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High Prevalence of HIV, Chlamydia, and Gonorrhea Among Men who Have Sex With Men Attending Trusted Community Centers in Abuja and Lagos, Nigeria
Babajide Keshinro, Study Group, Trevor A. Crowell, Study Group, Rebecca G. Nowak, Study Group, Sheila A. Peel, Study Group, Stefan Baral, Study Group, Sylvia Bolanle Adebajo, Study Group, Ogbonnaya S. Njoku, Study Group, Sunday Oluwaseun Odeyemi, Study Group, Teclaire Ngo‐Ndomb, Study Group, William A. Blattner, Study Group, Merlin Lee Robb, Study Group, Manhattan Charurat, Study Group, Julie A. Ake, Study Group
Résumé : Background. In Nigeria, men who have sex with men (MSM) face significant healthcare-related stigma which manifests as a barrier to the uptake of routine services including screening for sexually transmitted infections (STIs). The objective of this study was to characterize the prevalence of HIV, chlamydia, and gonorrhea in this population to provide insight into appropriate STI screening and management guidelines for this population. Methods. TRUST/RV368 is a cohort of MSM recruited at trusted community centers in Abuja and Lagos, Nigeria, using respondent-driven sampling. Participants undergo a comprehensive assessment of HIV-related risks and are screened for anorectal and urogenital Chlamydia trachomatis and Neisseria gonorrhea (PCR), syphilis (RPR), and HIV (two rapid tests). Statistical comparisons were made using Pearson's χ2 test and the t-test. Results. From March 2013 to April 2015, 655 men (187 in Lagos; 468 in Abuja) underwent screening for HIV and at least one additional STI at study enrollment. Participants' median age was 24 years (range 16-60). Only 34% had previously disclosed their MSM status to a healthcare provider and 50% reported condom use during the majority of anal receptive sexual encounters. The overall prevalence of HIV was 50% (Lagos 66%, Abuja 44%, p < 0.001). Of those with HIV, 56% reported knowing their status prior to enrollment. Chlamydia prevalence was 16%, of which 72% presented with anorectal infection, 17% urogenital, and 10% with infection at both sites. Prevalence of gonorrhea was 23%, of which 86% presented with anorectal infection, 4% urogenital, and 10% at both sites. While one participant with anorectal gonorrhea complained of fever/sweats, all other chlamydia and gonorrhea cases were asymptomatic. Conclusion. Most chlamydia and gonorrhea cases would have been missed without anorectal screening, which requires disclosure of MSM status to a healthcare provider. Since almost all cases were asymptomatic, a management strategy that relies on syndromic presentation for presumptive treatment is inadequate in this population. The high burden of STIs among MSM in Nigeria highlights the need for expanded, MSM-focused interventions in trusted venues that provide STI screening and management to this vulnerable population. Disclosures. All authors: No reported disclosures.