Policy Brief Mitigating the impact of HIV/AIDS amongst Men who have sex with Men(MSM) in Nigeria

Background

The average national HIV prevalence in Nigeria is 3.6% (NARHS 2007). The general HIV prevalance for Abuja is 5.3% (NARHS 2007). However, from our study, “Assessing the HIV/AIDS burden among MSM in Abuja”, the HIV prevelance among MSM in Abuja is 36.4%. This tends to corroborate or confirm the findings as recorded in the HIV/STI Intergrated Biological and Behavioural Surveillance Survey (IBBSS ) of 2007, which put the prevelance amongst MSM in the three states of Lagos, Kano and Cross Rivers at 13.5%. In essence, there seems to be an increasing rate of HIV transmission amongst MSM in the country. The study further stated that on average the surveyed were much younger than other groups with around three quarters under the age of 25.

There was considerable variation between HIV prevalence in the three states surveyed, with HIV prevalence highest among MSM in Lagos (25%) followed by Kano (10%), and Cross River (3%). Most MSM sexual partnerships with other men in the past six months were non-paying, though up to 50% in each state also had sex with women and around one-third also sold sex to other men.

The term ‘Men who have Sex with Men’ (MSM) relates to the behaviour rather than the identity of gay, bisexual or heterosexual men. It is important to note that sex between men occur in almost every race, culture and country, Therefore, it amount to an act of denial to think that homosexuality does not exist in Nigeria.

MSM are one of the high risk groups for HIV transmission. This assertion has been supported by the study conducted by the Center for the Right to Helath (CRH) on “Assessing the HIV/AIDS burden among Men who have sex with Men in Abuja”, 2008 and by the IBBSS survey of 2007.

In many African countries, including Nigeria, homosexuality and other related acts are criminalised, hence, these countries do not acknowledge the existence of MSM and have little or no HIV prevention programming targeting them. This is particularly true of MSM in Nigeria as revelaed by the CRH’s study.

Cultural and religious practices such as denial of male sexual contact tend to further render MSM vulnerable to HIV transmission and make them one of the high-risk groups to HIV transmission in the country. Some MSM identify themselves as being gay, whereas others do not, since they also have female sexual partners to whom many of them are married. Moreover, because most MSM have multiple partners, even among themselves, tend to heighten their vulnerability to HIV transmission. Consequently epidemiological vulnerability among MSM has been strongly linked to political, socio-cultural and religious beliefs. These factors prohibit same sex practice in Nigeria, and those engaged in them are seen as evil and as such are discriminated against. This may sometimes translate to physical attack or emotional harassment.

MSM often encounter serious challenges in accessing proper health care whenever they reveal their sexual orientation. The stigma associated with homosexuality may inhibit some men from identifying themselves as gay or bisexual, even though they have sex with other men. The result of this is an increase in sexually transmitted infections (STIs), high HIV/AIDS prevalence, limited access to health care services, and limited treatment options.

Thus, in the past, HIV/AIDS prevention programming in Nigeria has concentrated on heterosexual transmission and minimal public health efforts have focused on homosexual transmission. This approach supports the believe by many Men who see sex with Women as being a potential HIV/AIDs risk and male-male sex as a safer option.

Assessing the burden of HIV/AIDS amongst MSM in Abuja, Nigeria
The overall goal was to carry out a baseline research in order to identify the magnitude of HIV burden and challenges faced by MSM in Abuja, Nigeria. Specifically, the study assessed the magnitude and raise awareness about the risk of HIV/AIDS among MSM in Abuja.
The Study area was the Federal Capital Territory and the target population was men aged 18 – 65 years, who had reported having oral/manual sex with another man.

The Sampling procedures were : snow ball and respondent driven sampling, website, parties, and acquaintances. A structured questionnaire was administred on 384 MSM
Findings provided great insights on programmatic activities and interventions in mitigating the HIV/AIDS burden, while providing in-depth analysis on behavioural, sexual and human rights violations among MSM. The study revealed that MSM population is hidden due to several factors such as criminalization of same sex activities, stigma, etc and the easiest way to provide information to them was through peers, influencers, networks and parties. More than half of the respondents were bisexuals thus increasing their vulnerability and those of the larger population.

Issues & Recommendations

Issue 1: There was high knowledge on HIV/AIDS through media however, there was low uptake of HIV Counselling and Testing among the MSM community.There is a general lack of MSM specific resource materials in the Country.

Recommendations

We recommend the production and massive dissemination of MSM specific Information, Education and Communication materials using MSM trainned peer educators and targeting the different foras MSM can be met. Creation of MSM support groups should be given urgent attention by program planners and policy makers in Nigeria.

There is an urgent need to design strategies and programmes that focus on youths, sexuality and HIV vulnerability
Issue 2: Denial of sexuality has led to self medication in curing Sexually Transmitted Infections

Recommendation

Integrate Syndromic Management of Sexually Transmitted Infections in all HIV prevention, education and care packages. Condoms and lubricants should be made readily available, afforadble and accessible at all HIV prevention programmes, health care facilities and NGOs’ offices nationwide.

Issue 3: High incidence of discrimination among health care providers

Recommendation

There is an urgent need to educate Health care workers accross board on the need to accommodate and care for MSM reproductive health needs as well as the provision of friendly MSM specific health care services. Health care institutions should be MSM friendly as unfriendly attitudes of health care professionals have been a great hindrance to MSM accessing health care services.

Issue 4: Criminalization of male-male sex, cultural and religious factors have led to the denial of male to male sex thus forcing MSM underground.

Recommendation

Criminalization of same sex is not the answer. If anything it has forced many same sex practicing individuals underground. For social and cultural acceptablitiy a great number of MSM are bisexuals, since many are married. This increases their vulnerability and that of the general population to HIV transmision. Criminalization leads to service providers avoiding engaging with these groups for fear that by providing services to them they may be ‘encouraging’ the behaviour and thereby breaking the law. The existence of these laws actively discourages sex workers, MSM and IDUs from accessing services for fear that they may be reported to the police

Criminalization of these activities means that for sex workers and MSM their sexual behaviour often occurs clandestinely resulting in sexual encounters which are hurried; where there is little or no opportunity for condom negotiation; and where sex occurs in unsafe places

We propose that Nigerian government should consider decriminalisation of homosexuality and other related acts in Nigeria. Moreover, the government should ensure that the dehumanization of MSM is brought to an end and commence efforts towards working with MSM and homosexauls in general for the betterment of our common humanity.

Conclusion

According to Peter Piot of the Joint United Nations Programme on HIV/AIDS (UNAIDS), intervention is still very low... for many critical populations in many countries. Obviously this statement captures the plight of Africans and infact Nigerians who engage in same sex relationshps. Our study on “assessing the HIV/AIDS burden among Men who have sex with Men in Abuja has amply demostrated that without immediate intervensions to address the HIV burden amongst MSM in Nigeria using the human rights and public health approaches, efforts to combat the AIDS epidemic in Nigeria may be in very serious jeopardy.

References:

Center for the Right to Health. “Report on the Study on assessing the HIV/AIDS burden among Men who have Sex with Men (MSM) in Abuja, Nigeria”. 2009.
Policy Project/ Futures Group International. ‘HIV/AIDS and Human Rights in Nigeria: Background Paper for HIV/AIDS Policy Review in Nigeria”, Prepared by Center for the Right to Health. 2003
Federal Ministry of Health. HIV/STI Intergrated Biological and Behavioural Surveillance Survey Survey (IBBSS). 2007.
USAID Health Policy Initiative, Task Order 1. HIV Expenditure on MSM Programming in the Asia Pacific Region: Background paper produced for International Consultation on Male Sexual Health and HIV in Asia and the Pacific titled “Risks and Responsibilities”. 2006.

Johnson CA. Off the Map: How HIV/AIDS Programming is failing Same Sex Practicing People in Africa. International Gay and Lesbian Human Rights Commission. 2007.


Center for the Right to Health (CRH)
Advocating the Right to health and life

Headquarters and Field Offices
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