1. HIV and STI Prevalence among Men who Have Sex with Men in 3 Major Cities in Nigeria Sylvia Adebajo 1,2, Waimar Tun 2, Andrew Karlyn 2, Lung Vu 2, Idogho Omokhudu 3, Adeyemi Azeez 4, Meredith Sheehy 1, Austine Adeyemo 1 Population Council, Abuja, Nigeria; 2 Population Council, Washington DC, United States; 3 Enhancing Nigeria’s Response to HIV&AIDS (ENR) Programme, 4 Federal Ministry of Health, Abuja, Nigeria

2. Introduction MSM in Nigeria are at least 4 times more likely to be infected with HIV compared to the general population Little is known about STIs including hepatitis B (HBV), and hepatitis C (HCV) infections among MSM and the general population in Nigeria MSM are vulnerable for HIV infection Hidden and stigmatized Few tailored services addressing the unique needs of MSM

3. Objectives Determine the prevalence of and risk factors for HIV, STIs, HBV and HCV infections. Link MSM to HIV prevention health care services

4. Study design Cross-sectional survey. Participants recruited through the respondent driven sampling method Information collected included: Sexual history, Drug history, Social network, Health seeking behavior, discrimination Participants tested for HIV, Gonorrhoae, Chlamydia, HBV and HCV. Protocol approved by local and Population Council review boards.

5. Eligibility Criteria for Recruitment MSM 18 years and older living in the state who provided informed consent Screening questions were used to screen for impostors A total sample of 712 MSM were recruited from the FCT, Lagos and Ibadan between August and September 2010

6. Results

7. Demographic characteristics Characteristics Abuja % (95% CI) IbadanLagos Age (years) 18– 20 19.1 (10.1-27.7)29.8 (20.8-39.1)49.5 (41.2-56.5) 21– 25 48.5 (35.4-59.2)43.7 (35.1-52.8)39.7 (32.7-47.4) 26– 30 22.3 (14.7-34.1)15.3 (9.2-21.5)9.5 (6.2-14.6) >=31 10.2 (5.1-16.5)11.2 (0.6-17.4)1.3 (0.4-2.4) Education Primary 8.9 (4.5-14.0)9.0 (4.1-14.4)4.7 (1.7-7.9) Secondary 56.8 (47.2-66.1)67.3 (58.5-75.0)83.5 (77.9-88.4) Tertiary 34.3 (24.7-44.1)23.7 (16.7-32.4)11.8 (8.0-16.5) Job Not earning 35.4 (25.6-44.0)43.2 (34.0-50.8)34.0 (27.3-41.5) Part-time 19.8 (12.4-28.0)24.2 (18.3-31.6)38.2 (30.6-45.5) Self-employed 20.2 (11.6-28.2)21.5 (14.8-29.1)12.4 (8.2-17.2) Fulltime 24.6 (18.7-33.9)11.2 (6.9-16.3)15.4 (9.8-22.1)

8. Demographic characteristics Characteristics Abuja % (95% CI) IbadanLagos Marital Status Single79.1 (70.9-88.5)65.8 (56.8-74.5)57.0 (48.2-63.7) Single living w/ female partner 8.7 (3.5-18.6)2.1 (0.3-4.6)11.0 (7.1-15.8) Single living w/ male partner 10.2 (4.3-12.3)13.2 (7.8-19.1)28.7 (22.3-36.0) Married to a woman2.0 (0.2-2.7)18.9 (10.4-28.5)3.2 (1.1-6.2) Religion Christian 76.8 (66.9-86.3)59.6 (52.3-71.5)57.0 (48.2-63.7) Muslim 22.8 (13.3-32.8)38.0 (27.3-46.7)11.0 (7.1-15.8)

9. Self Identified Sexual Identity

10. Adjusted HIV Prevalence

11. Adjusted STI Prevalence

12. Prevalence of HIV and STIs SiteHIVSyphilis Gonorrhe a ChlamydiaHBVHCV Abuja 34.9 (25.5-45.9) 0.5 (0.1-1.4)00 21.9 (14.7-31.6) 4.1 (0.6-9.7) Ibadan 11.3 (5.1-16.8) 0.4 (0.4-1.6) 8.9 (4.7-13.6) 34.5 (26.4-42.8) 21.4 (15.1-27.3) 4.4 (0.5-4.6) Lagos 15.2 (9.7-21.2) 1.9 (0.4-4.0)4.2 (1.8-7.0)0 6.5 (3.3-10.3) 3.3 (0.9-6.4)

13. STI Symptoms in past 12 months

14. Factors associated with STIs Prevalence of STIs was low in Lagos and Abuja. In Ibadan, prevalence of Chlamydia was highest among MSM who: had casual sex partners [AOR=2.6 (1.2-5.5)] self-identified as homosexual [AOR=2.8 (1.3- 6.0)]. Hepatitis B infection was more likely among the more educated MSM [AOR=1.7 (1.01-2.7)] MSM who had sex with men exclusively compared with those who had with both men and women [AOR=2.0 (1.2-3.3)].

15. Conclusion This study afforded many MSM first time opportunities of being tested and treated for STIs. There is a large unmet need for MSM in Nigeria. This calls for an urgent need for targeted screening and vaccination to prevent the untoward consequences of STIs among MSM in Nigeria.

16. Acknowledgements Participants Federal Ministry of Health State SACAs – Lagos, Oyo and the FCT Enhancing Nigeria’s Response to HIV & AIDS (ENR) Programme Funding received from DFID The entire Research Team