Peer Education Plus (PEP) Model; A Veritable Tool for achieving Behaviour Change. Experience from a Rural Community In Kaduna State, Nigeria AUTHORS: P. Otache 1, J. Ekele 1, O Ezire 1, W. Adedeji 1 ; O. Salifu 2 ; H. Hassan 2 INSTITUTES: 1 Society for Family Health; 2 Kind Hearts Initiatives.

Background The National HIV and Reproductive Health Survey 2007 reported that, while awareness of HIV is as high as 93%, consistent use of condom is still relatively low, age at first debut and sex outside marriage have not changed remarkable over the last seven years. This is disturbing considering that reasonable local and international resources were expended over the years to promote behaviour change. While increase in awareness may be necessary for people to change their behaviours, it is important we move beyond increasing awareness to behaviour change. Are there available best practices we could learn from?

Description of intervention Society for Family Health with funding from the USAID implemented the Comprehensive integrated approach to HIV/AIDS prevention and care in Nigeria (CIHPAC) project in Nigeria. The project aimed at creating, strengthening and supporting the adoption of healthy sexual and reproductive health behaviour among the poor and Most At-Risk Populations (MARPs). The Peer Education Plus (PEP) which has three phases includes: Entry phase ; Intensive phase and Exit phase

Initial preparation phase (2-3 months) community entry/identification of gatekeepers and opinion leaders, advocacy visit participatory needs assessment baseline community mapping where appropriate Intensive intervention phase (6-8 months) selection of peer leaders training of peer leaders peer education sessions by peer leaders advocacy to create an enabling environment Linkages to services e.g. STI, family planning, VCT ongoing supervision/training/monitoring by field support staff. Phase down (2-3 months) encouragement of formation of CB0s support for local fund raising, Participatory evaluation of outcome exit by agency for that group preparation of a report/dissemination of experiences The Peer Education Plus model

Description of intervention cont’d Quarterly Participatory Monitoring and Evaluation exercises were conducted to monitor the intervention Baseline and end line report shows that correct and consistent use of condom increased by 11.5% in intervention sites as against 6.2% in non intervention sites. Behavioural Change was highest among those with higher exposure to the intervention. page 5

Description of intervention cont’d One year after the intervention, it was observed that there was not relapse but rather there was slight increase in the proportion of those who used condom correctly and consistently. page 6

Key Lessons Learned Mix of intervention are most likely to effect sustaining behaviour change. Behaviour change relapse can be minimised if community members are empowered to lead and participate in the change process. Frequent reminders are needed to keep the peer educators and peers informed on the aims and deliverables of the programme. If properly motivated, influencers/gate keepers can be very helpful as mobilizers which and can assist in monitoring and supervising peer sessions.

What Next Behaviour change interventions should actively seek and also engage benefiting communities members participation. Optimal use of resources can be promoted if interventions focus on programmes that will lead to behaviour changes. page 8

Conclusion “ Prevention remains the most important strategy as well as the most feasible approach for reversing the HIV epidemic since there are no vaccines and no medical cure. The majority of Nigerians are HIV-negative; keeping them uninfected is critical to the future of the epidemic and underscores the importance of prevention as a cornerstone of the national HIV and AIDS response”. (National Policy on HIV/AIDS 2009).

Thank you for listening