HIV Prevention and Treatment for Men who have sex with Men: Achievements and Challenges Ifeanyi Kelly Orazulike National Coordinator Sexual Minorities Against AIDS in Nigeria (SMAAN) ,

Outline Introduction Understanding MSMs Risk Factors Multiple Partnering, Inconsistent Condom Use Social and Economic Factors Consequences of challenges faced Preventive measures and control Moving forward Conclusion Introduction Understanding MSMs Risk Factors Multiple Partnering, Inconsistent Condom Use Social and Economic Factors Consequences of challenges faced Preventive measures and control Moving forward Conclusion

Introduction In Nigeria, MSM have been identified as the second most vulnerable group to HIV/AIDS. National HIV Prevalence: 4.4%, among MSM 13.5%(IBBSS 07) Prevention campaigns for MSM aim at reducing the rate of HIV infections that result from anal sex and restricting the overall spread of HIV in the country. Many countries that have recorded significant reductions in the national HIV prevalence have attributed it largely to HIV prevention initiatives aimed at MSM and their partners, e.g. South Africa. In order to conduct effective campaigns there is need to look at the problems that MSM may encounter in their lives, and examine why so many are becoming infected with HIV. In Nigeria, MSM have been identified as the second most vulnerable group to HIV/AIDS. National HIV Prevalence: 4.4%, among MSM 13.5%(IBBSS 07) Prevention campaigns for MSM aim at reducing the rate of HIV infections that result from anal sex and restricting the overall spread of HIV in the country. Many countries that have recorded significant reductions in the national HIV prevalence have attributed it largely to HIV prevention initiatives aimed at MSM and their partners, e.g. South Africa. In order to conduct effective campaigns there is need to look at the problems that MSM may encounter in their lives, and examine why so many are becoming infected with HIV.

Understanding MSM Risk factors MSM in Nigeria come from a diverse range of backgrounds and cultures, and can differ greatly in the lives that they lead. Similarly, levels of risk that they face in terms of HIV infection are different, depending on factors such as locations they operate in, whether they are visible or invisible, whether they have access to condoms or quality health services, etc. Despite this diversity, MSMs share similar characteristics regardless of their background. Some of these factors can increase their vulnerability to HIV. They include: MSM in Nigeria come from a diverse range of backgrounds and cultures, and can differ greatly in the lives that they lead. Similarly, levels of risk that they face in terms of HIV infection are different, depending on factors such as locations they operate in, whether they are visible or invisible, whether they have access to condoms or quality health services, etc. Despite this diversity, MSMs share similar characteristics regardless of their background. Some of these factors can increase their vulnerability to HIV. They include:

Multiple Partnering, Inconsistent Condom Use High numbers of sexual partners. This in itself does not necessarily increase their likelihood of becoming infected with HIV. If they use condoms consistently and correctly then they will probably be protected no matter how many people they have sex with. They do not always use condoms with their partners. This could be due to lack of access to condoms, or belief in myths associated with condom use, or powerlessness to negotiate safer sex. One of the most persistent challenges of condom use is the issue of non-use with partners. High numbers of sexual partners. This in itself does not necessarily increase their likelihood of becoming infected with HIV. If they use condoms consistently and correctly then they will probably be protected no matter how many people they have sex with. They do not always use condoms with their partners. This could be due to lack of access to condoms, or belief in myths associated with condom use, or powerlessness to negotiate safer sex. One of the most persistent challenges of condom use is the issue of non-use with partners.

Social and Economic Factors Poverty forces many MSM into risky behaviour MSM are generally stigmatised, marginalised and criminalised by the societies in which they live, and in various ways, these factors can contribute to their vulnerability to HIV Lack of legislation and policies protecting MSM from stigmatization, marginalisation, etc. puts them at risk. E.g. Community discrimination. In addition, MSM face stigma that makes it hard for them to access health, legal, and social services. Without access to these services, MSM may face a higher risk of HIV infection, and be more likely to pass on HIV if they do become infected. Poverty forces many MSM into risky behaviour MSM are generally stigmatised, marginalised and criminalised by the societies in which they live, and in various ways, these factors can contribute to their vulnerability to HIV Lack of legislation and policies protecting MSM from stigmatization, marginalisation, etc. puts them at risk. E.g. Community discrimination. In addition, MSM face stigma that makes it hard for them to access health, legal, and social services. Without access to these services, MSM may face a higher risk of HIV infection, and be more likely to pass on HIV if they do become infected.

Current challenges Government fail to acknowledge MSM happens - insufficient political will Sexuality is a tabooed subject for discussion - cultural Discrimination and stigmatization - moral values Criminalized by the law Government fail to acknowledge MSM happens - insufficient political will Sexuality is a tabooed subject for discussion - cultural Discrimination and stigmatization - moral values Criminalized by the law

Examples of Successful HIV Interventions in the MSM community

Institute of Human Virology-Nigeria/ARN/CRH- Impact mitigation of HIV among MSM in Abuja (10 months). Evaluations have shown Behavioral Change (high condom use and partner reduction) in the community in Abuja. Quarterly pee education workshop with UNAIDS Development of MSM friendly IEC material MSM friendly HCT centers in two locations in the FCT. Men's Health Network with population Council Institute of Human Virology-Nigeria/ARN/CRH- Impact mitigation of HIV among MSM in Abuja (10 months). Evaluations have shown Behavioral Change (high condom use and partner reduction) in the community in Abuja. Quarterly pee education workshop with UNAIDS Development of MSM friendly IEC material MSM friendly HCT centers in two locations in the FCT. Men's Health Network with population Council

Preventive measures and control Peer to peer education Monthly community meeting Free condoms and Lubricants distribution Distribution of IEC material in MSM parties Peer to peer education Monthly community meeting Free condoms and Lubricants distribution Distribution of IEC material in MSM parties

Moving forward Prioritize strategies and budget to address HIV prevention, care, and treatment needs of MSM Engage MSM, especially those infected with HIV in design, implementation, and monitoring programs Tailor national, state, and local HIV strategies for MSM to epidemiological and social data, taking into account diverse socio-cultural circumstances Prioritize strategies and budget to address HIV prevention, care, and treatment needs of MSM Engage MSM, especially those infected with HIV in design, implementation, and monitoring programs Tailor national, state, and local HIV strategies for MSM to epidemiological and social data, taking into account diverse socio-cultural circumstances

Continuation… Promote programs for MSM in different setting - military and prisons Support non-governmental and community based organizations addressing issues related to MSM - including organization of people living with HIV/AIDS. Deliver programs that promote access to HIV prevention, treatment, and care for MSM Promote programs for MSM in different setting - military and prisons Support non-governmental and community based organizations addressing issues related to MSM - including organization of people living with HIV/AIDS. Deliver programs that promote access to HIV prevention, treatment, and care for MSM

Continuation… Challenge stigma and discrimination against MSM and advocate legal and policy reforms to promote human rights and access to health services Increase networking and information exchange with organizations working on behalf of MSM Challenge stigma and discrimination against MSM and advocate legal and policy reforms to promote human rights and access to health services Increase networking and information exchange with organizations working on behalf of MSM

Conclusion UN human rights organizations have noted that sexual identity or orientation is prohibited as grounds for discrimination We should look forward to a world free of HIV/AIDS UN human rights organizations have noted that sexual identity or orientation is prohibited as grounds for discrimination We should look forward to a world free of HIV/AIDS

Thank you