ACTIVITY DESCRIPTION:

This project increases demand for, improves quality of, and creates linkages to the following services: ARV,

HCT, and PMTCT through education, promotion and referral by community advocates and safe spaces

youth clubs (SSYC).

While sero-prevalence in Nigeria is lowest in the Muslim North, the recipe for a rapidly expanding epidemic

exists in this area due to high prevalence pockets of HIV and high prevalence of STIs. Four of the eight

project states register the highest rates in the country including Benue (10.0%), Nasarawa (6.7%), FCT

(6.3) and Niger (5.3%). Rates of syphilis in Niger (15.3%), Katsina, (7.5%), and Taraba (6.3%) States far

exceed the national prevalence of 0.5%, while knowledge of STI prevention is lowest in these same areas

(NARHS, 2003).

Several factors contribute to the potential for the epidemic to expand rapidly in the North: low literacy among

women; low perceived personal risk; polygamy with high rates of divorce and re-marriage; high fertility; and,

low status of women and corresponding lack of control of household expenditures for health and education.

Further, modern health facilities are generally mistrusted and there is a pervasive belief that early marriage

protects girls from HIV. Over half of North West girls aged 15-24 are married by age 15, higher in rural

areas where roughly two-thirds are married by age 15. Eighty one percent are married by age 18. The

majority of girls in the North experience first sex in the context of marriage, with only 5 percent of girls in

North West and 11 percent of girls in North East reporting sex before marriage (Erulka, A. et al. Population

Council, 2007).

The HIV Prevention for Vulnerable Girls Project contributes to the Emergency Plan Five-Year Strategy by

reducing exposure to HIV among young women by delaying onset of sexual activity through abstinence,

delaying marriage, increasing fidelity and promoting condom use among male partners of married

adolescents. The project targets semi-rural, rural, and urban pre-marital, married, and post-married

adolescent girls who are vulnerable to exposure for HIV and STIs. Secondary targets include male partners

of adolescent girls including future and current husbands of married adolescents. Other target population

groups include the husbands and parents, religious leaders, women and community leaders who are major

influencers of the primary target group. Finally, the project targets mobile and migrant men, transport

workers, STI clients, and uniformed services.

The project operates in eight states: Adamawa, Bauchi, Benue, Borno, FCT, Kano, Nasarawa and Niger.

Sub-awards granted to partner multiplier national NGOs include AHIP, FOMWAN, IET, and AfrHP.

Adolescent Health and Information Projects (AHIP) conducts advocacy training for adolescents. Federation

of Muslim Women's Association/Nigeria (FOMWAN) and Islamic Education Trust (IET) provide training to

community/religious leaders, parents, and husbands at community advocacy meetings. Trained religious

leaders include messages in Friday/Sunday sermons while messages are conveyed to youth in Islamiya

schools. African Health Project (AfrHP) provides technical support for greater male involvement to prevent

inter-generational sex, coercive sex, and STI prevention and treatment.

Key program elements carried out in COP07 included training through Days of Dialogue (DoD) and other

advocacy training, community-level advocacy sessions conducted by a trained network of over 180

community advocates (CAs), and HIV counseling, particularly pre-marriage counseling, and referral to

community-based service delivery points for HCT, ARV, and PMTCT. In COP07, over 150,000 AB contacts

have been made, plus 225 community advocates trained. This represents just under half the target for

COP07 which has been accomplished in just over a single quarter. In COP08, the intervention strategy will

change to conform with new strategic guidance of reaching each individual with a minimum of 3 strategic

interventions in appropriate dosage and intensity of messages and services for a more highly targeted set of

beneficiaries.

COP08 activities will promote abstinence and fidelity for adolescent girls and their male partners, protective

male norms and behaviors, and link communities and service delivery points through direct referral. The

HVAB prevention package for each participant will consist of: 1) community awareness campaigns through

small group discussions; interpersonal communications; and community dialogues, 2) peer education

through the safe spaces youth clubs (SSYC) model consisting of a series of 14 modules led by trained peer

mentors; and reinforced by social peers of lay religious leaders who advocate using religion to support delay

in marriage, 3) reducing vulnerability in adolescent girls through social support, life skills training, savings

mobilization, income generation, and conditional cash transfers, 4) curricula and non-curricula based

approaches to incorporate secular topics of HIV and AIDS prevention, reproductive health, hygiene, and life

-skills in Islamiya school curricula and after-school activities; 5) mass media activities using radio

spots/jingles and phone-in radio discussion slots to stimulate public dialogue and debate on early marriage,

vulnerability of young girls, protective practices of men, and risk reduction through AB.

As per OGAC TA recommendations, COP08 focuses on male involvement to promote abstinence and

mutual fidelity, prevent inter-generational sex and coercive sex. A fourth multiplier organization, the African

Health Project (AfrHP), was added in COP07. In COP08, AfrHP will introduce and support enhanced male

involvement activities to promote AB. As part of the AB program area, AfrHP will support a referral voucher

system by validating the referral and, mapping of service delivery points.

LINKS TO OTHER ACTIVITIES:

This project is linked to ART (3.3.10), HCT (3.3.09), and PMTCT (3.3.01) services.

POPULATION BEING TARGETED:

Population targeted are adolescent girls in the north and central belts of Nigeria. Additional population

targets are men both as gatekeepers to reach young girls with information and as resources to prevent HIV.

Others are male partners of adolescent girls including future and current husbands of married adolescents,

parents, religious leaders, women and community leaders.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will contribute to the Emergency Plan Five-Year Strategy in preventing new HIV infections

among vulnerable youth—especially unmarried adolescent girls and those engaged to be married—who are

most at risk and underserved by promoting the delay of sexual initiation and abstinence to reduce HIV

prevalence or avert infection.

Community advocacy AB activities will be conducted with targeted beneficiaries including young girls pre-

during- and post-marriage, men engaged in extra-marital relations, women engaged in transactional sex,

and other significant persons like parents, religious leaders, and community leaders.

The AB activity is based on the Safe Space Youth Clubs (SSYC) methodology developed in COP07. Each

quarter, the SSYC participants will receive the HVAB intervention package specified above. SSYCs will be

established in communities where each of the 140 CAs is based. Each CA will support 2 SSYCs per

quarter, totaling 8 SSYCs per year. A total of 1120 SSYCs will be established in COP08. Each SSYC

consists of up to 35 members. A total of 39,200 participants will benefit from these SSYCs. A quarter of

SSYC participants will be non-married adolescent girls who will receive A-Only messages as a subset of

those reached with the AB intervention package, totaling 9600 young women.

Activity Narrative: Each of the 140 CAs will be retrained in peer group methodologies to support SSYCs, including HCT

training for 70 CAs, peer support and mentoring techniques, counseling support for prevention with

positives, couples counseling techniques focused on discordant couples, gender based violence prevention,

and skills training to provide livelihood support to participants. As a result of the trainings, 9600 individuals

will have received HIV prevention, care, support, or treatment services in COP08.

12 sub-grantee staff will receive in-service training for project related activities in finance and project

management. 1 sub-grantee will apply for a NPI APS by the end of COP08. The three established sub-

awards will total $55,000 per year, with the fourth sub-award to AfrHP for $25,000. At the end of COP08,

AfrHP will submit an NPI proposal to compete independently for funding by PEPFAR.

EMPHASIS AREAS:

The activity complements emphasis areas including male involvement in prevention activities, strategic

information (SI), gender equity, human capacity development, and local organization capacity building.

HVSI will be supported through a PHE to identify the barriers to use of the female condom in military and

non-military communities. IEC will be addressed through the development of radio messages featuring

community/religious leaders and their weekly sermons. Strategic information—M&E, IT, reporting—will be

addressed through the MIS to track project outputs while the BSS will measure the project's impact.

ACTIVITY DESCRIPTION:

This project increases demand for, improves quality of, and creates linkages to the following services: ARV,

HCT, and PMTCT through Condom and Other Prevention activities including condom messaging and

distribution, STI syndromic management training and referral, male involvement in HIV prevention, and

promotion and referral by community advocates (CAs) through safe spaces youth clubs (SSYC).

While sero-prevalence in Nigeria is lowest in the Muslim North, the recipe for a rapidly expanding epidemic

exists in this area due to high pockets of HIV and high prevalence of STIs. Four of the eight project states

register the highest rates in the country including Benue (10.0%), Nasarawa (6.7%), FCT (6.3) and Niger

(5.3%). Rates of syphilis in Niger (15.3%), Katsina, (7.5%), and Taraba (6.3%) States far exceed the

national prevalence of 0.5%, while knowledge of STI prevention is lowest in these same areas (NARHS

2003).

Several factors contribute to the potential for the epidemic to expand rapidly in the North: low literacy among

women; low perceived personal risk; polygamy with high rates of divorce and re-marriage; high fertility; and,

low status of women and corresponding lack of control of household expenditures for health and education.

Further, modern health facilities are generally mistrusted and there is a pervasive belief that early marriage

protects girls from HIV. Over half of North West girls aged 15-24 are married by age 15, higher in rural

areas where roughly two-thirds are married by age 15. Eighty one percent are married by age 18. The

majority of girls in the North experience first sex in the context of marriage, with only 5 percent of girls in

North West and 11 percent of girls in North East reporting sex before marriage (Erulkar, A. et al. (2007)

Population Council).

The HIV Prevention for Vulnerable Girls Project contributes to the Emergency Plan Five-Year Strategy by

reducing exposure to HIV among young women by delaying onset of sexual activity through abstinence,

delaying marriage, increasing fidelity and promoting condom use among male partners of married

adolescents. The project targets semi-rural, rural, and urban pre-marital, married, and post-married

adolescent girls who are vulnerable to exposure for HIV and STIs by virtue of their marital status and

underserved by current programming. Secondary targets include male partners of adolescent girls who are

the primary vectors of exposure to HIV and STIs, including future and current husbands of married

adolescents. Other target population groups include the husbands and parents, religious leaders, women

and community leaders who are major influencers of the primary target group. Finally, the project targets

MARPs including mobile and migrant men, transport workers, STI clients, and uniformed services.

The project operates in eight states: Adamawa, Bauchi, Benue, Borno, FCT, Kano, Nasarawa and Niger.

Sub-awards granted to partner multiplier national NGOs include AHIP, FOMWAN, IET, and AfrHP.

Adolescent Health and Information Projects (AHIP) conducts advocacy training for adolescents. Federation

of Muslim Women's Association/Nigeria (FOMWAN) and Islamic Education Trust (IET) provide training to

community/religious leaders, parents, and husbands at community advocacy meetings. Trained religious

leaders include messages in Friday/Sunday sermons while messages are conveyed to youth in Islamiya

schools. African Health Project (AfrHP) provides technical support for greater male involvement to prevent

inter-generational sex, coercive sex, and STI prevention and treatment.

Key program elements carried out in COP07 included training through Days of Dialogue (DoD) and other

advocacy training, community-level advocacy sessions conducted by a trained network of over 180

community advocates (CAs), and HIV counseling, particularly pre-marriage counseling, and referral to

community-based service delivery points for HCT, ARV, and PMTCT. In COP07, over 150,000 AB contacts

have been made, plus 225 community advocates trained. In COP08, the intervention strategy will change to

conform with new strategic guidance of reaching each individual with a minimum of three strategic

interventions in appropriate dosage and intensity of messages and services for a more highly targeted set of

beneficiaries.

As per OGAC TA recommendations, COP08 focuses on male involvement to prevent inter-generational

sex, coercive sex, and STI prevention and treatment. A fourth multiplier organization, the African Health

Project (AfrHP), was added in COP07. In COP08, AfrHP will introduce and support enhanced male

involvement activities with strong linkage to AB program. Under the OP program area, AfrHP will facilitate

partners to develop appropriate condom messages for MARPs, particularly for husbands of adolescent girls.

AfrHP will support of a referral voucher system by validating the referrals, mapping of service delivery points

(STI, HCT, ARV, PMTCT, OVC, MCH, RH, and PwP). Further, AfrHP will develop and support community-

based condom services and messaging for married and married discordant couples, train and support STI

syndromic management in three clinics. Clinic support will include training for healthcare providers and lay

counselors to deliver prevention messages during routine clinic visits using tools and job-aids.

The HVOP/Condom prevention package for each participant will consist of: 1) community awareness

campaigns through small group discussions; interpersonal communications; and community dialogues, 2)

peer education through the safe spaces youth clubs (SSYC) model consisting of a series of 14 modules

using led by trained peer mentors, 3) community outreaches for counseling and testing, balanced ABC and

condom messaging, direct distribution and through condom service outlets; 4) reducing vulnerability in

adolescent girls through social support, life skills training, savings mobilization, income generation, and

conditional cash transfers, 5) training and support to public sector health clinics to provide syndromic

management of STIs, introduction of prevention messaging for STI services, 6) and mass media activities

using radio spots/jingles and phone-in radio discussion slots to stimulate public dialogue and debate on

early marriage, vulnerability of young girls, protective practices of men, and risk reduction through AB.

HVSI will be supported through a PHE to identify the barriers to use of the female condom in military and

non-military communities.

LINKS TO OTHER ACTIVITIES:

This project is linked to ART, HCT, and PMTCT.

POPULATION BEING TARGETED:

Population targeted are men both as gatekeepers to reach young girls with information and resources to

prevent HIV, but also as MARPs who place married young girls at risk for HIV. MARPs include mobile men,

male transport workers, women engaging in transactional sex, negative partners in discordant couples, STI

clinic attendees, and uniformed services.

Activity Narrative:

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will contribute to the Emergency Plan Five-Year Strategy in preventing new HIV infections

among vulnerable youth—especially unmarried adolescent girls and those engaged to be married.

Community advocacy activities will be conducted specifically targeting young girls during- and post-

marriage, men engaged in extra-marital relations, and MARPs including male transport workers, women

engaged in transactional sex, discordant couples, STI clinic attendees, and uniformed services. The Safe

Space Youth Clubs (SSYC) will provide one platform for condom distribution, referral for HCT and STI

treatment. SSYCs will cover communities where each of the 140 CAs is based. Condom distribution at the

community level through the SSYCs and condom outlets will total 438,840 male condoms and 120,960

female condoms. Condom distribution outlets will be established in each community where CAs are

present, with each conducting monthly 2 community dialogues with community leaders, influential

gatekeepers, and targeted MARPs. A total of 3360 community outreach activities will take place in COP08.

A total of 10,080 participants will benefit from these community sessions. A third of all participants will be

MARPs.

Each of the 140 CAs will be retrained in peer counseling techniques, half of whom will receive HCT training.

Referral by CAs will result in a third of all targeted individuals receiving HIV and/or STI prevention, care,

support, or treatment services in COP08.

12 sub-grantee staff will receive in-service training for project related activities in finance and project

management. 1 sub-grantee will apply for a NPI APS by the end of COP08. The three established sub-

awards will total $55,000 per year, with the fourth sub-award to AfrHP for $25,000. At the end of COP08,

AfrHP will submit an NPI proposal to compete independently for funding by PEPFAR.

EMPHASIS AREAS:

Emphasis areas include male involvement and human capacity development. Additional emphasis areas

include gender equity, human capacity development, and local organization capacity building. HVSI will be

supported through a PHE to identify the barriers to use of the female condom in military and non-military

communities.