The burden of HIV among adolescents in sub-Saharan Africa calls for urgent interventions. With the burden of HIV in sub-Saharan Africa, some countries have the sero-prevalence among young adults exceeding 30% 12. The poor economic situations in most developing countries including Nigeria, have made biomedical prevention and treatment methods for HIV simply not affordable to most citizens 34. Therefore, using intervention strategy to reduce sexual risk behaviours is the best option for preventing HIV infection among adolescents, especially the in-school adolescents.

Although there is abundant literature on behavioural interventions for adolescents’ training and practice in specific skills on condoms use, there is growing evidence that such interventions when adapted to the local culture can positively influence adolescents’ sexual risks, perceptions and knowledge on HIV infection but proof is lacking on their effectiveness in reducing unprotected sex among adolescents 5.

Research has shown that it is extremely difficult to achieve behavioural change among adolescents who have already initiated sexual activity. It is therefore, more beneficial to prevent HIV infection among sexually-inexperienced adolescents than the sexually active ones 67. Meanwhile, studies have found that the increasing prevalence of HIV infection among adolescents, gave rise to implementing numerous educational and behavioural interventions that produced varying successes in reducing sexual risks 89.

Research has provided some evidences showing that ‘My Future is My Choice’ intervention can reduce rates of HIV sexual risk behaviours among sexually inexperienced adolescents. In addition to this, researchers have also argued that adolescents can reduce the practice of unprotected sexual activity if intervention strategies that encourage them to adopt competencies in all aspects of HIV prevention measures are used 10. However, some researchers have advised that HIV prevention interventions which are expensive, time-consuming, and extraordinarily difficult to implement because of the need to include counseling for safer sex, treatment for sexually transmitted infections, as well as monitoring participants’ adherence to the interventions provided should be avoided 11.

The differential effects of HIV risk intervention on sex have been reported among adolescents, thereby, prompting some researchers to recommend sex-specific intervention programmes for adolescents rather than that of generic. Issue of concern in intervention for adolescents is that of the effects of emphasizing ‘safer sex’ through ‘abstinence only’ to the sexually inexperienced adolescents. Some researchers argue that using interventions that focus on discussions on sexual relationships may hasten the initiation of sexual intercourse 12. Others contend that if adolescents engage in high rates of unprotected sex before participating in HIV risk reduction interventions, that such adolescents are not likely to abstain totally from having further sexual activity 1314. Others maintain that in the post-intervention period, that virgins who have initiated sex will be more likely to use condoms during sex than others. Though few studies specifically addressed this issue, researchers have found that role plays that stress more on ‘safer sex’ intervention will prolong virginity among adolescents and also enable them experience positive intervention effects especially those that were sexually inexperienced at baseline or pre-intervention 15.

Although increased sexual activity for those with multiple sexual partners who do not use condom will escalate the risk of HIV infection, available studies demonstrate that a behavioral intervention that targets risk reduction can decrease HIV incidence among these adolescents 1617. However, researchers have suggested role plays as feasible intervention strategy that can assess the efficacy of risk-reduction counseling on sexually active adolescents 1819. Realizing that schools are ideal settings to reach sexually inexperienced adolescents, before they initiate in sexual activity, the study concentrated on in-school adolescents for the study. In this study, role play was used for sex specific adolescents as an intervention strategy for HIV risk reduction that will be capable of disseminating effective behavioral interventions.

The study adopted role play which focused on MFMC strategy. The study used a randomly selected sex specific (girls) secondary school in the community. The girls’ secondary school chosen represented the sex specific sample used for the intervention. In this study, all the SS2&3 students in the selected girls’ secondary community school were studied. These were the students considered to be sexually active who can respond to the questions in the questionnaire. The study was conducted in May 2020.

The role-play was carried out by 4 peer leaders after being trained in the theoretical framework of role-plays and peer facilitation by a consultant. With mastery and experience after the training, the peer leaders carried out the role play in a regular classroom section for over 3 class periods. This was co-facilitated with the assistance of a volunteer teacher in the school. A unique feature of this intervention was the dual focus on strategies that influenced both individual risk factors (attitudes, behavioral skills) and social environments (peer resources). Also, the intervention sessions had varieties of narratives, facts, exercises as well as time for questions and discussions. There were emphases on abstinence and on how to protect selves from unwanted sexual intercourse.

The role play consisted of theoretically-based interventions that incorporated behavioural skill training and other strategies that are aimed at improving adolescents’ attitudes to HIV prevention. The theoretical aspect of the role play focused on the understanding measures for HIV risk reduction and these were expanded to include behavioural and emotional factors associated with HIV risks. The comprehensive primary prevention approach used ensured that adolescents who are not engaging in high-risk behaviours received prevention services before they initiate themselves in risky sex. The target approach to the study was to minimize new cases of HIV infection among in-school adolescents. The role play presented provided the researchers with several potential advantages which included: having access to larger numbers of adolescents, the likelihood of positively influencing behaviour change at individual and peer group levels, as well as the possibility of monitoring adolescents’ behavioural change longitudinally. During the role play, the following four intervention areas were stressed: group-based interactive HIV prevention intervention, motivation to adopt abstinence for HIV risk reduction, safer sex building skills and intensive AIDS education. Condom use was avoided so as not to infuriate the school authorities who felt that emphasizing condom use during the intervention will result to negative effects like increasing the sexual desires of the adolescents.

The study used self-administered pre- and post-questionnaires. These were retrieved by the researchers at the completion of each set of the questionnaire. Data were analysed qualitatively and quantitatively using tables, percentages and inferential statistics.

The positive outcome measures of the MFMC intervention for the in-school adolescents focused on reduction in HIV infection, and sexual risk behaviours. The results of the pre-intervention and post-intervention when compared showed that successes were recorded on abstinence and safer sex decision-making as well as on HIV risk intentions and perceptions. Chi-square statistics were employed for statistical testing in these comparisons and there were no statistically significant effects at each interval.

The research which used ‘My Future is My Choice’ (MFMC), intervention that succeeded in reducing HIV risk behaviours among sexually inexperienced participants showed that the emphasis on ‘Safer Choices’ reduced the desire for unprotected sex as 22(33.8%) and 20(30.8%) of the respondents suggested that not having boyfriends and visiting boys in their houses respectively will help to prevent HIV infection and pregnancy. These suggestions are capable of delaying initiation of sex. This finding also collaborated with that of 1014 which argue that if HIV risk reduction intervention is expanded to include behavioural skills training and strategies that will improve attitudes to HIV prevention, that adolescents who have not engaged in high-risk behaviours are likely not to initiate in risky sex thereby, result to the greatest impact on reducing new cases of HIV among them.

The fact that 5(7.7%) of the respondents during the pre-intervention had the view that one can be infected by sharing needles or razor blades with others and after the intervention, 17(26.2%) of the respondents realized that sharing razor blades or needles with others constitutes risk for HIV infection showed that successes were recorded after the MFMC intervention to the adolescents. Also as high as 28(43%) of the respondents during the pre-intervention had poor knowledge of what constitutes HIV risks and after the post-intervention, only 1(1.5%) of the respondents showed poor knowledge suggest the benefits of the intervention. These positive intervention effects appear to have been contributed primarily by changes among the respondents’ perception on what constitutes HIV risk reduction.

The MFMC intervention used appears to have encouraged the adolescents to freely discuss their past sexual experiences among themselves. Although the rates of discussion were equal both during pre-intervention and post-intervention periods, respondents easily reported their past sexual relationships and other HIV risk behaviours. About 26(40%) of the respondents reported that they have been approached for sexual relationships and 4(6.2%) of them said they have had sex with those who approached them for sex. Also 17(26.2%) of the respondents during the pre-intervention and 23(35.4%) during the post intervention accepted that they have shared needles and razor blades with others. However, an insignificant number of the adolescents 1(1.5%) respectively reported that they use lubricants, take medicines and use condom after sex to protect themselves from HIV infection and pregnancy, while 8(12.4%) said they use nothing after sex.

The MFMC intervention for the in-school adolescents was associated with decrease in intentions to share sharp objects and to engage in multiple sex partners. Also it was associated with increase in adolescents’ knowledge on what constitutes risk to HIV infection. However, the desire to adopt abstinence and safer sex intentions increased at baseline (pre- intervention) and this increase became even greater during the post-intervention period, although the difference was not statistically significant. Therefore, national implementation of ‘My Future is My Choice’ intervention for adolescents is encouraged. It will be important to corroborate the self-reports of the intervention effects by using specific sex population instead of generic. Monitoring the effects of the intervention will also be necessary so as to help ensure that the adolescents are indeed given every opportunity to positively shape their futures. For more acceptability of MFMC intervention, emphasis on condom use for sexually inexperienced adolescents should be minimized for HIV risk reduction.

In summary, based on the findings of the study, and those of a few other investigators carried out in relevant cultural settings, MFMC is an ideal strategy for in-school adolescents and could also be cautiously used for other classes of adolescents, though adaptation process requires significant time and resources to achieve. Finally, considerations should be given to the benefits of using sex-specific interventions for adolescents.