LAUSR

Introduction Sexual stigma affecting men who have sex with men (MSM) in Nigeria may contribute to acquisition and onward transmission of HIV and other sexually transmitted infections (STIs). Prior analysis found stigma to be associated with increased HIV and STI prevalence and larger MSM social network size. The aim of this study was to explore the association between stigma and MSM social networks. Methods From March 2013 to February 2016, the TRUST/RV368 study recruited 1,480 MSM in Abuja and Lagos, Nigeria into a prospective cohort that provides HIV and STI diagnosis and treatment. From this parent study, 15 semi-structured in-depth interviews were conducted with participants who experienced elevated stigma. Interviews were transcribed and coded using thematic analysis. Results The key themes for how sexual stigma may have led to greater vulnerability for HIV and STIs were: financial vulnerability and emotional trauma, constrained opportunities to share HIV and STI resources, and internet use. Participants described financial exploitation and emotional trauma as common consequences of stigma that at times was associated with condomless sex and transactional sex. Fear of stigma constrained MSM’s willingness to openly socialise, which may have limited exposure to sexual health services, as MSM social networks were often described as a medium for emotional support, information on HIV/STIs, and referrals to clinics serving MSM. Instead, many relied on the internet to find MSM. This strategy was considered to be safer, but it may have increased participants’ exposure to HIV/STIs through exposure to more sex partners and increased their vulnerability for blackmailers to locate and extort them for money. Conclusion These interviews suggest that interventions that reduce sexual stigma and leverage social resources in networks among Nigerian MSM can support improved HIV and STI outcomes such as improved awareness of services, earlier diagnosis and engagement in care. Capitalising on the broad use of social media applications represents an important platform for these services.