Sexual and Reproductive Behaviour of HIV-positive Men and the Response of the Health Care Service: A Mixed Methods Study in Kano, Northern Nigeria

Background: HIV/AIDS remains a major public health challenge in sub-Saharan Africa. Despite their important role in the spread of HIV, the impact of a HIV-positive diagnosis and treatment on the sexual and reproductive behaviour of heterosexual Nigerian men is under-researched. Aim: To determine the sexual and reproductive behaviour of HIV-positive men in Kano, Nigeria in the era of antiretroviral therapy and the health care service response. Methods: A sequential, explanatory mixed methods design was used. First, a quantitative study collected and analyzed survey data on a clinic-based sample of HIV-positive men (n=270) and matched controls (n=270). This was followed by in-depth interviews with a sub-sample of survey participants (n=22) and health workers/health managers (n=5). Findings: Compared to controls, a greater proportion of HIV-positive men were sexually active (91.9% vs. 82.2%, P<0.05). However, they had reduced coital frequency, out of fear of transmission, psychological effect, energy expenditure and perceived nutrient loss. Post-diagnosis consistent condom use was higher compared to controls (18.9% vs. 13.0%, P<0.05). Lack of interest, reduced pleasure, partner’s refusal and desire to conceive were the reasons for low condom use. A smaller proportion of HIV-positive men desired more children than controls (79.3% vs. 91.1%, P<0.05) and intent to have a child within three years (57.0% vs. 67.0%, P