1. Andrew Karlyn 1, Lung Vu 1, Sylvia Adebajo 2, Waimar Tun 1, Sandra Johnson 3, Meredith Sheehy 4, Jean Njab 2 1 Population Council, Washington DC, akarlyn@popcouncil.org 2 Population Council, Abuja, Nigeria 3 Independent data manager 4 Population Council, New York Abstract number: MOAC0305 Session: Novel Approaches to Prevention Interventions and Measurement Date: Monday, 18.07.2011 Time: 14:30 - 16:00 Room: Session Room 3

2. Study Objectives 1. Provide critical epidemiological and methodological information for the Government of Nigeria’s HIV and STI programs targeting MSM and IDUs. 2. Validate behavioral data by comparing a face-to-face survey with an ACASI self-administered survey

3. ACASI Significantly reduces social desirability biases in surveys providing more accurate and reliable behavioral data. (Aral & Peterman, 1996; Hewett et al. 2004; Mensch et al. 2003; Murphy et al., 2000) Increases consistency of reported sensitive behaviors (Jarlais et al. 1999; Langhaug et al. 2010), while improving privacy and confidentiality (Wijgert et al. 2000; van der Elst, et al. 2009).

4. MSM and HIV in Nigeria HIV prevalence among MSM is estimated at 14 % (FMOH, IBBSS, 2007) Proportion of new infections attributable to MSM ranges from 10% to 25% (FMOH/UNAIDS MOT Study, 2010) Socially stigmatized, legally criminalized (Human Rights Watch, 2007; UNAIDS, 2005; Onyango-Ouma, 2005) Limited access, targeting, quality of service delivery

6. Methods Cross-sectional survey (Abuja, Ibadan, Lagos) 712 MSM participants recruited through respondent driven sampling (RDS) Biological samples were obtained to test for HIV and STI - syphilis, HBV, HCV, Chlamydia, and gonorrhea Behavioral interview administered to participants randomized to face-to-face or ACASI method Low tech – netbook, QDS, headphones ($450/unit) Adjusted prevalence estimates in RDSAT

8. Reported HIV risks by interview mode among MSM (N=712)

9. VARIABLE FTF (N=372) % (n) ACASI (N=342) % (n) OR (95% CI) Self-reported gay identity 29.1 (103)57.1 (172)3.3 (2.4-4.6)* ** Multiple female sex partner 43.0 (159)50.6 (173) 1.4 (1.1-1.9)* Multiple male sex partner 54.1 (200)70.0 (239) 2.1 (1.5-2.8)*** Anal sex w/ women 21.3 (60)71.6 (121) 13.1 (7.9-21.7)*** Unprotected anal sex 57.1 (36)71.7 (86) 2.1 (1.1-4.1)* STI in past 12 mo 20.5 (76)42.7 (146)2.9 (2.1-4.1)*** OR=odds ratio, CI= confidence interval, *: significant at p <.05, **: significant at p <.01, ***: significant at p <.001. Adjusted for age, education, and study sites

10. User Experience with ACASI (N=94) % (n) How often you use computer? Everyday/almost everyday42.5 (40) Once/twice a week23.4 (22) Once/ twice a month19.2 (18) Almost never14.9 (14) How comfortable were you using the ACASI? Very comfortable80.9 (76) Comfortable18.1 (17) Uncomfortable1.1 (1) How difficult in using the ACASI? Very difficult3.2 (3) Somewhat difficult12.8 (12) Not at all84.0 (79)

11. Conclusions ACASI contributes to Quality of interviews for MSM Improves user experience among some groups Reduces costs Interviewers Data management Return to systematic surveillance Integration with systematic screening Link to service delivery

12. Acknowledgments Generously funded by DFID contract Enhancing Nigeria’s Response (ENR) to HIV/AIDS, contract number: CNTR 200808311 Service delivery component funded by CDC Nigeria, CA 1 U2 GPS001066-01 Special thanks to: National AIDS/STI Control Program (NASCAP) National Agency for the Control of AIDS (NACA) Society for Family Health FHI Centre for the Right to Health