Project

THE RUBBER REVOLUTION, 1

THE RUBBER REVOLUTION: PREVENTING HIGH PREVALENCE RATE AND

REDUCING THE INCIDENCE OF NEW HIV INFECTION IN UMUEBULU

COMMUNITY, ETCHE LOCAL GOVERNMENT AREA, RIVERS STATE, NIGERIA

PROMISE, O, TEWOGBOLA; UYIOSA, O, CHUKWUKA, OLAJUMOKE, T,

BABATUNDE

WESTERN ILLINOIS UNIVERSITY.

THE RUBBER REVOLUTION, 2

EXECUTIVE SUMMARY

HIV is one of the most fatal diseases globally. The widespread of this virus has not only

destroyed individuals but it has also inflicted great problem on families, societies and economies.

The Rubber Revolution program is a grassroots community program targeted at preventing HIV

prevalence in Umuebulu local government area, Rivers state, Nigeria. Its main goal is to promote

the correct and consistent use of condoms in males ages 20-35. The focus area to be addressed is

to encourage the correct and consistent use of condoms among males in this age group between

20-35.

The proposed services of the Platinum Initiative Development team in carrying out the

Rubber Revolution program are provision and distribution of condoms free of charge,

improvement of accessibility and availability of condoms, promoting the correct way of

application of condoms, knowledge dissemination, advocacies to the Health centers for the

continuous supplies of condoms even after the program has ended. This program will address the

factors that contribute to this health issue such as lack of knowledge, inconsistent use of

condoms, accessibility, availability, and utilization of condoms. The program is targeted at the

population of the individuals in Umuebulu community but particularly 45 individuals will be

served.

The Rubber Revolution program will empower men as agents in their own self-care, and

empower their partners to insist on consistent condom use.

THE RUBBER REVOLUTION, 3

PROGRAM RATIONALE

HIV is a major global public health issue that has claimed over 35 million lives

worldwide since the beginning of the epidemic (WHO Fact Sheets, 2014). Currently, about 36.7

million individuals globally are living with HIV (UNAIDS, 2016). Nigeria has the second largest

HIV positive prevalence rate epidemic in the world, with 3.2 million people living with HIV

(NACA, 2015; GARPR, 2015). In 2015 alone, there were over 227,000 new cases of HIV

infection, as well as 180,000 AIDS related deaths cases (AVERT, 2016).

In Nigeria, HIV prevalence rates are highest in the Southern States, commonly referred to

as the ‘South-South Zone’ (NACA, 2015). In the South-South Zone, Rivers State stands out as

the most affected state in Nigeria, with a HIV prevalence rate of 15.5% (NACA, 2015; Nigeria

GARPR, 2015). Generally, men in sub-Saharan Africa face challenges in HIV vulnerability, as

well as problems of low engagement in HIV-related programs (Mills et al, 2012). In fact of the

36.7 million cases of HIV infection worldwide, approximately 16.9 million [15.7 million – 19.5

million] are males ages 15 and older, making up nearly 49% of the global population of people

living with HIV aged 15+ (Rights, Roles and Responsibilities of Men in Fast-Tracking the End

Of AIDS, 2015). Of the 16.9 million HIV positive males worldwide, approximately 10% are

males ages 15-24, of which 64% reside in sub-Saharan Africa (Rights, Roles and

Responsibilities of Men in Fast-Tracking the End Of AIDS, 2015).

Clearly there is a great need for HIV prevention programs such as the ABC Approach

which focuses on Abstinence, Being Faithful and use of a Condom. Condom use is primarily a

male-driven prevention method that can prove to be effective in combating the rate of HIV

incidence (UNFPA, 2015). This need is even more pressing given the vast differences in the

THE RUBBER REVOLUTION, 4

health-seeking behaviors of men and women who inhabit the predominantly rural sub-Saharan

Africa (Mane and Aggleton, 2001). For instance, African men may feel that participating in

HIV-intervention programs may expose their hidden sexual behaviors (UNIRIN, 2006), as well

as the complication of work-related migrations that require men to be far away from their sexual

partners, ultimately leading to engage in the potential elevated risk behaviors which put them at a

risk of contracting HIV (Mane and Aggleton, 2001). Additionally, men are less likely to seek

health-related care because of their perceptions of masculinity, a characteristic generally

considered to be part of the same phenomenon that drives multiple partnering which also

increases the risks of HIV infection (Higgins et al, 2010; Dworkin et al, 2011). Continual failure

to engage men in HIV prevention may also have a significant impact on household family

income, since African men are typically the income-generators in their families, and if infected

their employment may be in jeopardy (Mills et al, 2012). Factors that contribute to this health

problem include lack of knowledge, low personal risk perception, a dislike of condom,

accessibility, availability and utilization of condoms (Sohail et al, 2002).

The use of condoms provides an impermeable barrier to the particles size of HIV

pathogen (Carey et al, 1992; WHO/UNAIDS, 2001). Condoms when used consistently and

correctly, are highly effective in preventing the sexual transmission of HIV (UNFPA, 2015).

Condoms have helped to reduce HIV transmission and curtailed the broader spread of HIV in

settings where the epidemic is concentrated in specific populations, leading to the prevention of

around 50 million new HIV infections since the onset of the HIV epidemic (UNFPA, 2015).

After reviewing national and state data, HIV infection remains a significant health

problem, especially in the rural communities of sub-Saharan Africa. Thus, there is a great need to

THE RUBBER REVOLUTION, 5

think globally and act locally to forestall HIV infections and the subsequent decreases in quality

in rural sub-Saharan communities. In addition, condom promotion programs at community-level

have proven to be highly effective in changing high-risk sexual behaviors that are associated

with HIV transmission (Task Force on Community Preventive Services, 2007). With respect to

this, the Platinum Development Initiative has designed a condom promotion campaign tagged

‘The Rubber Revolution’.

Rubber Revolution is a grassroots campaign that will play a crucial role in preventing

HIV infection in Sub-Saharan Africa through Peer Education, Condom Accessibility and

Utilization in males ages 20-35 in Umuebulu Community (Etche Local Government Area),

Rivers State, Nigeria. The Rubber Revolution will also empower men as agents in their own self-

care, and empower their partners to insist on consistent condom use.

‘The Rubber Revolution’ will be successful because it addresses the factors leading to

lack of condom use while also remaining sensitive to the cultural beliefs of Sub-Saharan

Africans.

THE RUBBER REVOLUTION, 6

PROGRAM PLANNING DOCUMENTATION

Platinum Development Initiative will be using the PRECEDE-PROCEED planning model to

create, implement and evaluate the Rubber Revolution program. PRECEDE-PROCEED was

chosen as the planning model because it is a comprehensive planning model that allows the

categorization of factors into predisposing, reinforcing and enabling while ultimately focusing on

improving quality of life.

This is because the health-promoting behaviors that the Rubber Revolution program plans to

introduce to the target population in Umuebulu Community (Etche Local Government Area,

Rivers State, Nigeria) would ultimately need to be voluntary for it to be effective. In addition, the

Platinum Standard Initiative also considered that the HIV prevalence rates of any community is

affected by that community’s underlying attitudes, environment, as well as history. The model

that attends to these three determining factors of health is the PRECEDE-PROCEED model and

this further influenced the Platinum Standard Initiative to adopt this model for the

implementation of the Rubber Revolution program.

Finally, the Platinum Standard Initiative is interested in using the Rubber Revolution program to

ultimately improve the quality of life of the target population in Umuebulu Community. The

ultimate focus of the PRECEDE-PROCEED model is to better the quality of life of the target

population, making it the model of choice for the implementation of the Rubber Revolution

program.

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The Platinum Standard Initiative would also be making use of a combination of different

behavior change theories because of their concepts that line up with the purpose of the Rubber

Revolution program in Umuebulu Community.

On the Individual level, the following behavior change theories would be used:

1. The Health Belief Model – For members of targeted population to adopt the

recommended behaviors that the Rubber Revolution seeks to promote, their perceived threat of

disease (and its severity) and benefits of action must outweigh their perceived barriers to action.

A study by Tarkang, E. E., and Zotor, F. B. (2015) revealed the effectiveness of the Health Belief

Model in the implementation of an HIV prevention program in rural Cameroon.

2. Relapse Prevention Model - Members of targeted population who eventually adopt the

recommended behaviors that the Rubber Revolution seeks to promote, would be aided greatly by

interventions that help them anticipate barriers or factors that can contribute to relapse. A study

conducted by Roffman et al, (1998) revealed the effectiveness of the Relapse Prevention Model

in the implementation of a male-focused HIV prevention intervention.

On the Interpersonal level, the following behavior change theories would be used:

1. Social Cognitive Theory – The behavioral changes that the Rubber Revolution seeks to

promote is the result of reciprocal relationships among the environment, personal factors, and

attributes of the behavior itself. Self-efficacy is one of the most important characteristics that

determine behavioral change. A study by Dilorio C, et al (2000), showed that HIV-focused

interventions using self-efficacy have a better chance of reducing condom-use anxiety, while

THE RUBBER REVOLUTION, 8

also increasing positive condom perceptions, as well as facilitating the adoption of condom use

behaviors.

2. Theory of Planned Behavior – The target population’s perceived control over the

opportunities, resources, and skills needed to perform the behavioral changes that the Rubber

Revolution seeks to promote would affect their behavioral intentions (Montanaro, E. A., &

Bryan, A. D., 2014).

THE RUBBER REVOLUTION, 9

MISSION STATEMENT

The Mission of the Rubber Revolution is to prevent high HIV prevalence rates and reduce the

incidence of new HIV infections through condom use in Umuebulu Community Southern States,

Nigeria.

GOAL

To promote the correct and consistent use of condom for prevention against HIV in Umuebulu

Community

OBJECTIVES

1. Before the beginning of the program, all participants will receive a cassette tape containing all

materials pertinent to the intervention in the local dialect.

2. During the program, 50% of the sexually active men aged between 20– 35 will be able to

identify their own three greatest risk factors of contracting HIV infection.

3. After the poster demonstrating the correct way of using a condom has been distributed, at least

50% of the participants will be able to properly use a condom to prevent HIV/AIDS.

4 By January 2018, the program planners will supply condoms free of charge to the sexually

active men aged between 20 – 35 in Umuebulu community

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5. By the end of January 2018, 50% of the participants will be able to explain the ABC approach

to HIV prevention.

6. 6 months after the program has ended, 50% of the participants who have more than one sexual

partner will use of condom during each sexual encounter.

THE RUBBER REVOLUTION, 11

IMPLEMETATION PLAN

The Rubber Revolution will be implemented as a grassroots community program which meets

once a week on a Sunday, from 4:00pm to 6:00 pm for 10 weeks. It will occur at the Umuebulu

Community Town Hall, Rivers State, Nigeria. Facilities needed include a power generator, one

microphone and sound system, one projector and projector screen, three laptops, seven tablets for

peer educators, one whiteboard and 10 markers, 10 penile models, 10 tables and 70 chairs.

Four weeks before the Rubber Revolution kicks off, a marketing campaign will occur. Advocacy

visits will be conducted to the Rivers State Ministry of Health as well as the Etche Local

Government Health Department. Furthermore, advocacy visits will be conducted to the

community gatekeepers (Council of Community Chiefs and the Community Development

Council) to buy-in into the program. In addition, the advocacy visits will be conducted to the

Umuebulu Community Health Center for the purpose of seeking storage space for free condoms

obtained from the Rivers State Ministry of Health and the Health Department of the Etche Local

Government Area. They will also be asked to provide free condoms for the target population of

the Rubber Revolution during the program implementation and after implementation is over.

Posters and fliers will be posted at community hotspots such as churches, brothels, community

youth centers, the community secondary schools, markets, and bars. Several radio jingles will be

produced and aired on the community’s radio station. Publicity will also be facilitated through

THE RUBBER REVOLUTION, 12

community town criers, rallies, town hall meetings, community dialogues, and one on one

conversations.

Seven members of the National Youth Service Corps (NYSC) currently serving in Umuebulu

community will be recruited and trained as peer educators by program planners. This will be

done after letters have been sent to the NYSC requesting for these corps members. They will be

trained three times a week for two hours by program planners. The training will last for three

weeks. There will be a short pretest to assess the background knowledge of the potential peer

educators on HIV and condom use. At the end of the training, a post-test will be conducted to

assure that peer educators can successfully carry out intervention activities.

The Rubber Revolution will meet once a week for two hours, for a total of 10 sessions and 20

contact hours. Each session will cover information, skills, and other activities important to sexual

health. The sessions will begin promptly at 4pm with a short prayer and an ice breaker. The

participants will be segmented into smaller discussion groups according to their ages to facilitate

better participation. After each session, participants will be served palm wine, snacks, and water.

On the first day, there will be an educational segment on the overview of HIV and reproductive

health. The trained peer educators will give participants information about HIV and other STIS,

and information about preventing HIV. Information on the following will also be given. HIV

prevalence, contraceptive prevalence, life expectancy, and adult death rate.

On week two, education and activities will be centered around ABC approach to prevention of

HIV, barrier methods, and dual protection. The peer educator will explain the “ABC approach

“(Abstinence, be faithful and Condom use) to preventing HIV. Participants will be asked what

THE RUBBER REVOLUTION, 13

they think dual protection means and asked to identify situations were dual protection is most

needed. Participants will also be asked what they understand by “barrier method”. The trained

peer educator will give a presentation on barrier methods and dual protection after which

participants will return to their sub groups to discuss the barriers and challenges of dual

protection. Participants will role play on barrier methods and dual protection, where one

participant will act as a health professional who is skeptical about condom use while the second

participant will try to convince him about the merit of condom use.

On week three, education and activities will be centered around sexual and reproductive health

rights. Participants will be asked to share what they understand on sexual and reproductive health

and give examples. They will be asked to give examples on when such rights are violated.

Finally, participants will debate for 5-10minutes on women’s rights to have access to dual

protection.

On the fourth week, participants will be asked “when did you first realize that you are a boy”?

and they will be encouraged to recall and describe experiences in their childhood that first made

them aware of their gender. They will also be asked what it means to act as a man. The peer

educator will then explain the differences between men and women in the rate of sexual

transmission of HIV. He will also explain how gender norms influence vulnerability, prevention

and treatment, outcomes and consequences related to HIV and AIDS.

Factors contributing to the spread of STIs and HIV will be discussed on the fifth week.

Participants will be asked to go back to their groups and list factors contributing to the spread of

HIV among men, women, and children. The peer educator will also tell the groups to consider

biological, social, cultural, and economic factors if the participant hasn’t done this already. The

THE RUBBER REVOLUTION, 14

peer educator will make use of the Piot’s pyramid to explain how different conditions impact the

incidence and management of HIV.

Week six asks the participants to classify diverse types of behavior that is either high-risk, low-

risk, or no risk. Examples of such behaviors will be multiple sexual partners, vaginal sex without

a condom, and dry sex. After having discussions on this, two participants will roleplay the

following scenario: “A 28-year-old man who has experienced penile discharges on three separate

occasions in a row and is in a multiple relationship, while the other is the doctor performing the

risk assessment.

For week seven, the peer educator will explain how behavior change is a process that may or

may not be attained quickly, how different people will be at different points in the process at

various times, and how the behavior change process can go in both directions. The peer educator

will then describe the various stages of behavior change. He will obtain examples from the

participant’s lives about the various stages of behavior change. Finally, the participants will be

asked of practical methods that facilitated behavior change in their own experience.

In week eight, the peer educator will provide diagrams of the male reproductive organs and ask

participants to label appropriately in their local dialect. After that, samples of condoms will be

passed out. While this is being done, the peer educator will describe the characteristics of the

male condom. He will also explain the advantages and disadvantages as well as the

misconceptions of the male condom. Then, he will demonstrate the correct use of the male

condom on a penile model. After this, participants will practice the correct application on the

penile model.

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In the ninth week, the peer educator will ask the participants to get into pairs. Participants will be

asked to discuss their last sexual act and state if condoms were used. After this, peer educator

will stop the discussion and ask the participants how they felt discussing their last sexual act?

The peer educator will then explain why it is not easy to talk about sexuality. This will be

followed by a discussion on the barriers to effective communication skills.

For the last week, participants will return to their subgroups and be asked to role play a scenario

of a young married man who frequents the brothels but does not like to wear condoms. One

participant plays the man, another the health provider, and the other an observer. The peer

educator will observe the roleplay in each group and provide feedback as appropriate.

The time line for the Rubber Revolution program will last for six months (26weeks) and starts

with creating the program rationale in the first month. Three weeks are assigned for needs

assessment and two weeks for formation of goals and objectives based on the needs assessment.

The intervention development, gathering of resources, and marketing of the program will occur

in weeks five through nine. The program will start in week 10 and last through week 20.

Throughout this period, data will be collected weekly and monthly until the end of the Rubber

Revolution program. The data collected will be analyzed upon completion of the program, and

the results will be disseminated to the stakeholders. Since the Rubber Revolution will be

implemented again, the process evaluation data from personnel will be used for the program

improvement and strategies.

Numerous resources will be required to implement Rubber Revolution, such as personnel,

educational materials, space, storage containers, and equipment. The personnel required are 7

peer educators to lead the educational sessions, 10 volunteers to assist with logistics, 2 bus

THE RUBBER REVOLUTION, 16

drivers. The educational materials such as 7 instructional manuals, 10 penile models, six

diagrams of male reproductive organs, and 70 cassette tapes in the local dialect will be provided

by the Platinum Development Initiative. The town hall will serve as the meeting space required

to hold the Rubber Revolution sessions and will be provided at no cost. The 20 storage

containers will be used for holding condoms placed at strategic hotspots in Umuebulu

community as well as the Umuebulu Community Health Centre. The seven tablets, 10 penile

models, stationeries, one printer, UPS, one white board,10 white board markers, and three

laptops needed will be purchased. Other equipment such as the projector, projector screen,

microphone and sound system, 70 chairs and 10 tables, two buses, power generator will be

rented. Promotional materials (such as branded t-shirts, branded hand bands, branded calabash

and calendars) will be supplied by the Platinum Initiative Development team . Log books will

also be used in conjunction with the tablets as data capturing tools.

The Rubber Revolution is a 10-week program focusing on reducing the incidence of new HIV

infections through condom use in Umuebulu community. The bulk of the $15,000 grant will be

spent on snacks, program marketing, transportation, and educational materials. Donations of

condoms from the Rivers States Ministry of Health will help reduce the cost of this program.

Personnel will include peer educators and community volunteers. All activities will be held at the

Umuebulu community town hall. The Platinum Development Initiative has worked hard to

ascertain that the bulk of the grant money is spent on meeting the goal and objectives of the

Rubber Revolution.

THE RUBBER REVOLUTION, 17

EVALUATION PLAN

Evaluation is the process of ascertaining the value, efficiency or effectiveness of a program. By

subjecting the Rubber Revolution program to the evaluation process, Platinum Development

Initiative will be able to determine if the Rubber Revolution is being executed as it was

envisioned, meeting its objectives, and if any changes should be made before its next execution.

Process, impact and outcome evaluations will be carried out by the Platinum Development

Initiative. This team is made up of Promise Tewogbola, Uyiosa Chukwuka, and Olajumoke

Babatunde.

The Rubber Revolution will be implemented as a grassroots community program which meets

once a week from 4:00pm to 6:00 pm for 10 weeks. The Rubber Revolution is a community

based intervention designed by the Platinum Development Initiative planning committee. It has

the goal of promoting the correct and consistent use of condoms for the prevention of HIV/AIDS

in Umuebulu community. Umuebulu community was specifically selected for this program

because it falls within Rivers State, which is the region with the highest incidence of HIV

infection in Nigeria (NACA 2015; Nigeria GARPR 2015). In addition, sexually active males

between 20-35 in Umuebulu community will also be selected to participate in the project because

they are subject to the factors that contribute to the high incidence of HIV infection. These

factors include: lack of knowledge, low risk perception, dislike for condoms, inaccessibility to

THE RUBBER REVOLUTION, 18

condoms. The Rubber Revolution will meet its goal of promoting the correct and consistent use

of condoms for prevention against HIV in Umuebulu Community. This goal will be attained via

the following objectives:

(1.) Before the beginning of the program, all participants will receive a tape containing all

materials pertinent to the intervention in the local dialect. (2.) During the program, 50% of the

sexually active men aged between 20– 35 will be able to identify their own three greatest risk

factors of contracting HIV infection. (3.) After the poster demonstrating the correct way of using

a condom has been distributed, at least 50% of the participants will be able to properly use a

condom to prevent HIV/AIDS. (4.) By January 2018, the program planners will supply condoms

free of charge to the sexually active men aged between 20 – 35 in Umuebulu community (5.) By

the end of January 2018, 50% of the participants will be able to explain the ABC approach to

HIV prevention. (6.) 6 months after the program has ended, 50% of the participants who have

more than one sexual partner will use of condom during each sexual encounter.

The objectives were developed from a health needs assessment conducted in Nigeria which

shows Rivers state as the state with the highest rate of HIV prevalence (NACA, 2015; Nigeria

GARPR, 2015).

Resources that will be necessary and available for the successful running of the Rubber

Revolution include program planners, the Rivers State Ministry of Health, the health department

of the Etche Local Government Area, the Umuebulu Community Health Center, the Umuebulu

Council of Community Chiefs, the Umuebulu Community Development Council, use of the

Umuebulu community town hall, funds from grants and goodwill, 10 community volunteers and

7 peer educators. The activities that will be conducted during the Rubber Revolution sessions

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include an educational segment, a session for questions and answers, an interactive session, and

sessions for other activities such as role plays, ice-breakers and educative games. It is expected

that the long-term outcome of the Rubber Revolution will be prevention of high HIV prevalence

rates, as well as the reduction in the incidence of new HIV infections through condom use in U

The stakeholders involved in the Rubber Revolution include:

(1.) The Rivers State Ministry of Health and Etche LGA Health Department: They will provide

resources, especially the 10,000 condoms that are necessary for the implementation of the

Rubber Revolution. They will be engaged through advocacy visits.

(2.) The Rubber Revolution program planning committee: They will be responsible for

controlling the general direction of the evaluation process.

(3.) The Umuebulu Community Development Council and The Umuebulu Community Council

of local Chiefs: They are the gatekeepers of the Umuebulu community and will be responsible

for providing access of the Rubber Revolution program into the community. In addition, they

will provide resources and facilities, such as the town hall for meetings, as well as community

volunteers that are necessary for the implementation of the Rubber Revolution. They will be

engaged through advocacy visits.

(4.) Umuebulu Community Health Centre: They will be involved in providing storage facilities

for the condoms procured from the Rivers State Ministry of Health and the Etche LGA Health

Department. In addition, they will also be providing free condoms for the target population in

Umuebulu, once the condoms stored are exhausted. They will be engaged through advocacy

visits.

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(5.) Community-Based Organizations: They will be involved in providing resources which will

be useful in the implementation of the Rubber Revolution. They will be engaged via advocacy

visits.

(6.) The Umuebulu Youth Council.

(7.) The peer educators and Community Volunteers.

(8.) The grant awarding agency.

(9.) Businesses who donate items for the program: items such as palm wine, bottled water, food,

and snacks

The role(s) that each group of stakeholders will play in the evaluation process are given as

follows:

(1.) The Rivers State Ministry of Health and Etche LGA Health Department:

(a.) Process evaluation, where representatives from the two government bodies will come over to

Umuebulu community to ascertain that the procured condoms were used to implement the

Rubber Revolution project; (b.) Impact evaluation, where the two government bodies will obtain

a final report showing the results of the Rubber Revolution and ascertain whether the right

population was served and whether the target population’s needs were met.

(2.) The Rubber Revolution Planning Committee:

(a.) Process evaluation, where the members of the Rubber Revolution planning committee will

search the web for HIV interventions and condom promotion programs targeted towards the men

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in rural communities. This will be used in identifying models and program activities that have

produced results in the past. The Rubber Revolution planning committee will use this

information to formulate the workplan for the Rubber Revolution, as well as the budget; (b.)

Impact evaluation, where the members of the Rubber Revolution planning committee will

monitor the weekly activities to measure how the program is in line with meeting its objectives.

This will be done by a SWOT analysis, observation and taking of attendance; (c.) Outcome

evaluation, where members of the Rubber Revolution planning committee will measure the

effects of the program on the target population while also keeping an eye on aspects of the

Rubber Revolution that will need to be modified for subsequent implementation of the Rubber

Revolution.

(3.) The Umuebulu Community Development Council and The Umuebulu Community Council

of Local Chiefs:

(a.) Outcome evaluation, where members of the Umuebulu Community Development Council

and The Umuebulu Community Council of Local Chiefs will receive a final report of the

effectiveness and performance of the Rubber Revolution in the community.

(4.) The Umuebulu Community Health Centre:

(a.) Memorandum of Understanding (MoU), where the Umuebulu Community Health Centre

will agree with the Rubber Revolution planning committee to offer its storerooms for the

safekeeping of the condoms that will be distributed during the program. The Memorandum will

also need the Community Health Centre to make provisions for offering condoms for free to

members of the target population after the stored condoms have been used up.

THE RUBBER REVOLUTION, 22

(5.) Community Based Organization:

(a.) Input evaluation, where the Rubber Revolution planning committee will access the inputs

and resources contributed by the Umuebulu Community-Based Organizations and see how they

will be useful in attaining program objectives.

(6.) Members of the Umuebulu Youth Council:

(a.) Process evaluation, where members of the Umuebulu Youth Council participating in the

Rubber Revolution program will partake in self-report surveys where they will report on whether

they learnt how to wear a condom correctly: (b.) Outcome evaluation, where members of the

Umuebulu Youth Council who participated in the Rubber Revolution program will partake in

self-report surveys and will report on whether they made use of condom(s) at least once, six

months after the end of the Rubber Revolution.

(7.) Peer Educators and Community Volunteers:

(a.) Process evaluation, where they will help facilitate and keep track of the activities of the

Rubber Revolution program. They will also partake in 9 trainings (3 times a week for 3 weeks)

organized by the Rubber Revolution planning committee, to engage them with the activities that

will constitute the Rubber Revolution program; (b.) Outcome evaluation, where they will provide

feedback on activities that were carried out during the period of implementing the Rubber

Revolution program.

(8.) Grant Awarding Agency:

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(a.) Impact evaluation, where they will receive results pertaining to the progress of the Rubber

Revolution; (b.) Outcome evaluation, where they will receive the findings necessary to make a

final evaluation of the success and significance of the Rubber Revolution program.

(9.) Businesses who donate resources to the Rubber Revolution:

(a.) Impact evaluation, where they will receive results of the intervention from the Rubber

Revolution and know for certain that the resources they invested into the program produced its

desired results.

The Rubber Revolution planning committee will be making use of process evaluation, impact

evaluation, as well as outcome evaluation to answer the evaluation questions that will be raised

by the Rubber Revolution program. These different evaluation types will be used for the

following reasons: (1.) They are all found within the PRECEDE-PROCEED model which will be

used for implementing the Rubber Revolution program; (2.) They also provide a straightforward

approach towards measuring the different objectives of the Rubber Revolution program.

The Rubber Revolution will make use of the participatory approach for process, impact and

outcome evaluations. This is because there will be a need for inputs from every stakeholder that

is involved in the Rubber Revolution. The Rubber Revolution will be evaluated non-

experimentally as it is unethical to withhold a health intervention program from members of the

target population who would have been used as the control group in an experimentally designed

intervention.

Examples of specific evaluation questions that will be asked include:

THE RUBBER REVOLUTION, 24

(1.) Did each participant get the tapes in the local dialect explaining the pertinent points of the

Rubber Revolution?

(2.) Were there any weeks where intervention sessions did not hold due to unforeseen

circumstances?

(3.) How many participants used condom(s) at least once after the end of the Rubber Revolution?

Data will be obtained via both qualitative and quantitative methods. Data will also be obtained

from the participants through checklists, focus groups, self-report surveys and log books. There

will also be document reviews carried out on the activity logs completed by the participants of

the Rubber Revolution. The specific age of the participants, as well as the number of condoms

used by participants after the intervention will be obtained by direct measurement, while quality

of life, satisfaction with the program, and sexual habits will be obtained through surveys

conducted on the participants.

Differences between the subgroups in the target population will be obtained by using the

Student’s t-test, as well as correlation design and regression. Members of the Rubber Revolution

planning committee will be responsible for the analysis of data obtained from the

implementation of the program. In the event where problems arise during the data analysis, the

planning committee will consult with Dr. Amanda Divin for assistance. Cross-checking of data

will be carried out at the stage of data entry and data analysis. This will be done by members of

the Rubber Revolution planning committee. This will be done to ensure that the data quality is

not compromised at any point during the evaluation process. The master data collection sheet

THE RUBBER REVOLUTION, 25

will be saved to a password-protected, cloud-based drive to ensure that the data obtained from

the implementation of the Rubber Revolution program does not fall into the wrong hands.

Every member of the Rubber Revolution planning committee will be involved in the evaluation

process. Data will be collected weekly from the community volunteers and peer educators, which

will be discussed at weekly committee meetings. The different results will be shared with the

different stakeholders at varying times during the evaluation process. There will be biweekly

meetings between community volunteers, peer educators and committee members, where results

will be shared through presentations. A written report will be sent to the Rivers State Ministry of

Health, the Health Department of Etche LGA, the Umuebulu Community Development Council

and the Umuebulu Council of Chiefs. A presentation and final report will be forwarded to the

grant funding agency. Feedback received from all stakeholders will be considered by the

planning committee for the next round of the Rubber Revolution.

.

THE RUBBER REVOLUTION, 26

APPENDIX

TABLE 1: DETAILED IMPLEMENTATION PLAN

Week 1 – Overview of HIV and Reproductive Health

60mins Registration of participants

Participants will be registered by writing their name, age, occupation, and other

details into the attendance register. If they are unable to write, community

volunteers/peer educators will assist participants in obtaining their details

5mins Opening prayer by volunteer

20mins Introduction of facilitators and participants to one another

This will be done in the form of a participatory game where the participants will

introduce themselves one at a time

5mins Welcome remarks and inauguration of the Rubber Revolution

The opening remarks will be given by the Program Director of the Rubber

Revolution

10mins Training expectations discussion

Participants will be asked to discuss their expectations for the Rubber Revolution.

15mins Overview of HIV and Reproductive Health

THE RUBBER REVOLUTION, 27

Peer educators will give a presentation on the facts about HIV, as well as, other STIs.

There would also be information given on HIV prevalence, contraceptive prevalence,

life expectancy and adult death rate.

Participants will be handed copies of the presentation which will largely be made up

of pictures associated with the content of the discussion

5mins Questions and Answers

Participants will be served palm wine, snacks (meat pie) and water as refreshment

Week 2 - Barrier Methods and Dual Protection

5mins Opening Prayer by volunteer

10mins Revision from the previous week

The peer educator will ask participants to discuss the lessons learnt from the previous

week.

40mins Discussion on Barrier Methods and Dual Protection

Firstly, the peer educators will explain the ABC approach for the prevention of HIV.

The peer educator will then ask participants about their ideas about dual protection

and barrier methods. The participants will also be asked about when they think dual

protection is most suitable. All the while, the peer educators will write out the

answers of the participants on the whiteboard.

40mins Presentation on Barrier Methods and Dual Protection

THE RUBBER REVOLUTION, 28

The peer educator will give a presentation on barrier methods and dual protection

Participants will be handed copies of the presentation which will largely be made up

of pictures associated with the content of the discussion

20mins Participants will role play on barrier methods and dual protection, where one

participant will act as a health professional who is skeptical about condom while the

second participant will try to convince him about the merit of condom use

5mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as refreshment

Week 3- Sexual And Reproductive Health Rights

5mins Opening prayer

10mins Recap from last week’s discussion

20mins Participants will converge into their groups and discuss on what they

understand about sexual and reproductive health rights and examples of

when such rights are violated

30mins The peer educators will explain what sexual and reproductive health rights is

about

50 mins The participants will debate on women’s rights to have access to dual

protection. Each group will select a representative for the debate and will be

given 5-10mins to debate

5mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

THE RUBBER REVOLUTION, 29

Week 4 - Discussion On The Differences Between Men And Women In The Rate Of

Sexual Transmission Of HIV

5mins Opening prayers

10mins Recap on last week’s discussion

40mins Participants will share their experiences on when they first realized that they

were a boy or when they got aware of their gender and explain what it means

to act as a man

50mins The peer educator will explain the differences between men and women in

the rate of sexual transmission of HIV, how gender norms influence

vulnerability, prevention and treatment, and consequences related to HIV

and AIDS

20mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 5 – Factors Contributing To The Spread Of STIs And HIV

5mins Opening Prayer

10mins Recap on last week’s discussion

40mins Participants will be asked to converge to their various groups and list factors

contributing to the spread of HIV among men, women, and children. They

will consider biological, social, cultural, and economic factors in the spread

of HIV

50mins The peer educator will make use of the Piot’s pyramid to explain how

different conditions impact the incidence and management of HIV

THE RUBBER REVOLUTION, 30

15mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 6 – Behaviors That Predisposes To HIV

5mins Opening prayers

10mins Recap on last week’s discussion

50mins Interactive session on diverse types of behaviors that predisposes to HIV

30mins Two participants will Role play on the following scenario: One will be a

28year old man who has experienced penile discharges on three separate

occasions and in multiple relationship, while the other is the doctor

performing the risk assessment.

15mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 7- Behavioral Change

5mins Opening prayer

10mins Recap from last week’s discussion

50mins The peer educator will explain about behavior change and describe the

various stages of behavior change.

30mins The participants will describe practical methods that facilitates behavior

change in their own experience

THE RUBBER REVOLUTION, 31

15mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 8 – The Male Condom

5mins Opening prayers

10mins Recap on last week’s discussion

20mins The participants will label appropriately the diagram of male reproductive

organ in their local dialect

50mins The peer educator will explain the characteristics of the male condom,

advantages and disadvantages as well as misconceptions of the male

condom. He will then demonstrate the correct use of the male condom on

a penile model

20mins Participants will practice the correct application of the male condom on

the penile models provided in each group

15mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 9 – Sexuality And Barriers To Effective Communication

5mins Opening prayers

10mins Recap on last week’s discussion

THE RUBBER REVOLUTION, 32

30mins Participants will be in pairs to discuss their last sexual act and state if

condoms were used.

20mins The peer educator will ask the participants on how they felt discussing

their last sexual act. This will be an interactive session

50mins The peer educator will explain why it isn’t easy to talk about sexuality and

will also discuss on barriers to effective communication skills

5mins Questions and answers

Participants will be served palm wine, snacks (meat pie) and water as

refreshment

Week 10 – General Interactive Session (Last Week Of The Program)

5mins Opening prayers

20mins Role play on a young man who frequents the brothels but does not like to

wear condom. One participant plays the man, another the healthcare

provider and the other an observer. Other participants will also be

involved in other characters of the role play.

10mins The peer educator will observe the role play and provide feedback as

appropriate

60mins General overview on lessons learnt so far from week one to ten

15mins Questions and answers

THE RUBBER REVOLUTION, 33

Participants will be served palm wine, snacks (meat pie), food and water

as refreshment

THE RUBBER REVOLUTION, 34

Table 2: Timeline for Rubber Revolution

Week

Tasks 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 2

7

2

8

Develop program

rationale

+ + + +

Conduct needs

assessment

+ + +

Develop Goals &

Objectives

+ +

Create

Interventions

+ + +

Conduct advocacy

with stakeholders

+ + +

THE RUBBER REVOLUTION, 35

Select and train

peer educators and

community

volunteers

+ + + + +

Formative

Evaluations

+ + + + + + + + + + + + + + + +

Assemble

necessary materials,

facilities and

resources

+ + +

Market program + + + +

Program Kickoff +

Pilot test Rubber

Revolution

+ + + + + + + + + + +

Collect data + + + + + + + + + + +

THE RUBBER REVOLUTION, 36

Summative

evaluation

+ + + + + + +

Data analysis + +

Share outcomes

with stakeholders

and funding agency

+ + +

Continue with

follow-up for long-

term evaluation

+

THE RUBBER REVOLUTION, 37

TABLE 3: PROJECTED BUDGET FOR RUBBER REVOLUTION. REVENUE AND RESOURCES

S/N Contribution from sponsors: Amount ($) 1 Grants $15,000 2 Funds $4,600 3 Human Resources (Community volunteers) 4 Palm wine 100 gallons 5 Food and snacks 1,000 meat pies 6 Bottled water 48X50 packs 7 condoms 8 Storage space (Umuebulu Community Health Center) 10,000 condoms

Total Contribution 19,600

EXPENDITURES Supplies

1 Branded T-Shirts 200x$14 2,800 2 Branded Calabash 70x$1.50 105 3 Condoms storage container 20x$3 60 4 Calendars 200x$1.5 300 5 Tablets 7x$100 700 6 Toshiba laptops 3x$200 600 7 Hand band 200x$0.20 40 8 Penile models 10x$6.1 61 9 Printer 1x$120 120

THE RUBBER REVOLUTION, 38

10 Cassette tapes 70x$1.50 105 11 Gas to power generator 50litersx$1 50 12 White board 1x$11 11 13 Markers 10x$0.40 4 14 Staple pin 2packetsx$1 2 15 Ink 3x$20 60 16 UPS 1x$50 50 Communication Allowance

1 Internet 100 2 Call cards 100 Advertising and Marketing

1 Radio jingle 42x$14.50 609

2 Recording of information in local dialect on cassette tapes 100

Printing

1 Fliers 200 pieces 120 2 Posters 200pieces 200 3 Printing Papers 1 packet 20 4 Self-evaluation checklist printing 50 5 Diagram of male reproductive organ 6x$10 60

Transportation

1 Vehicle for rallies 1x$150 150

THE RUBBER REVOLUTION, 39

2 Two buses with two drivers hired per week for 10 meeting sessions 10x$60 600

3 Round trip ticket to Nigeria for program planners 3x$2,000 6,000 4 Inter-state transport 3x100 300 Rentals

1 Power generator for 10 meeting sessions 10x$10 100

2 Microphones and sound system for 10 meeting sessions $20 20

3 Projector and projector screen for 10 meeting sessions $50 50 4 Tables 10x$1.5 15 5 Chairs 70x1.2 84 Trainings

1 Training of peer educators and volunteers 1,500 2 Per diem for peer educators and volunteers 1,000 3 Accommodation and per diem for program planners 3x$1,000 3,000

Medicals 1 First Aid Box 1x$34 34

1 Security for 10 days 10x32 320

Total Expenses 19,600

THE RUBBER REVOLUTION, 40

Table 4: Examples of Specific Questions to be asked during Evaluation

How Collected From Whom Collected

Process Evaluation

Did every session meet for

the allotted 120 minutes?

Checklist, focus group Peer educators, community

volunteers

Were log sheets distributed

and collected at the

appropriate times?

Count of log books, checklist Peer educators, community

volunteers

Did each participant learn

how to wear a condom

correctly?

Checklist, focus group Peer educators, community

volunteers

Were there any weeks where

intervention sessions did not

hold due to unforeseen

circumstances?

Checklist, Focus group Peer group educators

Did each participant get the

tapes in their local dialect

explaining the pertinent

points of the Rubber

Revolution?

Checklist, self-report survey Peer group educators,

participants

Impact Evaluation

How many participants used

condom(s) at least once after

Log books, self-report

surveys

Participants

THE RUBBER REVOLUTION, 41

the end of the Rubber

Revolution?

Did the participants know the

ABC approach to preventing

HIV

Log books, self-report survey Participants

Outcome Evaluation

Did the participants use

condom(s) at least once, six

months after the end of the

Rubber Revolution?

Log books, self-report survey Participants

Did the participants

remember the ABC approach

for staying free from

HIV/AIDS, six months after

the end of the program?

Log books, self-report Participants

Did the participants quality of

life improve following the

Rubber Revolution?

Self-report survey Participants

THE RUBBER REVOLUTION, 42

TABLE 5: EVALUATION WORK PLAN

Evaluation Task Person(s) Responsible Timeframe

Staffing

Selection and training of peer educators and

community volunteers

Members of the Rubber

Revolution Planning

committee

Week 5 –

Week 9

Engaging Stakeholders

Conduct Advocacy visit to the Rivers State Ministry

of Health and Etche Local Government Health

Department

Members of the Rubber

Revolution Planning

Committee

Week 4

Conduct Advocacy visit to Umuebulu Community

Development Council and Council of Community

Chief

Members of the Rubber

Revolution Planning

Committee

Week 5

Conduct Advocacy visit to the Umuebulu Community

Health Center

Members of the Rubber

Revolution Planning

Committee

Week 6

Conduct Open ‘Carnival-style’ Rally in Umuebulu

Community

Members of the Rubber

Revolution Planning

Committee, Peer Educators,

Community Volunteers,

Week 10

THE RUBBER REVOLUTION, 43

Evaluation Task Person(s) Responsible Timeframe

Conduct Radio jingles on the Rubber Revolution on

the local radio station

Members of the Rubber

Revolution Planning

Committee

Week 6 –

Week 9

Focusing the Evaluation

Create the evaluation questions that will measure

whether program objectives are being met

Members of the Rubber

Revolution Planning

Committee

Week 5 –

Week 6

Gathering Credible Evidence

Develop evaluation tools that will be used to capture

data from the Rubber Revolution program, such as

checklists, self-report surveys, attendance sheets, etc.

Members of the Rubber

Revolution Planning

Committee

Week 5 –

Week 6

Obtain data from participants of the Rubber

Revolution through checklists, self-report surveys,

and attendance sheets

Peer Educators, Community

Volunteers

Week 10 –

Week 20

Justifying Conclusions

Analyze data with data analyzing software Members of the Rubber

Revolution Planning

Committee

Week 21 –

Week 22

Using Evaluation Results

THE RUBBER REVOLUTION, 44

Evaluation Task Person(s) Responsible Timeframe

Share evaluation reports with Rivers State Ministry of

Health and Etche Local Government Health

department

Members of the Rubber

Revolution Planning

Committee

Week 23 –

Week 25

Share and present evaluation reports with funders Members of the Rubber

Revolution Planning

Committee

Week 25

Follow-up for long-term evaluation of the Rubber

Revolution

Peer Educators and

Community Volunteers

Week 27 -

THE RUBBER REVOLUTION, 45

THE RUBBER REVOLUTION, 46

PIOT’S PYRAMID

Piot’s pyramid is a pictorial representation of the varying levels at where diverse circumstances

can have an effect on the incidence and management of HIV.

THE RUBBER REVOLUTION, 47

LOGO FOR THE RUBBER REVOLUTION

THE RUBBER REVOLUTION, 48

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