Comprehensive Integrated Approach to HIV/AIDS Prevention and Care (CIHPAC) Project
Funded by: United States Agency for International Development (USAID)
Principal Recipient: Society for Family Health (SFH)
Sub-Recipient: Economic and Social Empowerment of Rural Communities (ESERC)
Project Duration: April 2008 – December 2010
Project Location: Enugu North Local Government Area (LGA), Enugu State, Nigeria
Project Background and Context
HIV/AIDS has remained a significant public health and development challenge in Nigeria, with young people and key populations disproportionately affected due to social, economic, and structural vulnerabilities. During the period of this project (2008–2010), Nigeria recorded one of the highest HIV burdens globally, with transmission driven largely by unprotected sexual activity, low risk perception, stigma, gender inequality, and limited access to accurate information and preventive services.
Key populations such as Female Sex Workers (FSWs) were identified as having a higher risk of HIV infection due to multiple sexual partners, inconsistent condom use, limited negotiating power, and social marginalization. At the same time, young people, including both In-School Youths (ISY) and Out-of-School Youths (OSY), faced increased vulnerability due to experimentation, peer pressure, lack of comprehensive sexuality education, and limited access to youth-friendly health services.
Obiagu Community in Enugu North LGA is an urban-poor setting characterized by high population density, youth unemployment, and limited access to structured health information and services. These factors created a conducive environment for risky sexual behaviors and increased HIV transmission risk.
In response to these challenges, the Comprehensive Integrated Approach to HIV/AIDS Prevention and Care (CIHPAC) Project was designed to deliver a holistic, community-based HIV prevention intervention that combined behavior change communication, peer education, HIV Counseling and Testing (HCT), and socio-economic empowerment.
Project Alignment and Rationale
The CIHPAC project aligned with:
• USAID’s HIV/AIDS prevention and care priorities
• Nigeria’s National HIV/AIDS Strategic Framework
• Evidence-based best practices for key population programming
The project adopted a combination prevention approach, recognizing that effective HIV prevention requires addressing not only knowledge gaps but also behavioral, social, and economic drivers of vulnerability.
ESERC’s Role and Implementation Approach
As a Sub-Recipient to the Society for Family Health (SFH), ESERC was responsible for community-level planning, implementation, and monitoring of CIHPAC activities in Obiagu Community.
ESERC leveraged its strong grassroots presence, community trust, and experience in working with vulnerable populations to ensure effective delivery of project interventions. The organization emphasized participation, confidentiality, and cultural sensitivity, which were critical for engaging stigmatized groups such as FSWs.
Project Goal and Objectives
Overall Goal
To reduce the risk of HIV transmission among Female Sex Workers, In-School Youths, and Out-of-School Youths in Obiagu Community through integrated, community-based HIV prevention and care interventions.
Specific Objectives
• To increase HIV knowledge and risk perception among target populations.
• To promote safer sexual behaviors, including consistent and correct condom use.
• To expand access to HIV Counseling and Testing (HCT) services.
• To reduce stigma associated with HIV testing and HIV-positive status.
• To support socio-economic empowerment as a strategy for HIV risk reduction, particularly among FSWs.
• To strengthen peer-led HIV prevention structures within the community.
Target Populations
The project focused on three key groups:
• Female Sex Workers (FSWs) – due to high exposure to HIV risk and limited access to mainstream health services.
• In-School Youths (ISY) – adolescents and young people enrolled in schools who required age-appropriate HIV education.
• Out-of-School Youths (OSY) – young people not enrolled in formal education, often more vulnerable due to unemployment and limited supervision.
Implementation Strategy: Peer Education Plus (PEP) Model
The CIHPAC project utilized the Peer Education Plus (PEP) Model, an evidence-based approach that recognizes peers as credible and effective agents of behavior change.
Key features of the PEP Model included:
• Selection and training of peer educators from within each target group.
• Use of peer-to-peer communication to promote HIV prevention messages.
• Integration of life skills, negotiation skills, and self-efficacy building.
• Provision of referrals to HIV Counseling and Testing and other health services.
• Continuous mentorship and supervision of peer educators.
This model ensured that messages were culturally relevant, trusted, and sustained beyond formal project activities.
Key Interventions and Activities
1. Peer Education and Behavior Change Communication
ESERC trained peer educators drawn from FSWs, ISY, and OSY groups. These peer educators conducted regular one-on-one and group education sessions focusing on:
• HIV transmission and prevention
• Condom negotiation and correct condom use
• Reduction of multiple sexual partnerships
• Prevention of sexually transmitted infections (STIs)
• Gender norms and power dynamics
2. HIV Counseling and Testing (HCT)
The project facilitated access to HIV Counseling and Testing services, ensuring confidentiality and informed consent. Testing services were either provided directly through outreach or via referrals to designated health facilities.
3. Condom Promotion and Distribution
Peer educators promoted consistent condom use and provided information on correct usage, contributing to safer sexual practices among target populations.
4. Socio-Economic Empowerment for FSWs
Recognizing poverty as a key driver of HIV vulnerability, ESERC supported some Female Sex Workers to transition out of sex work. Beneficiaries received guidance and support to start small businesses, enabling alternative and sustainable livelihoods.
This intervention significantly reduced reliance on high-risk income sources and improved overall well-being.
5. Youth Engagement and Life Skills Development
Youth-focused sessions incorporated life planning, goal setting, self-esteem building, and decision-making skills to help young people avoid risky behaviors.
Key Achievements and Outputs
• 220 youths in Obiagu Community were reached with comprehensive HIV prevention interventions.
• A significant number of individuals accessed HIV Counseling and Testing services, many for the first time.
• Improved HIV knowledge and safer sexual practices among ISY and OSY.
• Several Female Sex Workers successfully exited sex work and established meaningful income-generating activities with ESERC’s support.
• Strengthened peer networks that continued HIV prevention messaging beyond the project lifespan.
• Reduced stigma around HIV testing within the community.
Outcomes and Impact
The CIHPAC project contributed to:
• Increased uptake of HIV testing services.
• Improved condom use and risk reduction behaviors.
• Enhanced community acceptance of HIV prevention interventions.
• Economic empowerment of vulnerable women, reducing structural drivers of HIV risk.
• Sustained peer-led HIV education within the community.
Challenges Encountered
• Stigma and fear initially limited willingness to access HIV testing.
• High mobility among FSWs made sustained engagement challenging.
• Economic pressures continued to influence risky behaviors for some participants.
• Limited duration of the project constrained long-term follow-up.
Lessons Learned
• Peer-led interventions are highly effective for reaching marginalized populations.
• Integrating economic empowerment into HIV prevention enhances impact.
• Youth-friendly and confidential services increase service uptake.
• Community trust is essential for successful HIV programming.
Sustainability and Way Forward
The project strengthened local capacity through trained peer educators and improved linkages with health facilities. Knowledge, skills, and peer networks established during CIHPAC continued to influence HIV prevention practices beyond the project period.
Future programming can build on this model by:
• Expanding livelihood support for vulnerable women.
• Integrating HIV services with broader youth development initiatives.
• Strengthening long-term community-based peer structures.
Conclusion
The Comprehensive Integrated Approach to HIV/AIDS Prevention and Care (CIHPAC) Project implemented by ESERC in partnership with SFH and USAID demonstrated the effectiveness of integrated, community-driven HIV prevention strategies. By combining peer education, HIV testing, behavior change communication, and economic empowerment, the project addressed both behavioral and structural drivers of HIV vulnerability.
The intervention contributed meaningfully to improved health outcomes, reduced risk behaviors, and enhanced resilience among Female Sex Workers and young people in Obiagu Community, Enugu State.
