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Background  The study objectives were to identify differences in HIV sexual risk behavior of men who had sex with other men (MSM) resident in urban and rural Nigeria, their perspectives on need for HIV prevention services and perceived barriers and facilitators to access of HIV prevention services in private, public and peer-led health facilities.    Method  Data were collected from MSM resident in urban and rural parts of River and Kaduna States. Qualitative assessment sought perspectives on barriers and facilitators of MSM uptake of HIV prevention services. In addition, a questionnaire was administered to seek information on HIV sexual risk behaviors (sexual abuse, age of sexual debut, multiple sexual partners and use of condom at last sexual intercourse), willingness to use and perceived barriers to access of HIV prevention services in public, private and peer-led health facilities, and willingness to use and perception about availability of structural intervention services. Differences in HIV sexual risk behaviors by residential location, and associations between sexual risk behavior and willingness to access HIV prevention services were determined.    Results  More MSM resident in urban than rural areas engaged in three or more HIV sexual risk behaviors (25.9% vs 8.7%;  p  = 0.02). More respondents were willing to access HIV prevention service provided through peer-led health facilities. Less than 35% of respondents identified non-availability of free services as a barrier to HIV prevention service access in the three types of health facilities. More MSM with multiple sexual risk behaviors were willing to access services promoting mental and psychosocial health ( p  < 0.001), HIV positive peer support programs ( p  = 0.002) and training on human rights and paralegal services (p < 0.001). Respondents opined that services that assured confidential HIV testing and mitigated structural drivers of HIV infection for MSM provided through peer-led facilities, will increase MSM’s uptake of HIV prevention services.    Conclusion  HIV risk reduction intervention services differentiated by rural and urban residence, may be needed for MSM. Services provided through peer-led facilities, that include mental and psychosocial health care, peer support, human rights and paralegal services will likely increase its use by MSM with more HIV sexual risk behaviors.

HIV sexual risk behavior and preferred HIV prevention service outlet by men who have sex with men in Nigeria