Promoting HIV/AIDS Prevention on Nigerian Campuses: Students Take the Lead

A Nigerian NGO devoted to preventing HIV/AIDS among young people discovers that the best way to organize on university campuses is to let students help plan and lead the campaign themselves.

Dele,* a business executive in Lagos, has been looking forward to the weekend. As he's done many times before, he tells his wife that he's leaving town on a business trip, then joins his friends and checks into a cheap hotel near Lagos State University. From there, they venture onto campus to search for what they call "bush meat": young female students.

*Not his real name.

This ugly term has come to signify a dilemma facing many young Nigerian women. With little financial aid available for women students at Nigerian universities, some turn to occasional commercial sex work to pay for tuition and living expenses. Men like Dele and his friends take advantage of their predicament, and -- believing that college women aren't likely to be infected with HIV -- pay them small sums for a night of unprotected sex.

But this time, Dele's first attempt at a pick-up doesn't turn out the way he expects. The young woman he encounters sits him down to discuss his risk of contracting HIV and advises him -- for the sake of his own health and that of his family -- to avoid casual sex, or at least to protect himself and his partner.

"If you want sex, why don't you have any condoms?" she challenges the perplexed Dele before walking away.

The young woman who administered Dele's wake-up call is a beneficiary of a novel HIV prevention education project based on eight college campuses in the Lagos area and implemented by the Nigeria Youth AIDS Program (NYAP). Funded by the U.S. Agency for International Development through the AIDS Control and Prevention (AIDSCAP) Project, the Tertiary Institution Project (TIP) is the first to target college-age Nigerians and their special needs. Using volunteer student peer health educators (PHEs), TIP's year-old program bases its student-initiated educational activities on campus, yet -- as the story of Dele demonstrates -- the project also has an impact on the surrounding communities with which students interact every day. Condom promotion and sales, distribution of targeted educational materials and referral for sexually transmitted disease (STD) treatment are also primary activities for TIP.

Widespread Misconceptions

When TIP first began in 1993, NYAP staff were surprised to find that misconceptions about HIV/AIDS were as widespread among well-educated college-age students as among the general population.

"I assumed that people on campuses would be much more exposed to information about HIV/AIDS, but when we conducted focus group discussions we found the level of knowledge was very low," said Edem Effiong, TIP's project manager.

For example, some students in that initial focus group said that people who have sex only once can't contract HIV, while others thought that normal social interactions -- hugging, shaking hands and so on -- could spread HIV. Some were certain that if they had already had unprotected sex and were healthy, they were likely to remain uninfected. Still others insisted that Nigerians could not contract this "foreign disease."

Abdulhakeem Ikharia, an undergraduate and PHE at the Lagos State College of Education (LACOED), recalls his own ignorance about HIV prior to joining TIP.

"I thought HIV was transmitted only through blood transfusions, not through sex," he said.

One of the most deeply entrenched misconceptions about HIV/AIDS among students is one they share with the rest of society. Most Nigerians believe AIDS to be a disease of commercial sex workers that doesn't threaten university students because they're too knowledgeable, intelligent and hygienic, making safe sex precautions and condom use unnecessary. Given the high exchange rate of sex partners on campuses and the widespread practice of older men seeking sex among female students, the risks are very serious, and growing continuously. The repercussions can reach far beyond the university setting, when men like Dele and his friends return home to have unprotected sex with their wives.

The health of students is also endangered when, fearful that they've contracted an STD, they engage in the common Nigerian practice of going to a chemist's shop for antibiotics without seeing a doctor first. The staff in these shops seldom have training in STD management, yet often prescribe treatment. By the next day, believing themselves cured, students may engage in high-risk sexual behavior all over again.

Student Initiatives

About 60,000 students attend the eight tertiary institutions where TIP is based: the University of Lagos, Lagos State University, Lagos State College of Education, the Yaba College of Technology, Lagos Polytechnic, Federal College of Education, Federal Technical College and the Institute of Moral and Religious Studies. Since the project began in November 1995, nearly 300 of them have received a week of training to become PHEs, and more will be trained in the future. Unfortunately, campus closures this past spring due to faculty and staff strikes slowed PHE training at some of the universities, but the work stoppages have now ended and training continues.

As students themselves, PHEs serve as direct links to the student community.

"Students are able to target their colleagues more than if an outsider were to come in to teach them about HIV/AIDS," said TIP Project Manager Effiong.

The effectiveness of the peer education approach has helped NYAP staff recognize the value of allowing students to organize and initiate their own prevention activities and campaigns. NYAP now encourages the creation of anti-AIDS clubs, organized and run by students, which soon sprouted up on many of the TIP campuses.

"When students plan their own event, they go all out -- they devote their time and money to ensure it succeeds," said Effiong. "But if you come and say, 'This is what I want you to do,' it's not their own idea, and they won't be that committed."

The clubs will also provide a long-term structure for sustaining TIP's prevention efforts after AIDSCAP support for the project ends in April 1997, said Dr. Eka Esu-Williams, AIDSCAP's resident advisor in Nigeria.

"These campus-based clubs, with their strong foundation of volunteers, will continue at least in part because of the motivation of their members," she said.

The main message that the clubs promote among the student body is that they must choose and stick to one of three prevention methods: abstinence, fidelity to one partner, or condom use. Apart from distributing behavior change communication (BCC) materials advancing these messages, TIP has also created campus billboards that reinforce the need to act responsibly and choose one's own path to protection.

NYAP maintains a TIP coordinator for each campus who is a member of the faculty or staff. This person advises the clubs and provides condoms and BCC materials for members and PHEs to distribute. The clubs organize many educational events on the campuses, including lectures, film showings, interventions at campus activities and one-on-one counseling. For students who need treatment for STDs, TIP identifies medical staff at each campus health center to whom referrals can be made.

Student-run anti-AIDS clubs and peer education are also at the heart of NYAP's HIV/AIDS prevention education activities reaching 52,500 youth in secondary and college-level institutions in Nigeria's Cross River State. The ease with which students talk to each other facilitates discussion about behavior change. "My friends are easy to talk to because most times we discuss relationships, marriage and other issues of common interest," said Estee Effa, a 24-year-old agriculture student and PHE at the University of Calabar. "I look for an opening in any of these discussions to chip in something about HIV/AIDS."

NYAP also sponsors a radio call-in show that broadcasts throughout Cross River State on Saturdays, when kids are most likely to tune in at home. "NYAP Talk-Back" provides a forum for questions about HIV/AIDS and valuable reinforcement of messages that young people hear at school.

Changing Behaviors

Given initially high levels of ignorance about HIV and the powerful denial throughout Nigerian society of the personal risks of transmission, it's not surprising that many of the earliest prevention activities on campus were a real challenge. When student Abdulhakeem Ikharia, head of the LACOED club, first addressed a campus audience on the dangers to students of HIV infection, he was booed. He and his fellow PHEs responded by adopting a one-on-one or one-on-two interpersonal approach to educating and counseling their fellow students -- and it began to work.

"Now there's hardly anybody within this college community who is unaware of the campaign against AIDS," Ikharia says proudly.

This claim applies to the other seven campuses, too, where an estimated 30 to 80 percent of the student bodies have been reached in one or several ways by TIP's prevention activities, depending on the size of the campus.

In the first seven months of the project, PHEs distributed some 15,000 condoms free to students and sold about 3,000. The initial free distribution was designed to motivate students to try condoms and become comfortable with using them. Prices have now been set at levels students can easily afford: approximately six cents (U.S.) for a packet of four. But as NYAP moves into cost recovery, condom sales so far are lower than expected, primarily because last spring's strikes and subsequent campus closures disrupted plans to set up sales outlets where students congregate.

The PHEs have found that their commitment to educating their fellow students requires an equal commitment to their own sexual health and avoidance of casual and unprotected sex. One PHE at Yaba College of Technology told Effiong that her own behaviors had changed permanently.

"If you tell people that having more than one sexual partner is bad, that means you yourself have to live up to that standard," she said. "If you tell people to abstain from sex, then you have to abstain from sex."

Notably, the messages that promote examining and changing one's own behavior also extend to non-students, such as the men who, like Dele, prey upon the vulnerabilities of women students. One billboard at the University of Calabar -- located right outside the women's dormitories -- shows a young female student facing bystanders and posing the question: "Are You a Customer?" The billboard encourages abstinence, monogamy and condom use, and although it's addressed to off-campus men, it strengthens the ability of female students to demand condom use if they decide to go ahead with a liaison.

"This billboard is also being used by peer educators -- male and female -- as a talking point when they conduct behavior change activities," said Dr. Esu-Williams of AIDSCAP.

And for male "customers" from outside campus, the billboard is a reminder that their own actions carry risks -- to themselves, to their permanent partners and to the young students from whom they seek one-night stands -- and that the university community and society at large expect them to act responsibly.

-- Mkpe Abang

Mkpe Abang is a senior reporter with Punch, a Nigerian newspaper. He is a founding member of the Healthwatch Project-Nigeria, an NGO of journalists working to educate the populace on health matters, including HIV/AIDS and STDs. Nigerian journalist Kammonke Abam also contributed to this article.