Background: Little is known about effective modes of interviewing highly stigmatized groups such as MSM in settings such as Nigeria
Methods: We compared self-reported risk behaviors between ACASI and FTF interview methods among 712 MSM aged ≥18 years in Abuja (n=194), Lagos (n=308) and Ibadan (n=210). Participants were randomized into two groups: one completing a FTF interview administered by trained peer interviewers; the other completing a 40-45 minute self-administered survey via ACASI using netbook computers with headphones. The survey elicited information about HIV risk, health-seeking, and sexual identity. Multiple- logistic regression was used to ascertain differences in reporting of sensitive information across the two interview modes.
Results: Statistically significant differences were found by interview mode, with ACASI yielding higher reporting of sensitive, socially stigmatized behaviors compared to FTF interviews. After controlling for age, education, marital status and study locations, ACASI participants were more likely to report multiple male anal sex partners [AOR=1.5 (1.1-2.2)]; unprotected anal sex with men [AOR=1.5 (1.02-2.2)]; unprotected anal sex with women [AOR=1.9 (1.1-3.4)]; STI symptoms in the previous year [AOR=3.0 (2.0-4.5)]; drug use in the past year [AOR=24.4 (5.5-108.6)]; and homosexual identity (versus bisexual identity) [AOR=5.2 (2.1-4.7)]. Reporting of selling sex was lower among ACASI participants [AOR=0.7(0.5-1.0)].
Nearly all felt comfortable using the system, with 82% rating the experience as very good or better on a Likert scale. The most commonly cited reasons for liking ACASI were privacy (46.8%) and usability (30.9%). The majority of ACASI participants said they would like to use ACASI again for surveys.
Conclusion: The ACASI method consistently elicited a higher frequency of reporting of risk behaviors compared to FTF interviews among MSM in Nigeria. Behavioral surveillance surveys involving Nigerian MSM should consider adopting ACASI more broadly. Additionally, these findings cast doubt on the validity of behavioral data collected via FTF interviews with this population.
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