Sexual Behaviour Driving the Epidemic
In the latest Nigeria Demographic and Health Survey (2003) early sexual debut and multiple sexual partnerships among youths are the main driving forces behind the epidemic:

* 20% of women age 15-19 debut at age 15
* 8% of men age 15-19 debut at age 15
* 2.2% of women (15-24) had 2+ partners past 12 months
* 8.4% of men (15-24) had 2+ partners past 12 month
Meanwhile the use of contraceptives was found to be low among teens and youths
* 3.2% of girls and 6.4% of boys aged 15-19 were currently using modern methods of contraception.
Ad hoc surveys of the general population revealed equally high levels of sexual risk taking. The one group that was actively doing something about pregnancy prevention were mostly married female clients of the few family planning clinics.

Promoting Dual Protection: 1999 to 2001

It was these features of sexual behaviour that informed the initial operations research response of ARFH between 1999 and 2001 through the implementation of the dual protection project with Worlds AIDS Foundation funding. Dual protection was the logical starting point given the relative indifference to the slow spread of the HIV epidemic in most parts of Nigeria a decade ago. The four general principles in the promotion of dual protection among women in family planning clinics were:
* Focus is on barrier method as single or dual method protection
* Its effectiveness based on consistent use in all doubtful sexual contacts
* Its adoption requires critical self-assessment of risk
* Its acceptance requires male and female cooperation

Because of the poor response of male partners to the adoption of barrier methods and the female condom the operations research focus shifted to the involvement of male partners in the promotion of dual protection and the female condom. A couple male involvement project was conducted between 2001 and 2003 focusing on the joint appeal to couples to consider the sexual and reproductive health risks of unprotected sex and reliance on hormonal contraceptives which offer no protection against STIs in general and the emerging HIV infection. The achievements of that phase of the operations research included the significant interests shown by males in barrier methods once they are alerted to the implications of persistent objection to such methods.

HIV Awareness Creation and Behavioural Change Communication: 2001 to 2003

By 2001, the increasing awareness of the HIV/AIDS epidemic and the evidence of increase in HIV prevalence encouraged the transfer of the lessons learnt from the clinic based dual protection project to the wider audience. Consequently ARFH embarked on the first of the AIDS Prevention Initiative in Nigeria sponsored projects with the introduction of dual protection and HIV prevention awareness creation in the following settings:
10 traders were trained in peer education, HIV basics and counseling, DP from each of 5 Ibadan markets with combined daily transit traffic of over a million persons. They were also trained in promotion and distribution of male condoms. organization of beahviour change activities in open forum in each market on monthly basis and in the organization of outreach activities to other markets.
Dual Protection was also promoted in 87 public secondary schools among the senior secondary school students. Two student peer educators and two teacher-counselors were trained per school in HIV counseling, referral and group activities needed to change behaviour.
Staff of 43 doctor or nurse-owned facilities in Ibadan were also trained in HIV counseling and promotion of dual protection and in outreach activities. The trained staff were given supplies of IEC material, male and female condoms and registers. Basic records of activities including referrals were kept. And regular updates on HIV prevention for proprietors were conducted.
The multimedia methodology of behaviour change in the different settings included use of sketch drama series, health talk, video clips and question and answer sessions on a monthly basis. The achievements from this phase of the HIV prevention operations research include the following:
* A total of 400 were involved in training on Peer education, Counseling, IEC and condom distribution
* 12 updates were conducted for over 100 doctors and nurses on HIV/AIDS management
* 15 outreach activities were organized by groups of schools, health facilities and markets in local communities
Substantial changes took place in sexual behaviour with respondents reporting fewer partners, increased use of condom, abstaining from sex, avoiding blood transfusion and a few testing for HIV infection.

HIV Surveillance Project: 2003 to 2005

Armed with the experiences on the market awareness and behavioural change phase and in response to increasing demand by the population for opportunities to take the HIV test, ARFH embarked on the HIV surveillance project in 2003. It was implemented in partnership with the Department of Virology, College of Medicine, University College Hospital, Ibadan. The project implementation was preceded with appropriate institutional capacity building in data management, ethical and laboratory standards.
The project strategies and activities included four rounds of 6-monthly HIV and Syphilis testing in 4 markets involving over 1300 volunteers; treatment of Syphilis; distribution of vitamin supplements and distribution of male and female condoms.
The achievement of the project included a doubling of condom use in one year from 27% to 67% and a reduction in multiple sexual partnership from 18% to 13 % (ref.). Respondents also reported a less discriminatory disposition to persons living with HIV than was observed at baseline.

HIV Counselling and Testing (HCT) Clinics: 2005 to Date

The final phase of the HIV prevention operations research started in July 2005 with the establishment of 2 HCT clinics in Ibadan and Ogbomoso, Oyo State, Nigeria. They were to take on the post project demand for HIV testing from the market population and from the neighbouring communities. In addition, the HCT clinics provided an entry point into the national ART programme for those who test HIV positive. Support for the running of the HCT clinics is coming from APIN+/PEPFAR sources.

The Way Forward

The next steps arising from the high patronage of the HCT clinics is to provide the necessary adherence, care and support services for those testing HIV positive so as to assure their quality of life living with the infection.
Publications arising from the operations research are listed below:

Monograph Series
Reproductive Health/Family Planning
Manual / Curriculum
Instructional Flipcharts
Brief on WHO Project


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P.O. Box 30259 Secretariat, Ibadan , Oyo State, Nigeria.


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