TUAD0305LB - Oral Abstract
Discrimination among men who have sex with men in Nigeria: assessment of the immediate HIV-related impact of anti-gay laws
Presented by Sheree Schwartz (United States).
S. Schwartz1, I. Orazulike2, R. Nowak3, S. Kennedy3, S. Ketende1, K. Ugoh4, B. Keshinro5, J. Ake5, O. Njoku5, M. Charurat3, W. Blattner3, S. Baral1
1Johns Hopkins School of Public Health, Epidemiology, Baltimore, United States, 2International Centre for Advocacy on the Right to Health, Abuja, Nigeria, 3University of Maryland, Insitute of Human Virology, Baltimore, United States, 4Improving Men's Health Initiative, Abuja, Nigeria, 5US Military HIV Research Project, Silver Spring, United States
Background: Across Sub-Saharan Africa, men who have sex with men (MSM) are
disproportionately affected by HIV with limited engagement in the HIV treatment
cascade. In January 2014, Nigeria signed a law further criminalizing same-sex
relationships, including any promotion of homosexuality affiliated with community-based
organizations that support programmatic needs of MSM. We document discrimination
and the potential impact of recent legislation.
Methods: MSM were recruited through respondent-driven sampling in Abuja and
enrolled into a prospective cohort. Stigma, discrimination, HIV-related testing,
treatment and clinical outcomes were assessed at enrollment visits and every 3
months thereafter. Characteristics related to discrimination and HIV care are
described and compared pre-post legislation using chi-squared statistics.
Results: Between March 2013-March 2014, 606 MSM contributed 758 enrollment and
follow-up visits prior to new legislation and 106 visits post-legislation. Fear
and discrimination were common among MSM as illustrated in Figure 1, and both
fear of seeking healthcare and lack of safe spaces increased significantly since
the law went into effect. At baseline 20.8% of MSM had told a healthcare
provider they were MSM. Baseline viral loads were available for 144/172
HIV-infected MSM. HIV-infected men that had discussed their sexual behavior
with a healthcare provider were more likely to be virally suppressed at
baseline (31.2% vs. 15.7%, p=0.03), and among those not already on treatment,
more likely to complete treatment preparation and HAART initiation during
follow-up (85.2% vs. 56.9%, p=0.01).
Conclusions: Fear of seeking health care has increased and safe spaces for MSM decreased
in the immediate period since new anti-gay legislation went into effect in
Nigeria. MSM who communicate openly with health care providers are more likely
to engage in treatment and achieve viral suppression, highlighting the
importance of supportive providers. Immediate efforts must be made to ensure
that discriminatory policies do not prevent engagement in HIV care.
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