Initial surveys of MSM in Nigeria show high levels of bisexual behaviour and low condom and lube use

Two surveys of men who have sex with men (MSM) in Nigeria who are attending local HIV support organisations show that between a third and half of men who are attracted to other men define as bisexual and as many have had vaginal sex with a women as anal sex with a man.

The ‘snapshot’ survey adds another country to the list of African countries that have documented a hitherto invisible MSM culture – see recent report – and adds to evidence presented elsewhere at the 2010 International Microbicides Conference that even in supposedly heterosexually-driven epidemics, anal sex may play a much larger role than previously thought.

It also found high rates of anal sex between men and women. However, only 10% of MSM were consistent condom users and only 3% had used any form of water-based lubricant or understood what a lubricant was. Education sessions discussing microbicides had found that 68 to 74% of MSM would be willing to use a rectal microbicide.

The MSM studies published at the Microbicides 2010 conference looked at extracts of data from a larger survey of sexual practices and attitudes of "same-sex-attracted" persons conducted by the Lifeline Plus Foundation , a regional HIV support organisation with a centre near Enugu. Enugu state has one of the highest HIV prevalences in Nigeria at 6.5%.

Supporting both MSM and women who have sex with women (WSW) has been part of the organisation’s remit since it was founded in 2001, and it plans to release data on WSW later, which will be a first for Nigeria.

The following data are synthesised from two adjacent presentations: one a questionnaire distributed to local HIV support organisations throughout Enugu and Ebonyi states and one from support group members in the Lifeline Plus Foundation itself. Findings were similar so most of these data come from the two-state survey.

There were 498 same-sex-attracted respondents in the two-state survey of whom 205 were men (41%). Out of the whole group, 139 (22%) were married (27% of the men), and 39% of the men were in a steady relationship with a woman. A third of men in the two-state survey and nearly half in the Lifeline Plus survey defined themselves as bisexual. The mean age of the whole group was 26.6 (range 16 to 43).

Less than half of the men (48%) had actually had anal sex with a man, one per cent less than the proportion who’d had vaginal sex with a woman. Of those who defined themselves as bisexual, 25% (8% of men) in the two-state survey and half in the Lifeline Plus survey (25% of men) had had anal sex with a woman. Half the men who defined themselves as bisexual and 55% of those who defined as exclusively gay/MSM had multiple partners (sex not specified).

Interestingly, 33 of the 80 men with a steady female partner had disclosed to her that they also had sex with men. This figure was questioned as unexpectedly high. Lifeline Plus’s director Ijeoma Nnaji told aidsmap: “This is a literate, urban group of men on the whole – quite good ‘catches’ for women. There may not actually be much sex going on in the marriage. In return, the women ‘cover’ for the men in what is still a very traditionally Christian part of the country."

“There is no male sex worker community, as there is in the (Islamic) northern states; instead there’s a network of private parties. Lifeline Plus members get invited to them and give safer-sex advice.”

There is, however, no access to free condoms, and only 9.7% of the men said they used condoms consistently.

Condoms may at least be accessible, but there is no access to water-based lubricants. Only 3% of men had used a water-based lubricant (mainly KY Jelly) and only four (2%) a lubricant specifically intended for sex. However 82% said they had used a lubricant in anal sex and 37% in vaginal sex. When asked what they used, the majority had used petroleum jelly, a third body lotion, a quarter baby oil and 13% saliva alone. Four specifically mentioned a cotrimoxazole antibiotic cream that is sold in Nigeria.

The lubricant survey was part of a survey to gauge the knowledge and acceptability of microbicides if they were available. Because of seminars at the centre, 84% of the Lifeline Plus group had learned of microbicides through education and 68% said they would be willing to use one if they were available. They would, however, be reluctant to go to a statutory provider for fear of being revealed as gay: Nnaji told aidsmap that there is only one polyclinic in Enugu, a city of three million, that is tolerant of homosexuality and offers a confidential HIV and STI service.