FINDINGS FROM A MULTIDISCIPLINARY STUDY OF MEN WHO HAVE SEX WITH MEN [MSM] IN NIGERIA – PHASE 1
Allman, D., S. Adebajo, T. Myers, O. Odumuye, S. Ogunsola, S. Akanmu, R.S. Remis, M. Wawer, R. Gray, P. Sandstorm, and J. Payne.
HIV Social Behavioral and Epidemiology Studies Unit University of Toronto, Alliance Rights Nigeria, Department of Microbiology, College of Medicine University of Lagos, HIV Clinic Department of Hematology, Lagos University Teaching Hospital, Mailman School of Public Health Columbia University, Department of Family Health Services John Hopkins University, National HIV & Retro virology Laboratories Public Health Agency of Canada and Department of Public Sciences University of Toronto.
Background
· Today over 40% of all Nigerians are under 15 years of age and while life expectancy increased from 45 years in 1963 to 51 years in 1991, the impacts of HIV/AIDS and related infections (i.e. tuberculosis) have reversed any previous trends, in 2001 life expectancy in Nigeria was estimated at 47 years. Sixty percent of new HIV infections occur in young Nigerians and HIV prevalence is highest in those between 15 to 29 years of age, Adult HIV prevalence among the general population in Nigeria increased from 1.8% in 1991 to 5.4 % in 2004. It is expected to increase to 9% by 2010.
· There is a lack of research on MSM sexual risk in Nigeria.
Methods
· This analysis is based on qualitative research conducted in Nigeria during phase 1 of a multidisciplinary study that seeks to examine patterns of male same-sex sexual activities and to understand their potential role in HIV and STI acquisition. The formative research described here reports on focus groups whose aim was to provide in-depth qualitative understanding of the target population and to assist in the development and conduct of a subsequent quantitative research phase of the project.
· Working in collaboration with members of the Alliance Rights Nigeria, an advocacy organization for Nigerian sexual minorities, structured focus groups incorporating anonymous self-completed questionnaires were conducted in secure locations in Nigeria. Men were recruited by word-of-month. Focus groups were organized by community members and conducted by three researchers. While English was the main language, informal translation between English, Yoruba and Ibo occurred.
· Focus groups discussions were audio-taped transcended and thematically analyzed. Techniques for analysis were influenced by the grounded theory of Strauss (1987) and the open coding of Strauss and Corbin (1990)
Results
Table 1. Socio-Department Characteristics of Sample
|
|
No
|
%
|
|
Age
|
16-24 years
25-34years
35+ years
|
19
31
7
|
33.3
54.4
12.3
|
|
Country of Birth
|
Born in Nigeria
|
54
|
93.0
|
|
Ethnicity
|
Yoruba
Igbo
|
33
22
|
56.9
37.9
|
|
Education
|
None
Secondary
College or Technical
University
Post-graduate
|
1
22
13
17
5
|
1.7
37.9
22.4
29.3
8.6
|
|
Employment
|
Full-time
Part-time
Unemployed
|
18
14
25
|
31.6
24.6
43.9
|
|
Religion
|
Christian
Moslem
Athiest
|
48
9
1
|
82.8
15.5
1.7
|
· Five focus groups were held in which 58 men participated.
· Storytelling played a large role in these discussions. Men were quick to assume the role of storytellers and others within the groups welcomed this. Men described their experiences growing up with the knowledge of their same sex attraction. Men agreed that while some initial homosexual behavior might be circumstantial, initial experiences were overall a natural evolution in individual self-development.
· Sexual identity developments were sometimes presented as part of a natural linear narrative of a life course other times they were experienced as more reactionary understood and rationalized by core family experiences by a search for intimacy or as a result of power differentials.
· Men could be challenged by their families if they were not developing heterosexual friendships and courtships as reproduction played a very important role in Nigerian family and social life. If one were to act in a particular way they well look at you with total disregard.
· Social rejection of same-sex sexual behavior frequently began and was experienced within the family and then would subsequently be experienced from other social institutions such as organized religion or from the broader Nigerian society.
· Men reported appearing as heterosexual in their public lives while being homosexually-active in their private lives. Secrecy was required out of respect for one’s family. For the safety of one’s self and one’s family, and in other to attain a measure of social acceptance within one’s social networks.
· Societal and family pressure to conform to community norms as well as the role of children and procreation within family structure meant that most participants either planned to or were currently married. Many believed that this was non-negotiable within Nigerian society and some did not see it as being a particular issue at all.
· Because same-sex sexuality was denied, stigma and discrimination were elements of public and private reaction that men lived with on a daily basis.
· For some, the lived experience of men who have sex with men in Nigeria could be considered secondary, given the realities of some of the social problems experienced in Nigeria such as poverty and economic divides, corruption, environmental destruction, and availability and access to health care and medicines.
· While the realities of the HIV epidemic are an extremely real threat to homosexually bisexually active men in Nigeria. It was recognized as an equal or even as a greater threat to all Nigerians, particularly to women and children.
· In discussing HIV prevention and education, all participants agreed that in Nigeria there was a good level of AIDS awareness among the community of men who have sex with men.
· Participants suggested that variation in condom use could be influenced by the view that condoms were a “western thing” or were opposed by traditional or formal elements of Nigerian society.
Table 2. Sexual Identity and Relationships
|
|
N
|
%
|
|
Sexual Identity
|
Gay
Bisexual
Heterosexual
Transgender
|
18
38
1
1
|
31.0
65.5
1.7
1.7
|
|
Last time had sex with a female
|
Within 6 months
6-12 months ago
1-5 years ago
5+ years ago
Never
|
24
12
8
3
8
|
43.6
21.8
14.5
5.5
14.5
|
|
Last time had sex with a male
|
Within 6 months
6-12 months ago
1-5 months ago
5+ years ago
Never
|
54
3
0
0
0
|
94.8
5.2
0
0
0
|
|
Number of people known to have HIV/AIDS
|
None
1-2
3-4
5 or more
|
39
5
7
6
|
68.4
8.8
12.3
10.6
|
|
Number of people known to have died of AIDS
|
None
1-2
3-4
5 or more
|
32
16
5
5
|
55.2
27.6
8.6
8.6
|
Limitations
· Men in the sample were well-educated in urban areas-these characteristics do not reflect the reality for a significant proportion of the Nigerian population.
· Given the secrecy surrounding same-sex sexuality behavior in Nigeria, recruitment of men for the research activities described here was facilitated largely via personal networks. Self-selection may have limited the diversity of men who have sex with men represented.
· Focus group discussions were conducted in several cities in Nigeria only.
Conclusion
· The lack of social recognition of same-sex sexuality within Nigeria society is not only reflected in the words and experiences of the participants in the focus groups discussed here. This social position is reflected also in National Policy which Criminalizes homosexuality through sections 214 and 215 of the Nigerian Criminal Code and through the 1999 constitution which limits the recognition of the rights of sexual minorities.
· Yet the status of same-sex sexuality is not only an issue of criminal codes and national practices it speaks also to what Jonathan Mann (1998) suggested when, in considering the Universal Declaration of Human Rights, he wrote, “All human beings are born free and equal in dignity and rights”.
· These research findings suggest the risks confronting men who participate in same-sex sexual activity in Nigeria, and the potential risks confronting their families, children, and male and female partners are critical. Ostracized by elements of culture social institutions and political will the risk experienced by men who have sex with men would appear to be unacceptably high.
· Prevention and education information targeted to a single Nigerian society may not be effective in education and changing the behavior of men who have sex with men. Also variation in education targeted to different age groups may be required.
Acknowledgements
· Participants and Volunteers.
· Department of Microbiology, College of Medicine, University of Lagos.
· Alliance Rights Nigeria. (ARN)
· HIV Clinic, Department of Hematology, Lagos University Teaching Hospital.
· Faculty of Medicine, University Toronto.
· AIDS Bureau, Ontario Ministry of Health and Long-Team Care.
· Canadian Institutes of Health Research (CIHR)
