Background: The Nigerian 4.1% HIV-1 prevalence rate masks concentrated epidemics in most-at-risk populations (MARPs). Many MARPs are unable to access HIV services due to stigma and discrimination encountered in facilities. We report HIV and STI characteristics of Men who have Sex with Men (MSM) enrolled in a community-based HIV/AIDS clinic in Abuja, Nigeria.
Method: The Institute of Human Virology-Nigeria, a PEPFAR implementing partner, in partnership with ICARH, provides comprehensive HIV/AIDS prevention, care and treatment in a safe community-based environment for MSM. HIV counseling and testing (HCT), prevention and support services are provided by the community-based organization staff and peer volunteers supplemented by a mobile physician-led multidisciplinary team from a linked tertiary center and mobile laboratory services. All MSM clients are enrolled in the clinic irrespective of HIV status.
Results: In 4 months, 122 MSM (13 reporting being married or divorced), with a mean age of 26.5 years received HCT. Sixty six (55%) tested HIV-positive (15 of whom reported previously testing HIV-negative). Thirty three (26%) reported never having used a condom. In the 3 months preceding HCT, 57 (46%) had more than 1 sexual partner; 58 (47%) had unprotected sex with a casual partner; and 55 (45%) had unprotected sex with a regular partner. Twenty seven (22%) reported a history of STIs; and 20% had current STI symptoms. HIVnegative clients were more likely to report greater than 1 partner (61% vs 52%, P = 0.4); unprotected sex with a casual partner (57% vs 49%, P = 0.5); and unprotected sex with a regular partner (67% vs 43%, P = 0.03). For the 42 HIV-positive enrolled, baseline median CD4 count was 336 cells/[mu]L (range 86-916) and HIV-1 viral load 74,256 c/mL (IQR 5,966-284,122).
Conclusion: High rates of unrecognized and untreated HIV-1 seen are likely a significant driver of new infections due to increased transmission risk from high viral load, multiple sexual partners and STIs. Although HIV-positive MSM exhibited lower rates of risk behaviors, 49% were still having unprotected sex. For HIV-negative clients, engagement in a community-based clinic provides opportunities to achieve improved behavioral risk profiles before becoming HIV-infected through ongoing prevention education and interventions, and reduces lost-to-follow up in the link between testing, care and treatment. More efforts are needed to explore targeted combination prevention strategies, including test and treat for MARPs.
(C) 2012 Lippincott Williams & Wilkins, Inc.