TUAC0103 Avoiding Relapse: The Impact of the Peer Education Plus Model on Behaviour Change and Behaviour Maintenance among Sex Workers in Nigeria A Ankomah, J. Anyanti, S.B. Adebayo B. Ekweremadu Society for Family Health, Abuja, Nigeria

Background Interventions on HIV risk behaviour reduction often aim at changing behaviour; Few include the sustainability of the changed behaviour as a programme objective. Cost effective prevention interventions must be developed to sustain changed behaviours.

Background cont’d The Promoting Sexual and Reproductive Health and HIV Reduction (PSRHH) programme in Nigeria began in 2002. A key component was the need to monitor changed behaviours over time. The model used was the Peer Education Plus (PEP) model. It was developed by Society for Family Health, and ActionAid Nigeria.

The PEP model The PEP model was developed to take a step-by-step approach to HIV prevention programming. PEP is supported by a set of appropriate manuals for each at-risk group; It also has over twenty reader-friendly “How-to” manuals on how to implement every aspect of the programme from community entry to phase down/Behaviour Maintenance activities. The model also has in-built inter-activity, and contents have been made more visually driven with images.

Methods In addition to peer education and advocacy activities during the intensive phase of the intervention; The programme also has in-built low-cost behaviour maintenance activities at the conclusion of the main programme; the establishment of inter- and intra- brothel discussions groups Engagement with brothel management and law enforcement agents and occasional visits from programme staff.

Methods Representative samples of sex workers in same brothels (but not necessarily same respondents) were interviewed in 13 sites where the programme took place. Interviews took place over four waves of field surveys: 2002 (baseline), 2004 (post intervention), 2005 and 2006 (behaviour maintenance follow up surveys).

Results Consistent condom use with clients had increased from 76.6% at baseline in 2002 to 87.6% at time of exit (p< 0.01). The table below shows consistent condom use in the 4 waves of the study. There is no statistically significant variation between 2004 and 2006 (p>0.05). Behaviour 2002 2004 2005 2006 Consistent condom use with clients 76.6 87.6b 86.7a 86.4a a: no significant difference p>0.05, b: significant differences p<0.05 Percentages are adjusted for age, education, residence and ethnicity.

Results cont’d Condom use at last sex with boyfriends had increased after 3 years during the BM phase of the intervention from 40.8% at baseline in 2002 to 46.7% at time of exit (p> 0.05). Condom use with boyfriends was however still low and will require additional BM activities. Behaviour 2002 2004 2005 2006 Condom use at last sex with boyfriends 40.8 42.2a 46.7b 44.5b a: no significant differences from baseline p>0.05, b: significant difference p<0.05,

Results cont’d In addition, different measurements of knowledge about STIs were either increased or maintained. Indicators of HIV transmission knowledge such as knowledge about mother to child transmission and a healthy looking person could be HIV positive were consistently maintained in project sites.

Conclusions The PEP intervention succeeded not only in changing behaviour, but also maintaining changed behaviour. The length of time that changed behaviours are maintained determines, to a great extent, the actual cost-effectiveness of implementing the intervention.

Conclusions cont’d Consistent longer term programmes are needed to bring about significant changes in condom use with boyfriends. This is typically difficult to address. Working in the same brothels over time also provides for institutional change, as new entrants were also more likely to follow group behaviour.

Programmatic Recommendations Programmers working among sex workers are encouraged to adapt the PEP model for programme design, implementation and evaluation. Copies available at the PSI booth, the Nigerian booth and at www.pepmodel.org

Appreciation Sex workers/CBOs in communities. Field staff who took part in these interventions. DFID and USAID for funding support.

Contact Information Jennifer Anyanti Society for Family Health, Area 11, Garki, Abuja, Nigeria janyanti@sfhnigeria.com