Nigeria's restrictive legal environment creates a complex intersection of public health challenges and social stigma that fundamentally alters how infectious disease outbreaks affect vulnerable populations. The criminalization of same-sex relationships forces affected individuals underground, complicating both prevention efforts and clinical care delivery in ways that differ markedly from Western outbreak responses.
Interviews with 28 men who have sex with men in Lagos revealed critically low awareness of mpox transmission patterns and symptoms, with most participants avoiding public healthcare facilities entirely due to fear of discrimination or legal consequences. The study documented how intimate sexual contact serves as the primary transmission route within this population, yet traditional public health messaging fails to reach those most at risk. Healthcare-seeking behaviors include self-medication, traditional remedies, and reliance on specialized key-population-friendly services when available.
This research exposes a fundamental tension in outbreak response strategy: targeting high-risk populations could inadvertently increase stigmatization and drive further healthcare avoidance. Unlike mpox responses in countries with established LGBTQ+ healthcare infrastructure, Nigerian public health authorities must navigate competing priorities of disease control versus protection of already marginalized communities. The findings suggest that effective outbreak management in restrictive social contexts requires parallel development of trusted, discrete healthcare channels alongside broader awareness campaigns. The study's emphasis on context-sensitive responses challenges one-size-fits-all global health approaches, particularly as mpox continues spreading in regions where sexual minorities face criminalization. Enhanced surveillance systems that protect individual privacy while capturing transmission dynamics remain critically needed.
