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This study describes the patterns and drivers of online sex-seeking among a prospective cohort of MSM presenting for HIV testing and treatment in Abuja and Lagos, Nigeria. Overall, the availability of smartphone technology in Sub-Saharan Africa coupled with high levels of sexual behavior stigma ( 15, 17) presents opportunities to develop and optimize Internet-based technologies for HIV prevention programs. Previous successes have included the ability for online interventions to increase HIV/STI knowledge, risk reduction, and HIV/STI testing, although the evaluation of most online interventions has depended on self-reported behavioral change ( 23– 25).
Recently, Internet-based interventions have been developed in the US, Europe, and other settings to engage online sex-seekers in preventative HIV interventions ( 20– 22). In the Sub-Saharan African context there is limited information on the frequency and drivers of online sex-seeking among MSM. Another study of MSM in New York City indicated that MSM who wished to conceal their sexual orientation were more likely to seek male partners online than were MSM who were open about their orientation ( 19). A qualitative study conducted among MSM in Chengdu, China, noted that anonymity and safety were major contributing factors to using the Internet to find male sex partners ( 18). Furthermore, in countries with high levels of sexual behavior stigma affecting MSM, highly stigmatized MSM may be more likely to seek sex online.
This high prevalence has partly been due to the increasing popularity of the Internet and smart phone technology, which has led to a widespread phenomenon of online sex-seeking ( 16, 17). Data from Sub-Saharan Africa are more limited, but a previous study identified a prevalence of 39% for online sex-seeking in Lesotho and 44% in Swaziland ( 15).
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In many countries, the prevalence of online sex-seeking is particularly high among MSM, with 34–50% of MSM who were sampled offline across North America, China, and Europe reporting use of the Internet to find sex partners ( 12– 14). As a result, there is a strong need for HIV prevention interventions to reach these highly stigmatized and high-risk men. In some parts of Nigeria, homosexual activity between men is punishable by death ( 11). High levels of sexual behavior stigma may act as a barrier to HIV testing and care for MSM, and this is particularly problematic in countries with concentrated key population epidemics where anti-gay legislation erects further barriers ( 6– 10). MSM face high levels of stigma as a result of their sexual practices, including verbal, physical, and psychological abuse ( 5).
In Nigeria, the prevalence of HIV among MSM is 11–48%, whereas the overall adult prevalence is 3% ( 2– 4). Men who have sex with men (MSM) are among the populations at highest risk for HIV infection ( 1). Online sex-seekers in Nigeria are at increased risk for HIV/STIs but may not be benefiting from Internet-based risk reduction opportunities. Across visits, online sex-seekers were marginally more likely to test positive for chlamydia/gonorrhea (aOR=1.28, 95% CI=0.99, 1.64).
In addition, online sex-seeking was associated with testing positive for HIV at a follow-up visit (Adjusted Odds Ratio =2.02, 95% Confidence Interval =1.37, 2.98) among those who were unaware of or not living with HIV at baseline. Online sex-seeking (n=843, 61.5%) was associated with participation in MSM community activities, larger social and sexual networks, and higher levels of sexual behavior stigma. Logistic regression and generalized estimating equation models were used to assess associations with online sex-seeking. In this analysis we evaluate characteristics of online sex-seekers from the TRUST/RV368 cohort of 1,370 MSM in Abuja and Lagos. The TRUST/RV368 project was undertaken to apply innovative strategies to engage Nigerian MSM into HIV care.