Uptake of condoms and lubricants remains low among Nigerian men who have sex with men despite availability and counseling at trusted community health centers

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Article (peer-reviewed)

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Background: Condom-compatible lubricants increase pleasure and decrease condom breakage when used with latex condoms, thereby reducing the risk of HIV acquisition during receptive anal sex by men who have sex with men (MSM). Inadequate education and barriers to access may limit their use, particularly in resource-constrained settings. This study characterizes the availability and uptake of condoms and water-based lubricants while in care at two MSM-friendly clinics in Nigeria. Methods: Since March 2013, the TRUST/RV368 study has recruited MSM using respondent-driven sampling and enrolled them into care in Abuja and Lagos, Nigeria. Participants receive counseling and screening for sexually transmitted infections every three months. Condoms and water-based lubricants are freely available to participants. Questionnaires were used to assess access and use, with consistent use defined by self-report of “always” or “almost always” using the product. Comparisons at enrollment and after nine months in care were made using McNemar's chi-squared test. Results: As of 18 January 2016, 225 participants (136 in Abuja; 89 in Lagos) had reported receptive anal sex and completed at least nine months of study follow-up. They had a median age of 24 years (interquartile range 21–27). Ninety-five (42.2%) self-identified as gay/homosexual and 130 (57.8%) as bisexual. The percentage of participants reporting access to condoms, consistent use of condoms, use of any lubricant, and use of water-based lubricant increased over time (figure). At nine months, 103 participants (45.8%) reported consistently using condoms with water-based lubricants. Other lubricants consistently used with condoms included petroleum jelly (3 participants [1.3%]), body creams (2 [0.8%]), and cooking oil (2 [0.8%]). Conclusion: Engagement in care at MSM-friendly clinics improved key steps in the uptake of condoms and water-based lubricants by MSM who engage in receptive anal sex. However, fewer than half of participants reported consistent use after nine months in care. Most participants who used condoms also used water-based lubricants, suggesting that uptake of lubricants poses less of a challenge indicating that interventions to increase uptake of condoms should be a high priority in order to promote safer sex practices.