Perceived Facilitators and Barriers to Participating in a Combination Income-Generating HIV Risk-Reduction Intervention Among Adolescent Girls and Young Women in Nigeria: A Qualitative Study

Background: Human immunodeficiency virus risk-reduction interventions that include income-generating activities are garnering attention as effective strategies to engage adolescent girls and young women (AGYW) toward HIV risk reduction. To sustain and promote the uptake of these interventions, researchers must understand factors that may encourage or present barriers to AGYW participation in such interventions. This study explores AGYW perceived barriers and facilitators to participation in a school-based combination income-generating HIV prevention intervention in Nigeria.Methods: A convenience sample of AGYW who participated in a school-based combination income-generating HIV prevention intervention were recruited for the study. Data generated from focus group discussions (FGDs) (eight discussion groups comprising 10–12 participants) were analyzed by inductive thematic analysis.Results: A total of 93 participants with a mean age of 15.04 years (SD = 0.89) participated in the FGDs. The study participants identified several facilitators and barriers to participation in the intervention. Three main themes that emerged as facilitators were: (1) involvement of young female facilitators in the delivery of intervention components, (2) opportunity for social interaction with peers during the intervention period, and (3) support and approval from school authorities. Two main themes were also identified as barriers: (1) sexual conservatism from society and parents and (2) challenges in sustaining a microenterprise.Conclusions: Despite the perceived benefits and interest in participation in the intervention, the study participants outlined some challenges that may hinder participation in the intervention components. Addressing barriers, such as stigma associated with the discussion of sexual health-related topics, coupled with the promotion of facilitating factors, such as leveraging context-appropriate intervention delivery modalities, is important for enhancing the engagement of AGYW in HIV risk-reduction intervention. Our findings can guide future research and design of combination income-generating HIV prevention interventions for in-school AGYW in low-resource settings such as Nigeria.

Stakeholder acceptability of the risk reduction behavioural model [RRBM] as an alternative model for adolescent HIV risk reduction and sexual behavior change in Northern Malawi

We sought to assess stakeholder acceptability of a risk reduction behavioural model [RRBM] designed for adolescent HIV risk reduction and whose efficacy we tested in selected schools in Northern Malawi. We used qualitative procedures in sampling, data collection and data analysis. Our data collection instrument was the semi-structured interview and we applied thematic content analysis to establish stakeholder evaluations of the RRBM model. The study population included10 experts working within key organizations and teachers from two schools. The organizations were sampled as providers, implementers and designers of interventions while schools were sampled as providers and consumers of interventions. Individual study participants were recruited purposively through snowball sampling. Results showed consensus among participants on the acceptability, potential for scale up and likelihood of model sustainability if implemented. In essence areas to consider improving and modifying included: focus on the rural girl child and inclusion of an economic empowerment component to target the underlying root causes of HIV risk taking behavior. Stakeholders also recommended intervention extension to out of school adolescent groups as well as involvement of traditional leaders. Involvement of parents and religious leaders in intervention scale up was also highlighted. The study serves as a benchmark for stakeholder involvement in model and intervention evaluation and as a link between researchers and project implementers, designers as well as policy makers to bridge the research to policy and practice gap.

Overview of HIV Risk Reduction Interventions among Adolescents - A Call to Evaluate the HIV Education Curriculum in Nigeria

Background: Adolescence is typically a period of experimentation, new experiences, and vulnerability which influences their HIV risk behaviours. Some may out-grow many risk behaviors, yet prevention efforts are needed to reduce the risk of HIV infection during this period. Knowledge about risk is not sufficient for the prevention of HIV risk behavior. This review examines the existing types of education targeted at reducing HIV risk and their application to adolescents for optimal outcome. Methodology: Keywords from objectives of review were used to search for related literatures through online libraries of national and international journals. Out of 60 related studies initially generated, 38 literatures were selected for review. Results: School-based health services should ideally be complementary rather than replacement option for the provision of health care services for adolescents. Interventions to improve HIV knowledge and reduce risky sexual behaviour may need to specifically target adolescents. The types of HIV risk reduction education intervention among adolescents is classified into peer-based and health provider-based education. Given the complexity of factors that contribute to risk behavior, prevention efforts that focus exclusively on knowledge are unlikely to be successful. Effective school-based (youth-targeted) HIV prevention programs, which typically rely on principles of social cognitive (Learning) theory could be employed to bridge the gap. Conclusion and Recommendations: With this in mind, a comprehensive review of the Family life and HIV education (FLHE) programme in Nigerian secondary schools is long overdue.

The impact of Behaviour Change Intervention (BCI) on adolescent HIV risk reduction in selected schools in Northren Malawi

Introduction: We conducted a study to explore the impact of adolescent exposure to HIV and AIDS behaviour change Interventions (BCI) on their HIV risk reduction and sexual behaviour change in some selected secondary schools in the district of Mzimba, district of Nkhata Bay and Mzuzu city in Northern Malawi. Methods: We used mixed methods in a descriptive survey design triangulating both quantitative and qualitative approaches, with questionnaires and focus groups as instruments for data collection. Adolescent boys and girls [n = 552], were randomly sampled to participate in the quantitative component. For qualitative focus groups we sampled participants purposively. We analyzed quantitative data through multiple regression analysis. On the other hand qualitative data was analyzed through thematic content analysis.Results: Multiple regression analysis indicated that exposure to BCI did not impact risk reduction [Beta = -.082, p= .053, p > .05]. Qualitative focus group findings showed that proximate correlates such as: early sexual debut, lack of condom use, drug related sex, multiple and concurrent partnerships drive infection. Distal structural factors in socio-cultural, gender disparities and poverty were also noted drivers of sexual risk taking in the study area.Conclusion: Studies aimed to inform HIV prevention through top-down design of models involving primary beneficiaries are vital for the registering of positive outcomes in HIV programming for young people. Apart from identifying factors driving high HIV incidence in the study area, the study informed an intervention to test the efficacy of a risk reduction behavioural model [RRBM] developed and designed with input from adolescent participants. KEY WORDS: ADOLESCENT, HIV AND AIDS, BEHAVIOUR CHANGE, RISK REDUCTION, MALAWI

Psychological Sense of Community and the Use of Condoms and PrEP Among a Sample of Aging Black MSM

Psychological sense of community (PSOC) in Black men who have sex with men (BMSM) may facilitate condom and pre-exposure prophylaxis (PrEP) use to prevent HIV transmission. Understanding BMSM’s PSOC contribution to HIV risk reduction may inform HIV prevention efforts for this population, that is disproportionately affected by HIV. Adjusted for sociodemographic characteristics and HIV status, we conducted logistic regressions to test the association between PSOC and condom use among aging BMSM (n=176). Multivariate analyses exhibited no association between PSOC and condom use (AOR= 0.994, 95% CI= 0.942, 1.049). HIV+ participants had higher condom use odds compared to HIV- participants (AOR= 4.031, 95% CI= 1.723, 9.426). A sub-analysis of HIV- participants (n=61), showed no associated between PSOC and PrEP use (AOR= 1.002, 95% CI= 0.904, 1.112). These results have implications for secondary HIV prevention and future research on alternative aspects of social support that may increase BMSM’s HIV risk reduction behaviors.

‘I never hoped for anything . . . now I have other plans’: The role of microfinance in HIV intervention for women who use drugs and engage in sex work in Kazakhstan

Over the past decade, Kazakhstan has experienced increased cases of HIV, especially among women who engage in sex work and use drugs. Research has examined the efficacy of structural interventions to reduce HIV risk; however, few studies have examined the experiences of women participating in these interventions. This study aimed to understand the perceived impact that HIV risk reduction and savings-led microfinance components of the Nova study had on women’s sexual and drug risk behaviors as well as their capacity for reducing income from sex work and finding alternative sources of income over time. The Nova study is a cluster-randomized controlled trial conducted from 2013 to 2018 in Kazakhstan. It examines the efficacy of a combination of HIV risk reduction and microfinance among women who engage in sex work and women who use drugs. Data were drawn from the qualitative component of this study; 56 interviews with 19 participants were conducted. Template analysis and a qualitative trajectory approach were used to understand women’s perceptions of the impact that intervention had over time. Findings indicated that women perceived increased knowledge and skills related to condom use, safe sex practice, and drug use reduction. Women who received the microfinance component described perceived gains on budget management, capacity to plan for their future, and motivation to find alternative sources of income. Giving women the opportunity to express narrative experiences over time regarding the impact of this structural intervention may inform needed cultural adaptations of the intervention components and nuances of the environment in which the intervention is offered.