Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria

Abstract

BackgroundNigerian gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, with an estimated prevalence of between 11–35%. Pre-exposure prophylaxis (PrEP) has the potential to significantly decrease incident HIV infections among Nigerian GBMSM. Understanding the relationship between socio-demographic, sexual risk behavior, and psychosocial factors with PrEP awareness, willingness to use, and history of use among this group is pivotal to maximizing PrEP uptake.MethodsBetween March and June 2019, 419 participants completed an interviewer-administered survey assessing PrEP awareness, willingness to use, and history of use; socio-demographics; sexual risk behavior; and psychosocial factors. Bivariate and multivariable logistic regression were used to examine factors associated with PrEP awareness, willingness to use, and history of use.Results53.6% were aware of PrEP; 80.1% were willing to use PrEP; and 29.7% had previously used PrEP. In multivariable analysis, factors associated with an increased odds of PrEP awareness include residing in Abuja [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI): 2.13 to 11.83] and Lagos (aOR 12.30; 95% CI: 4.92 to 30.67) vs. residing in Plateau, living with HIV (aOR 2.56; 95% CI: 1.54 to 4.72), using location-based apps for seeking sexual partners (aOR 4.06; 95% CI: 2.28 to 7.24), having health insurance (aOR 2.31; 95% CI: 1.08 to 4.40), history of suicidal thoughts (aOR 2.05; 95% CI: 1.02 to 4.10), and history of PrEP use (aOR 45.5; 95% CI: 5.60 to 370.04). Decreasing clinically significant depressive symptoms was associated with lower willingness to use PrEP (aOR 0.96; 95% CI: 0.92 to 0.99). Lastly, factors associated with increased odds of having a history of PrEP use were those reporting 6 or more insertive anal sex acts in the last 30 days compared to those with none (aOR 5.76; 95% CI: 1.58 to 20.98) and being aware of PrEP (aOR 29.6; 95% CI: 3.78 to 231.84).DiscussionNearly half of the Nigerian GBMSM in this study had no prior awareness of PrEP, but after being informed about its potential benefits, the majority were willing to use it. However, PrEP uptake among Nigerian GBMSM remains low. Findings suggest that educational messages are necessary to ensure appropriate PrEP scale-up, especially tailored towards Nigerian GBMSM.

Acceptability of pre-exposure prophylaxis for HIV prevention: facilitators, barriers and impact on sexual risk behaviors among men who have sex with men in Benin

“…The level of PrEP knowledge and associated factors seems to vary by context. The level of PrEP knowledge among our participants was quite high and appeared to be similar to what was observed in Nigeria and Kenya [16,17]. It is not always high in developing countries [38].…”

“…PrEP acceptability level varies across countries and for various reasons: In Nigeria, 53.6% of MSM were aware of PrEP and 80.1% were willing to use PrEP in Nigeria weighted odds ratios (probability weights generated by RDS Analyst [16]. In Kenya, 64.3% who had heard of PrEP but only 50% were willing to use it.…”

“…PrEP acceptability varies across studies, with complex reasons in relation to the individual, the provider, the community and the health system [15]. Nearly half of the Nigerian MSM participants in one study had no prior knowledge of PrEP, but after being informed of its potential benefits, 80% were willing to use it [16]. In Kenya, it was found that 64.3% of participants had heard of PrEP and only half were willing to use it [17].…”

Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach

“…The LGBT Minority Stress Measure [21], is a 50-item scale developed to measure stress-related components of the minority stress model: prejudice events, victimization events, anticipation of rejection, identity concealment, internalized anti-LGBT stigma, everyday discrimination, and community support. These scales have been widely utilized to measure depressive symptoms, social support, and minority stress among GBMSM [22][23][24][25]. While many studies have investigated the psychometric characteristics of these scales, a vast majority have been conducted in the Global North (largely in the United States of America) [21,26,27].…”

Validation of depressive symptoms, social support, and minority stress scales among Gay, Bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: A Mixed Methods Approach

“…The LGBT Minority Stress Measure [21], is a 50-item scale developed to measure stress-related components of the minority stress model: prejudice events, victimization events, anticipation of rejection, identity concealment, internalized anti-LGBT stigma, everyday discrimination, and community support. These scales have been widely utilized to measure depressive symptoms, social support, and minority stress among GBMSM [22][23][24][25]. While many studies have investigated the psychometric characteristics of these scales, a vast majority been conducted in the Global North (largely in the United States of America) [21,26,27].…”