Adolescent girls and young women (AGYW) in Nigeria face a range of biological, behavioral, and structural factors that increase their risk of contracting HIV. These include social barriers that hinder young girls from negotiating safer sex and age-disparate sexual relationships, as well as socioeconomic disparities that contribute to low school completion rates, limited participation in key economic sectors, and a lack of involvement in economic decision-making. As a result, a large proportion of new HIV infections each year occur among AGYW. A higher proportion of new infections occur in AGYW compared to their male counterparts. 

From 2021 through 2023, The Global Fund supported and FHI 360 implemented the National Aligned HIV/AIDS Initiative (NAHI) that provided HIV prevention, care, and treatment programs for AGYW in two southeastern states: Abia and Anambra. During the first year of the project, FHI 360 conducted a risk and needs assessment in high-incidence local government areas in these states to inform the design of the intervention. The assessment identified AGYW ages 15 to 20 as the most vulnerable population across the two states. Risky sexual behavior, driven by poverty and lack of empowerment, was a main factor contributing to AGYW’s increased HIV risk. The assessment found a high level of knowledge about HIV but poor knowledge of prevention methods and low exposure to HIV testing among adolescents. Adolescent friendly facilities and community HIV prevention were lacking in these states. One key informant who participated in the assessment in Anambra said, “. . . our youths are not really empowered. Some of them in school, when they come out they are not employed. Some of [them] that have skills don’t have the finances to even start up something, you know, and they are just, you know, trying to survive and every other thing. So, these are the challenges.”  

In the first year, the project reached 138,537 AGYW with HIV prevention programs and tested 119,612 for HIV. This fell short of the project’s targets, representing only nine percent achievement toward both targets. Learning from these outcomes, the project reworked how it projected the number of community outreach testers (COTs) needed to reach AGYW. In 2022, 410 COTs were recruited for Abia, along with 523 additional COTs. The project established and equipped two adolescent and youth friendly service delivery points in Anambra and trained 24 health care workers on how to provide youth friendly health services to improve outreach to AGYW. The project also engaged AGYW, who were trained as champions to provide HIV counselling and testing, sexual and reproductive health literacy, condom education, and gender-based violence (GBV) information. These champions also referred their peers who had positive HIV tests for treatment, care and support, and adherence counselling.  

These interventions yielded promising results. In year two, the project reached 494,757 AGWY with HIV prevention programs and 448,406 with HIV testing, increasing achievement against targets to 75 percent and 80 percent, respectively. At the midpoint of year three, the program continued to show improvement in reaching the program’s targets, reaching 548,868 AGYW over a six-month period. Recognizing the vital role of structural interventions in enhancing this population’s well-being, NAHI also integrated activities to address gender-based violence (GBV), offer sexual and reproductive health services, and promote economic empowerment. The project held community dialogue sessions on GBV to improve legal literacy in both states and engaged nine paralegals to provide support to GBV survivors in Abia state. Fifty-five AGYW champions, peer educators, and other relevant stakeholders were trained as trainers on GBV prevention and response.  

The project found that economic empowerment interventions were essential to the full participation of AGYW in the project’s health interventions. NAHI engaged vendors to provide community-based vocational skills trainings in baking, hair dressing, sewing, beadmaking, and other trades. After the trainings, each person was given seed money to establish a business and encouraged to further their education with profits from the trades. The project also found that the AGYW they engaged as champions were motivated by their involvement in the program to pursue additional education. Many AGYW who had graduated from secondary school went on to enroll in tertiary institutions, such as nursing school or university. 

The NAHI project provides AGYW with access to high quality HIV prevention and other health services, as well as economic empowerment opportunities. It has also ignited a drive for higher education and personal growth.  

As of November 2023, the project has reached a total of 1,360,186 AGYW with HIV prevention programs and 1,054,837 AGYW were tested for HIV. The project remains committed to providing the tools and resources that empower women and girls to pursue their dreams and unlock their full potential. 

Featured image: AGYW at a business plan development workshop in Anambra (Photo credit: NAHI).