16th International Conference on AIDS
and Sexually Transmitted Infections in Africa (ICASA)
4–8 December 2011
"The Men's Health Network, Nigeria (MHNN): Increasing the uptake of HCT services among men who have sex with men"
Austin Adeyemo, Ayodeji Oginni, George Eluwa, Jean Njab, Sylvia Adebajo, Segun Odumosu, Segun Sangowawa, and Jason Houdek
Recent studies in Nigeria and elsewhere in sub-Saharan Africa have reported HIV prevalence among MSM to be higher than that of the general population. Moreover, widespread homophobia, stigma, and discrimination can make identification of MSM difficult. This presents a major challenge for those attempting to both provide HIV prevention services to MSM and encourage uptake of these services. The Population Council's Men's Health Network, Nigeria (MHNN) program employs multiple, integrated approaches to create demand for "hassle-free" health and social services targeted at MSM. These services are provided through a comprehensive HIV prevention package that seeks to bring about changes in behavior and community norms, to improve access to—and quality of—community-based HCT and sexually transmitted infection (STI) services, and to reduce the risk of HIV infection among men engaged in high-risk behaviors. Three innovative strategies are employed to create demand for HCT among MSM: “mainstream”, non-incentive referrals from MSM peer educators to HCT services delivered by “MSM-Friendly” health facilities; “incentive-based” referrals from MSM peer educators to HCT services delivered by “MSM-Friendly” health facilities; “community-based”, non-incentive referrals from MSM peer educators to HCT services delivered by community-based MSM organizations. A comparison of uptake of HCT services across the three approaches is presented.
Routine data collected from HCT services delivered through the three approaches described above in MHNN sites in Lagos, Abuja, and Ibadan between February 2010 and April 2011 were compared to identify the approach that provides the highest uptake of HCT services. Binary logistic regression analysis was used to determine factors associated with the uptake of HCT services.
Of a total of 3,834 MSM reached with HIV prevention messages during this period, 686 (17.9%) opted for HCT. Compared to the mainstream strategy (4.0%), MSM recruited through incentive-based (AOR 17.51, 95% CI [13.78, 22.26]) and community-based (AOR 9.24, 95% CI [6.61, 12.93]) strategies were significantly more likely to opt for HCT. Marital status (AOR = 1.02; 95% CI: 0.74 - 1.40, p=0.924), occupation (AOR = 1.16; 95% CI: 0.95 - 1.41, p=0.152), and age (p=0.318) were not significantly associated with HCT uptake.
Although our routine data have demonstrated significantly higher uptake of HCT services by MSM through incentive-based referrals and of services run by MSM, there is a need for further operations research to determine the most cost effective approach to rapidly increase access to HCT services within MSM communities in Nigeria.
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