High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria

Abstract

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6–9.4), less education (OR 2.0, 95% CI = 1.4–3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6–3.2), being an insertive partner (OR 3.0, 95% CI = 1.9–4.5), being HIV-negative (OR 1.6, 95% CI = 1.1–2.5), living in Lagos (OR 2.3, 95% CI = 1.7–2.2), being Muslim (OR 1.7, 95% CI = 1.1–2.5), and being away from home (OR 1.5, 95% CI = 1.0–2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5–10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5–3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9–4.9), being away from home (AOR = 1.6; 95% CI = 1.1–2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0–2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.

Keywords:

• men who have sex with men
• bisexual behavior
• Nigeria
• HIV
• MSMW
• Africa

Acknowledgments

The study was funded by the UK Department for International Development (DFID) through the Enhancing Nigeria's Response to HIV/AIDS (ENR). The authors wish to acknowledge the HIV and AIDS Division, Federal Ministry of Health, Nigeria for successfully conducting the ACASI Study in collaboration with the Population Council and the Enhancing Nigeria's Response to HIV&AIDS Program led by the Society for Family Health. The authors thank all participants, field supervisors, lab technicians, and interviewers who contributed to the success of the study. Special thanks also go to Denis Akpona, Oliver Anene, Apera Iorwakwagh, Sandra Johnson, Emeka Nwachukwu, Segun Sangowawa, and Akin Toyose.

Meredith Sheehy contributed to the study design, monitoring, analysis and interpretation of the data, and drafted this manuscript. Waimar Tun conceived the study concept and design and contributed to the interpretation of data, writing, and review of this manuscript. Lung Vu conceived the study concept and design and contributed to the monitoring, analysis, and interpretation of the data, writing, and review of this manuscript. Sylvia Adebajo and Andrew Karlyn conceived the study concept and design, monitored the study, and contributed to the interpretation of results and review of the manuscript. Otibho Obianwu contributed to the interpretation of results and review of the manuscript.