Theoretical Modelling of Health Communication Barriers in HIV Prevention Among Key Populations in South South Nigeria

HIV prevention health communication among key populations in South South Nigeria is shaped by multi-layered barriers that existing behaviour change models do not fully capture. This study developed and empirically tested an original theoretical model of health communication barriers in HIV prevention among key populations across Rivers, Akwa Ibom, and Cross River states. A sequential explanatory mixed methods design was used, beginning with a cross-sectional survey of 380 key population members including men who have sex with men, female sex workers, and people who inject drugs, followed by 36 in-depth interviews and 8 focus group discussions with programme implementers and key population representatives. Exploratory factor analysis and structural equation modelling were applied to survey data, while thematic analysis was applied to qualitative data. Six barrier dimensions were empirically identified: institutional stigma, legal vulnerability, health worker discrimination, community marginalisation, health system distrust, and digital exclusion. The structural equation model demonstrated acceptable fit (CFI 0.94, RMSEA 0.06) and explained 61 percent of variance in health communication non-engagement. The emergent Layered HIV Communication Barrier Model makes an original theoretical contribution and provides a robust evidence base for designing barrier-responsive HIV prevention health education for key populations. Keywords: HIV prevention, health communication barriers, key populations, South South Nigeria, theoretical model