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. 2017 Apr 20;20(1):21489.
doi: 10.7448/IAS.20.01.21489.

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Trevor A Crowell  1   2 , Babajide Keshinro  3 , Stefan D Baral  4 , Sheree R Schwartz  4 , Shauna Stahlman  4 , Rebecca G Nowak  5 , Sylvia Adebajo  6 , William A Blattner  5 , Manhattan E Charurat  5 , Julie A Ake  1
Affiliations

Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria

Trevor A Crowell et al. J Int AIDS Soc. .

Abstract

Introduction: Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria.

Methods: Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV.

Results: From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]).

Conclusion: These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.

Keywords: HIV; epidemiology; men who have sex with men; sex work; stigma; sub-Saharan Africa.

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Conflict of interest statement

TC has received a speaker fee from Gilead Sciences. The other authors declare no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Sexual behaviours and condom use. Bar height represents the percentage of all participants who reported each sexual behaviour within the 12 months prior to enrolment. Pearson’s chi-squared test was used to compare the proportion of participants reporting each sexual behaviour between men who sell sex and men who do not sell sex. Statistically significant p-values (p ≤ 0.05) are shown in bold. Shaded areas represent the percentage of participants who reported each frequency of condom use during a sexual behaviour out of all participants who reported that behaviour. There were no statistically significant differences in the frequency of condom use between men who sell sex and men who do not sell sex.
Figure 2.
Figure 2.
Stigma and access to care among men who sell sex and men who do not sell sex. Bars represent the percentage of all study participants who reported each indicator of stigma during the baseline structured interview. Comparisons are presented between men who sell sex and men who do not sell sex, with statistically significant p-values (p ≤ 0.05) shown in bold.
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