Disclosure of Same-Sex Sexual Practices to Family and Healthcare Providers by Men Who Have Sex with Men and Transgender Women in Nigeria

Abstract

Disclosure of same-sex sexual practices by men who have sex with men (MSM) and transgender women (TGW) may facilitate appropriate healthcare engagement, including risk assessment for HIV and other sexually transmitted infections (STIs), and negotiation of condom use with partners. However, disclosure may also generate stigma. In these cross-sectional analyses, MSM and TGW were categorized based on self-report of disclosure to family members and healthcare providers (HCP) at enrollment into the TRUST/RV368 study of comprehensive HIV and STI care programs in Abuja and Lagos, Nigeria. Multivariable Poisson regression models with robust error variance were used to estimate relative risk of disclosure with 95% confidence intervals. Pearson's chi-squared test was used to compare condom use and stigma indicators by disclosure status. Of 2557 participants who answered baseline questions about disclosure, 384 (15.0%) had ever disclosed to a family member and 733 (28.7%) to HCP, including 192 (7.5%) who disclosed to both. Higher education, prevalent HIV infections, and residence in Lagos were each associated with increased likelihood of disclosure to family and HCP. Older participants were more likely to disclose to HCP but not family. Participants who made a disclosure to family or HCP were more likely to report condom use during anal sex as well as perceived and experienced stigma that included healthcare avoidance, blackmail, assault, and sexual violence as compared to participants who had not disclosed. Improved disclosure practices within safe spaces may enhance engagement of MSM and TGW in healthcare and HIV prevention services.

Retention of a cohort of men who have sex with men and transgender women at risk for and living with HIV in Abuja and Lagos, Nigeria: a longitudinal analysis

“…Other qualitative studies have shown that sexual and gender minorities avoid testing because a diagnosis of HIV or rectal STIs could lead to unintended disclosure of anal sex practices [4,31,32]. We have previously reported substantial anticipated and enacted stigma surrounding disclosure of same sex sexual practices by participants in our cohort [7,33‐35]. Despite the goal of non‐stigmatizing care delivery in our clinics, it is possible that participants who had not previously been tested for HIV had experiences that affirmed their anticipated stigma and reduced likelihood of retention.…”

HIV status disclosure by Nigerian men who have sex with men and transgender women living with HIV: a cross-sectional analysis at enrollment into an observational cohort

“…There is concern that potential beneficial effects of disclosure could be offset by adverse consequences such as societal rejection, persecution, discrimination, abandonment, separation and feelings of shame, worry or fear [17,21,39]. MSM and TGW living with HIV may face additional stigma due to same-sex sexual practices [9,[17][18][19][20]. However, we found few differences in selfreported stigma based on disclosure status.…”

“…These factors perpetuate the HIV epidemic and drive some individuals to maintain both public heterosexual relationships and private same-sex ones [8]. Nigerian MSM and TGW rarely disclose their same-sex sexual practices to healthcare providers and family members, creating barriers to receipt of appropriate healthcare services such as HIV testing and anatomically appropriate screening for other sexually transmitted infections [9]. Stigma that is deep-rooted within Nigerian culture was codified into law in 2014, when Nigeria passed the Same Sex Marriage Prohibition Act, which prohibits marriage or civil union by persons of the same sex, solemnization of same sex marriage in places of worship, direct or indirect public displays of affection by same-sex couples and registration of homosexual clubs and societies [10][11][12][13].…”

From general to specific: moving past the general population in the HIV response across sub‐Saharan Africa

“…Past epidemiological studies among men who have sex with men in Botswana, Namibia, Malawi, South Africa, Kenya, Senegal and Nigeria suggest that sex with women is relatively common among men who have sex with men. The reported proportion who recently had sex with women has ranged from 20% to 75% [43‐46].…”