Key Social Norms Take-aways This study demonstrates that interventions co-designed with communities can shift entrenched social norms that heighten adolescent girls’ and young women’s vulnerability to HIV. Parental silence around sexuality, peer silence about safer sex, and stigma associated with condom access were actively challenged through tailored, participatory activities. Interventions that enabled parents to discuss sexual health, empowered peers to be credible messengers, and reduced stigma around condom use addressed not only knowledge gaps but also social expectations that shape behavior.
Objectives The study aimed to develop and evaluate a combination HIV prevention package tailored to adolescent girls and young women in Nigeria by addressing their specific vulnerabilities through context-sensitive, community-led strategies.
Methods The research employed an action research framework using the Breakthrough Series collaborative methodology in four Nigerian states. Interventions were developed through participatory learning sessions and implemented through iterative Plan-Do-Study-Act cycles. Mixed methods were used to evaluate exposure and uptake, including a household survey with 4,308 participants, 53 focus group discussions, and 40 interviews with key informants and stakeholders.
Intervention Details Interventions were co-created with youth and community stakeholders and grouped into five categories: parental communication, peer-to-peer education, facilitator-led sessions, non-traditional condom outlets, and social media engagement. Parental interventions trained mothers to communicate openly about sexual health. Peer and facilitator-driven programs included mentorship, life skills, and sexual health education. Non-traditional outlets like salons and sports centers were used for condom distribution. WhatsApp groups were tested for digital engagement but had limited reach.
Results Across intervention sites, 77.5% of respondents reported exposure to at least one intervention. Compared to control areas, uptake of HIV testing and condom use increased significantly—by 15 to 20 percentage points for HIV testing and 5 to 9 percentage points for condom uptake (p<0.001). Parental communication interventions led to a noticeable cultural shift, with more mothers discussing HIV and sexual health. Peer-led models and innovative condom distribution improved service accessibility and acceptance. Conclusions: Combining behavioral, structural, and biomedical approaches in a community-participatory model proved effective in reducing HIV vulnerability among adolescent girls and young women. Social norms—particularly around parental communication and condom use—can be shifted through localized, co-created interventions. Scaling such adaptable models with youth involvement is essential for lasting impact in HIV prevention.