Lessons Learned in Using Visual Media to Address High Prevalence of Genital Warts amongst MSM (Men who have sex with men) Accessing PrEP and ART Services in Delta State, South South Nigeria.

Description: The HIV PrEP/ART services provided by Levites Initiative for Freedom and Enlightenment (LIFFE) under the US-CDC 4GATES project being implemented by Caritas Nigeria in Delta State, south south Nigeria has been a 5 year project from 2018-2022 aimed at epidemiology control of HIV infection amongst key populations. At the one-stop-shop located within LIFFE, HIV prevention and ART services are offered to more than 3000 MSMs. Lessons learned: Over the course of 20 months, starting in April 2020, statistics from the One-Stop-Shop report showed that 80% of MSM aged between 19 - 24yrs who were accessing PrEP at the time contracted STIs such as anal warts and syphilis. 23% of others in ART had similar experience. After investigating to find out the reason behind such incidence, analysis show that many of the MSM accessing PrEP still engaged in risky sexual behaviours. On the other hand, behavioural analysis also indicated that many MSM who arrive viral suppression after being on ARVs stopped using condoms with the misunderstanding that since they couldn't transmit HIV sexually, they couldn't contract STIs. In order to address this challenge and mitigate future occurrence, the clinical team increased STI counselling and awareness amongst these population. Pictures/Videos of severe cases of anal warts and other STI were shown to them and subsequent persons accessing these services in order to help them better understand the risk factors associated with risky sexual behaviours even while on PrEP or having arrived viral suppression. The result of using visuals during STI counselling when initiating MSMs on PrEP, ART and EAC is a 95% reduction in STIs amongst MSMs on PrEP and 97% for others on ART whose proper use of condom eliminated their risk of further contracting other STIs and HIV reinfection for the latter, thereby leading to early attainment and retained viral suppression. Conclusions/next steps: It is evident that the use of visuals during STI counselling for persons accessing HIV prevention services and those already on ART is effective in changing the behavioral attitude of MSMs towards safe sex practices.