MOAE0302 | COMMUNITY-LED HIV SERVICE MODEL FOR LGBTQ+ POPULATIONS UNDER LEGAL RESTRICTION IN NIGERIA: RESULTS FROM THE NIGERIA LGBTQI+ CONSORTIUM PROJECT

Oluchi Ifeanyi, Godwin Kalu, Mauton Akoro, Kanyinsola Bashorun | The Initiative For Equal Rights, Oniru, Lekki, Nigeria

In Nigeria’s resource-limited and legally prohibitive environment, the Same-Sex Marriage (Prohibition) Act (2013) creates systemic barriers to HIV care for Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) populations. Financial insecurity, stigma, and fear of arrest restrict antiretroviral therapy (ART) access and adherence. As of December 2023, 67% of our clinic's key population clients had their viral load covered, which put their health and the control of the epidemic at risk. In January 2024, The Initiative for Equal Rights (TIERs), under the Elton John AIDS Foundation-funded Nigeria LGBTQI+ Consortium Project, implemented a multi-component, community-led HIV intervention to improve access and adherence to HIV services among LGBTQI+ populations in Lagos State, Nigeria. The package included: (1) transportation reimbursements for 23 economically disadvantaged clients to access drug refills and viral load testing; (2) systematic client tracing with the removal of 10 unreachable clients after multiple attempts, alongside regular SMS and phone follow-ups to confirm treatment adherence and results; (3) training of 20 LGBTQI+ Key Opinion Leaders (KOLs) as HIV counsellors/testers, with the KOLs conducting 15 monthly testing outreaches, reaching 1,556 individuals and identifying 61 reactive cases, and escorting 23 of the reactive clients to care; and (4) Value Clarification and Attitude Transformation (VCAT) training for 30 health workers across 8 general hospitals to promote LGBTQ+-affirming care, with their facilities included in a referral directory for LGBTQ+ persons living with HIV. 21 LGBTQ+ clients accessed PrEP/PEP via the new referral pathways. Viral load coverage increased from 67% (December 2023) to 95% (April 2025), peaking at 99% in February 2025. Among those tested, viral suppression reached 89%. Key drivers included socio-economic support, community co-design, and LGBTQ+-affirming service environments. Transport stipends and SMS follow-ups improved retention in care. KOL-led outreach expanded reach and linkage, while VCAT-trained providers reduced stigma and improved service uptake. This locally owned model shows that it is possible and effective to provide rights-affirming, peer-led HIV services even when there are structural barriers. We recommend expanding this model to other Nigerian states, conducting cost-effectiveness analyses, and advocating its inclusion in national HIV service guidelines through collaboration with state AIDS control agencies.