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.

IntroductionFace-to-face (FTF) interviews are the most frequently used means of obtaining information on sexual and drug injecting behaviours from men who have sex with men (MSM) and men who inject drugs (MWID). However, accurate information on these behaviours may be difficult to elicit because of sociocultural hostility towards these populations and the criminalization associated with these behaviours. Audio computer assisted self-interview (ACASI) is an interviewing technique that may mitigate social desirability bias in this context.MethodsThis study evaluated differences in the reporting of HIV-related risky behaviours by MSM and MWID using ACASI and FTF interviews. Between August and September 2010, 712 MSM and 328 MWID in Nigeria were randomized to either ACASI or FTF interview for completion of a behavioural survey that included questions on sensitive sexual and injecting risk behaviours. Data were analyzed separately for MSM and MWID. Logistic regression was run for each behaviour as a dependent variable to determine differences in reporting methods.ResultsMSM interviewed via ACASI reported significantly higher risky behaviours with both women (multiple female sexual partners 51% vs. 43%, p = 0.04; had unprotected anal sex with women 72% vs. 57%, p = 0.05) and men (multiple male sex partners 70% vs. 54%, p≤0.001) than through FTF. Additionally, they were more likely to self-identify as homosexual (AOR: 3.3, 95%CI:2.4–4.6) and report drug use in the past 12 months (AOR:40.0, 95%CI: 9.6–166.0). MWID interviewed with ACASI were more likely to report needle sharing (AOR:3.3, 95%CI:1.2–8.9) and re-use (AOR:2.2, 95%CI:1.2–3.9) in the past month and prior HIV testing (AOR:1.6, 95%CI 1.02–2.5).ConclusionThe feasibility of using ACASI in studies and clinics targeting key populations in Nigeria must be explored to increase the likelihood of obtaining more accurate data on high risk behaviours to inform improved risk reduction strategies that reduce HIV transmission.

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6-9.4), less education (OR 2.0, 95% CI = 1.4-3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6-3.2), being an insertive partner (OR 3.0, 95% CI = 1.9-4.5), being HIV-negative (OR 1.6, 95% CI = 1.1-2.5), living in Lagos (OR 2.3, 95% CI = 1.7-2.2), being Muslim (OR 1.7, 95% CI = 1.1-2.5), and being away from home (OR 1.5, 95% CI = 1.0-2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5-10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5-3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9-4.9), being away from home (AOR = 1.6; 95% CI = 1.1-2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0-2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.

In 1997 to 1998, Population Services International (PSI) carried out a targeted radio campaign in Mozambique to promote behavior change for the prevention of sexually transmitted infections (STIs) and HIV/AIDS. To evaluate the coverage and impact of the campaign, PSI designed and implemented a cross-sectional study using a two-stage random sample of "at-risk" individuals; 754 individuals between the ages of 13 and 49 were interviewed. Over half (52.4%) heard the campaign and 45.5% recalled one or more radio messages. However, recall of specific messages in specific risk groups was low. A multivariate model demonstrates that among those exposed to the radio campaign, 97.2% reported intent to change their sexual behavior compared with 62.8% of those not exposed to the campaign (p < .001). Among those who recalled campaign messages, 86.1% attempted to change their behavior compared with 58% of those who had no message recall (p <.001). Success in changing behavior is significantly higher among those with message recall (83.8%) than those without (56.8%, p < .001). This study illustrates the difficulties in using radio to target a specific group with a corresponding behavior change message. Although general recall of campaign messages was high per target group, the campaign did not succeed in ensuring exposure to the intended target group. The strategy of airing all of the spots simultaneously with different but similar messages resulted in one spot "stepping on" another. Despite the limitations in using radio to target, exposure to the radio campaign has contributed to individual intent to change sexual behavior.

The expanding AIDS epidemic in Mozambique is fuelled principally by heterosexual transmission, with young people identified as a key group for prevention efforts. However, little is known about the sexual behaviour of young people in Mozambique and the protective practices they adopt. This paper seeks to identify the contexts and rules governing sexual risk-taking among young people in Maputo. In doing so, the paper affirms the importance of context in understanding risk practices, but highlights the fluidity of practice as an important limitation for the use of contextual analysis in prevention interventions. By focusing on one innovation, the saca cena one-night stand, this paper shows how a subgroup of young people in Maputo has redefined a "risky" sexual practice to include exclusive condom use. As a risk context, the saca cena dictates a set of implicit rules emphasizing anonymity, discretion, verbal and non-verbal cues, and for a set of select innovators, condom use. The saca cena challenges the hegemonic gender roles found among many young people in Maputo of male dominance through sexual conquest and female acquiescence. Instead, the practice allows young people to be both adventurous and responsible. The discourse demonstrates how sexual identities have been redefined to combine risk reduction with sexual experimentation and the satiation of desire.