Negotiating access to the Nigerian healthcare system: the experiences of HIV-positive men who have sex with men.

Men who have sex with men in sub-Saharan Africa continue to have a disproportionately higher burden of HIV than their counterparts in the general population. In this qualitative study, barriers to participants accessing healthcare services in Nigeria, a country where same-sex relationships are criminalised and considered societally abhorrent, were explored. Four focus group discussions and 21 semi-structured interviews were conducted with HIV-positive men who have sex with men recruited from 3 NGOs in Abuja and Lagos, Nigeria in 2016. Interviews were transcribed verbatim and analysed thematically using NVivo. The findings of this study revealed the numerous barriers these men encounter accessing general (government and private) healthcare facilities. Data were organised into two categories: barriers associated with the wider legal context in relation to HIV-positive men who have sex with men and those with service delivery. There were barriers reported in relation to accessing an emerging service, which had hitherto sought to address some barriers encountered in general healthcare facilities. Findings point to the importance of facilitating a more enabling social and political environment whereby men who have sex with men can freely access healthcare services, potentially through these facilities.