average and all discussions were held over a period of two days.