Journal Article

Time to change the paradigm: Limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling

Purpose
This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men (MSM) and transgender women (TGW) in Abuja and Lagos, Nigeria.

Methods
Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs).

Results
From March 2013-November 2017, 2090 MSM and TGW enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7% to 67.1%, p<0.001) and insertive anal sex (25.4% to 67.8%, p<0.001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex.

Conclusions
Engagement in care improved condom and CCL uptake over time, but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to ART for those living with HIV and provision of pre- and post-exposure prophylaxis for those at risk.