Importance of social media in engaging young people on Human Immunodeficiency Virus ( HIV ) prevention

This paper dealt with the importance of social media in engaging young people on Human Immunodeficiency Virus (HIV) prevention. The data used in this study, was obtained through a social media survey conducted among young unmarried tertiary graduates between the ages of 15 to 35 who are working in Abuja Nigeria and activities of the National Agency for the Control of AIDS (NACA) on Facebook from 9 August, 2010 to 30 April, 2014. Respondents were made up of 42.6% males and 57.4% females. The predominant age group is between 26 and 30 (49%). Facebook was the most popular social media site as indicated by respondents. Out of 48% of the respondents who indicated they had sex within the last three months, only 38% claimed to have used condoms and 20% respondents have never had a HIV test. As at 30 April, 2014, NACA Facebook page amassed 2,593 likes. Males were predominant (80%) and 2,404 of the fans are from Nigeria. NACA sponsored competition for youth aged 18 to 29 years on the development of HIV prevention posters attracted a good amount of attention. The winning poster attracted 242 likes and 187 comments and the first runner up got 243 likes and 93 comments. The use of social media networking services to engage young people is recommended to organisations engaged in HIV and other related infections.


INTRODUCTION
From 1997 to 2010, social media users grew to 1.5billion and Facebook topped the list with over 901million users.Over 500 million people interact daily with Facebook and Facebook provides an invaluable resource for fulfilling the basic human need for social connection (Kross et al., 2013).Majority of social media users fall within the age bracket of 16 to 44 years (Olowu and Seri, 2012).Nigeria has a population of 167 million people (Olokor, 2012) out of which 48, 366, 178 are internet users and 113, 195, 591 are mobile subscribers (Terragon, 2013).About 75% of Nigeria's population is under the age of 35, and about 50% below are 18 years old (Ogunlesi, 2013).
Nigeria is the largest internet user in Africa.Internet users in Nigeria are made up of 67% male and 78% are between the ages of 19 and 35 years.Students represent 45% of internet users in Nigeria (Terragon, 2013).The Fact Bound Survey Report of 2012 on social media usage among Nigerians revealed that most of the respondents recruited for the survey were aged between 23 and 38 years.There were at least 9 million social media users in Nigeria (Terragon, 2013), out of which, 5, 357, 500 are Facebook users (Ogunlesi, 2013).According to a recent survey, Fact Bound identified networking and communication as the two most popular uses of social media in Nigeria, and Facebook was by far the most popular and widely used social media platform in the country (Ogunlesi, 2013).This makes social media an important media platform to reach young people in Nigeria.
About half of all persons living with Human Immunodeficiency Virus infection / Acquired Immunodeficiency Syndrome (HIV/AIDS) are said to be below the age of 25, and majority of the remaining may have been infected in their youth.The impact of HIV on young people has continued to generate increasing global medical, social, economic, political and academic interests (Babatunde, 2007).Before Social media became popular, HIV prevention messages were mainly disseminated through conventional media such as electronic and print media.Even though this practice is still an acceptable form of information dissemination, social media has become a very important medium of information dissemination because of its popularity among young populations.HIV prevalence in Nigeria increased from 1.2% in 1991 to 5.8% in 2001.After 2003, the prevalence declined to 4.4% in 2005 before slightly increasing to 4.6% in 2008.Results from the latest round of sentinel survey shows that the national prevalence is 4.1% in 2010.Analysis of the HIV prevalence trend in Nigeria indicates that the epidemic has halted and is showing signs of stabilizing at 4% from 2005 till date (FMOH, 2010).
In 2008, infection rates among young people in Nigeria aged 15 to 19 was put at 3.3%; 20 to 24 at 4.6% and 25 to 29 at 5.6%.These are considered very high and a key national strategy in the current national strategic framework is to direct focus on national HIV prevention efforts to address this trend (UNFPA, 2009).The National Sentinel Survey conducted in 2010 revealed that infection rates are still considered high among young people at 3% (15 to 19); 4.6% (20 to 24) and 5.4% (25 to 29) (FMOH, 2010).While new HIV infections have declined among children, adolescents and adults since 2000, HIV-related deaths have risen sharply among adolescents, especially 15 to 19 year-old males (Carole, 2014).Analysis of United Nations Programme on HIV/AIDS (UNAIDS) 2012 HIV and AIDS Spectrum estimates showed a 50% increase in AIDS-related deaths between 2005 and 2012 among adolescents aged 10 to 19 years (Leach, 2014).
The huge population of Nigerian youth with access to social media provides a platform to accelerate access to public health information messages.This paper therefore, examines the importance of social media in engaging the youth in Nigeria, in order to provide them with vital information on HIV and other public health issues.

MATERIALS AND METHODS
The study utilised data obtained through a social media survey conducted among young unmarried tertiary graduates between the ages of 15 to 35 who are working in Abuja.The young unmarried graduates were selected from the National Youth Service Corps (NYSC) scheme and were recruited voluntarily from the HIV/AIDS club which they belonged to as part of their community development service obligations.Structured questionnaires with objective and open ended questions were distributed to the 120 randomly selected young persons who met the criteria already described during their NYSC HIV/AIDS club meeting days.Out of this number, 101 questionnaires were returned.Other data sources included activities of the National Agency for the Control of AIDS (NACA) on Facebook (https://www.facebook.com/nacanigeria)from 9 August, 2010 to 30 April, 2014, and a HIV prevention poster competition conducted for youth aged 18 to 29 years.These data were used to demonstrate the practical use of social media in engaging youth in support of the objectives of this paper.Relevant literature obtained from journal articles, the internet and other sources were also used.Descriptive statistical methods on Microsoft Excel and qualitative appraisals were used to analyse and present information relevant to the objectives of this paper.

Result of social media survey
The demographic distribution of respondents from the social media survey conducted for young unmarried tertiary graduates between the ages of 15 and 35 is presented in Table 1.Facebook was the most utilised social media site while Twitter and Google+ were other important social media sites according to respondents (Figure 1).Majority of the respondents logged into social media sites every hour.Respondents also indicated that they logged into social media sites in the morning and evenings on a daily and weekly basis.With regards to total number of hours spent on social media sites in a day, the respondents predominantly indicated that they spend between 30 mins to 1 h a day on social media sites.Other important indications were between 1 to 2 h and 2 to 3 h (Figure 2).Social media is mostly used for chatting as indicated by respondents.There were also important indications that social media is widely used for education, learning and sharing of messages (Figure 3).A good percentage of respondents (73%) indicated that they have never seen a message on HIV prevention on social media and 96% thought that HIV prevention messages on social media were useful (Table 2).Despite the enthusiasm demonstrated by respondents on the usefulness of HIV prevention messages on social media, only 40% have never shared HIV prevention messages in chats and status posts (Table 2).Some respondents (48%) indicated they had sexual intercourse in the last three months but only 38% indicated that they used a condom (Table 2).Further analysis of these figures revealed that 23% of males and 25% of females indicated they had sex in the last three months.However, only 20% of males and 18% of females indicated they used condoms when they had sex.As revealed in Figure 4, 32% of the respondents had HIV test within the last 3 months and another 27% had HIV test within the last 3 to 6 months.20% of them indicated that they have never had an HIV test.

Result of NACA Facebook analysis
The National Agency for the Control of AIDS Nigeria joined Facebook on the 9 of August, 2010.As at 30 April, 2014 the page had attracted 2,593 mostly unpaid likes.
The results presented in this paper can serve as a reference point for future studies when NACA begins paid advertisements to reach a wider audience on Facebook.
Information on the fan base is presented in Table 3.

Respondents (%)
Social media  Majority of the fans were male and came from Nigeria.The predominant age bracket was 18 to 34 years and this age group is quite active in social media activities according to literature.The percentage distribution of fans in Nigeria is presented in Table 3 and Figure 5.This is also a measure of interest on the subject of HIV/AIDS.The internet can be accessed in Nigeria today on most mobile devices and not only through computers as used to be the case.This has improved access to some social media sites like Facebook.However, as earlier stated in the introduction, literature revealed that a little over 5 million Nigerians are on Facebook out of the over 100 million that access mobile telecommunication services.

Respondents (%)
As shown in Figure 5, the highest numbers of NACA Facebook fans in Nigeria were from Lagos and Abuja.
The figure shows the first fifteen cities with the highest number of fans.

Result of HIV prevention poster competition
The first three posters with the most number of likes and comments at the end of the competition were chosen as winners and presented with mobile telephone recharge cards.The competition attracted a large number of entries and proved to be an interesting one.The number

Nigerian cities
No. of Facebook fans  of likes and comments for the first five entries is presented in Table 4. Fourteen out of the fifteen poster entries were coloured and the most predominant colours used were red and green.The first five winning posters had common images of cartoon characters and common phrases.The most common phrase was "Know your HIV status today."The posters that attracted more likes and comments were more creatively designed and utilized the colour red very richly.

DISCUSSION
In many parts of the world today, individuals, groups, organisations and even nations are taking advantage of the opportunities provided by social media and other electronic-media platforms to mobilise millions of people to support and advance their course (Okoro and Nwafor, 2013).Facebook is the most popular social media site among internet users in Nigeria as stated in the introduction of this paper.Results from the social media survey conducted for young people in Abuja also support this assertion (Figure 1).Other popular social media networks among Nigerian users are Twitter, Google+, Skype, BlackBerry Chat, and YouTube in no particular other.The results show that a large number of Nigerian youth can be reached with important HIV information through social media.This potential exists and can be explored by all organisations dealing with issues of public health in Nigeria.The frequent use of social media will actively engage the attention of youth and will keep them reminded of obligatory practices to keep them safe and healthy.
As revealed in the survey results (Figure 1), Facebook and Twitter are the most widely used social media sites.Social media campaigns on public health issues such as HIV can refocus their efforts on reaching Nigeria youth through these popular social media sites.As indicated in Figure 2, most youth logged into social media sites every hour.This tends towards addiction as described in Olowu and Seri (2012).According to Ende and Udende (2011), young people spend an overwhelming amount of time on media, and Oyero (2013) found that social networks have become a primary source of information for young people.This means public health messages on social media should be more frequent as these can be viewed more frequently by youth.Doing this, will keep such messages longer in the minds of young people and may begin to stimulate conversations on such messages.It is important to structure public health campaign messages in a pleasant and appealing way to attract young people's attention.This is important because stigma around sexual health also affects sexual health communication in social media and social networking sites (Evers et al., 2013).
As shown in Table 2, though majority of respondents thought HIV messages on social media were useful, majority claimed they had never shared HIV message on social media.If HIV messages for social media are designed with the involvement of young people, it will have a wider appeal and acceptance and this will begin to feature more in social media conversations.This is because most respondents indicated (Table 2) they used social media for chatting, education and sharing of messages.This finding was similar to findings in Awan and Gauntlett (2013).The networking potential of the online social media environment is seen to influence young people's decisions in negotiating difficulties that can arise offline, in terms of forging identities and managing relationships (Dunne et al., 2010).Table 2, also revealed that messages on condoms and HIV testing should become a priority for social media campaigns as many respondents indicated they did not use condoms in their last intercourse and a high percentage (Figure 4) have never had HIV test.Social media is a useful platform to pleasantly and wittingly present the importance and benefits of condom use and HIV testing to the teeming number of young social media users.
Analysis of the NACA Facebook page, revealed that social media attracts an international audience and is not limited to a local audience.The NACA poster competition has demonstrated that paid advertisements reach a wider audience and enable the selection of a target audience.This allows public health campaigns for issues such as  , 2013).The report mentioned gender disparities and large variation in prevalence rates across states as a problem to be given more attention.Also mentioned were shortfalls in access to treatment for persons living with HIV/AIDS and the prevention of mother-to-child transmission.Furthermore, low comprehensive and correct knowledge of HIV/AIDS among males 52.2% and females 34.3% was mentioned in the report.In summary, the social media survey results have highlighted significant data on condom use, HIV testing among young people and social media use.Social media has an important role to play in providing the growing number of internet users in Nigeria who are predominantly young people with necessary information on HIV/AIDS.As revealed in results presented, young Nigerians are available to be reached with HIV Prevention messages and other information necessary to create demand for services.Targeted and paid advertisements will intensify the reach and coverage of relevant messages as demonstrated in the NACA HIV prevention poster competition.The number of Nigerians using social media networking sites will continue to grow.It is therefore, important that organisations involved in HIV/AIDS programmes begin to strategically tap into the huge potentials available in the number of social media users in Nigeria.

Conclusion
Social media networking has become popular globally.Internet users in Nigeria are not left behind as they have increasingly embraced social media networking.Data presented, show that Nigerian youth constitute the bulk of the population of the country and are the most active social media users.Data from a social media survey and NACA Facebook page demonstrated the importance of using social media to strategically engage young people on HIV prevention.The social media platform has the potential to viably support the prevention programmes of other public health issues.It is therefore, necessary for all organisations engaged in coordinating and implementing HIV and other related infectious diseases to embrace the active use of social media services to strengthen prevention programmes.

Figure 1 .Figure 2 .
Figure 1.Percentage of respondent indications for social media sites used.

Figure 3 .
Figure 3. Percentage indications for social media use among respondents.

Figure 4 .
Figure 4. Percentage respondents for time interval between last HIV tests.

Figure 5 .
Figure 5. Distribution of NACA Facebook fans in some Nigerian cities.

Table 1 .
Demographic distribution of respondents.

Table 2 .
Percentage respondent indications for questions on HIV prevention and sex.

Table 4 .
First five winners of the NACA HIV prevention message poster competition. S/