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High HIV Prevalence Among Men Who Have Sex With Men in Nigeria: Implications for Combination Prevention

Vu, Lung MD, PhD*; Adebajo, Sylvia MD, MSc; Tun, Waimar PhD; Sheehy, Meredith MPH§; Karlyn, Andrew PhD; Njab, Jean PhD; Azeez, Aderemi MD, MPH; Ahonsi, Babatunde PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2013 - Volume 63 - Issue 2 - p 221–227
doi: 10.1097/QAI.0b013e31828a3e60
Epidemiology and Prevention

Background: This study provides population-based estimates of HIV prevalence and factors associated with HIV infection among men who have sex with men (MSM) in 3 large cities in Nigeria. We aimed to increase the knowledge base of the evolving HIV epidemic among MSM, highlight risk factors that may fuel the epidemic, and inform future HIV prevention packages.

Methods: A total of 712 MSM, aged 18 years and older, living in Abuja, Ibadan, and Lagos were recruited using respondent-driven sampling. Participants completed a behavioral questionnaire and tested for HIV. Population-based estimates were obtained using RDSAT software. Factors associated with HIV infection were ascertained using multiple logistic regression adjusting for RDSAT individualized weights.

Results: A high proportion of MSM reported high-risk behaviors, including unprotected anal sex with men (30–50%), unprotected vaginal sex with women (40%), bisexual behavior (30–45%), and never been tested for HIV (40–55%). The population-based estimates of HIV among MSM in the 3 cities were 34.9%, 11.3%, and 15.2%, respectively. In Abuja, HIV was significantly associated with unprotected sex and transactional sex. In Ibadan, HIV was significantly associated with unprotected sex and self-identified bisexual. In Lagos, HIV was significantly associated with the older age.

Conclusions: HIV prevalence among MSM in the 3 cities was 4–10 times higher than the general population prevalence and was behaviorally linked. In response to a complex set of risks and disadvantages that put African MSM at a greater risk of HIV infection, future interventions targeting MSM should focus on a comprehensive approach that combines behavioral, biomedical, and structural interventions.

*Population Services International, Washington, DC;

Population Council, Abuja, Nigeria;

Population Council, Washington, DC;

§Population Council, New York, NY; and

Ministry of Health of Nigeria, HIV and AIDS Division, Abuja, Nigeria.

Correspondence to: Lung Vu, MD, PhD, 1120 19 Street, NW, Suite 600, Washington, DC 20036 (e-mail:

L. V., S. A., W. T., M. S., and A. K. conceived and designed the study. L. V., S. A., and J. N. coordinated the field data collection. L. V. conducted statistical analysis and drafted the paper. All authors interpreted the findings, provided critical review, and approved the final manuscript.

The authors have no conflicts of interest to disclose.

The study was funded by Department for International Development.

Received September 04, 2012

Accepted January 18, 2013

© 2013 by Lippincott Williams & Wilkins