Rising HIV prevalence among males that have intercourse with guys in Nigeria: a trend analysis

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Background

Guys who possess intercourse with guys (MSM) are conservatively calculated to be not as much as 1% associated with population that is nigerian nationally account fully for about 20per cent of brand new HIV disease. We estimated the trend in HIV prevalence and determined correlates of HIV disease among MSM.

This research used information from respondent-driven sampling in three rounds of built-in biological and behavioral surveillance study (2007, 2010 and 2014) and covered three states in 2007, six states this year and eight states in 2014. Each round utilized methodology that is similar hence enables contrast. Behavioral information were acquired making use of a structured pre-coded questionnaire. Variations in categorical variables were evaluated with Chi Square. Logistic regression had been utilized to determine facets related to HIV.

A complete of 879, 1545 and 3611 MSM were recruited in 2007, 2010 and 2014 correspondingly. Median age was 22 years for 2007 and 2014 although it ended up being 24 years this season. About one-third of MSM in 2007 and 2014 and about two-fifths this season had involved with transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent this season to 23per cent in 2014 (p

Background

Globally, males who’ve intercourse with males (MSM) remain disproportionately infected and affected by HIV 1, 2. Despite huge investments in international HIV and expanded antiretroviral treatment (ART) programs which have triggered significant decreases in HIV among other sub-populations (basic population, feminine intercourse workers), HIV among MSM has remained for a sustained increase globally 1, 3. The trend of HIV epidemic has been on a decline except among MSM 1 in high income countries. Likewise, available information on HIV incidence and prevalence from low and middle-income nations declare that the HIV epidemic among gay, bisexual as well as other males who have intercourse with males are on a markedly different and trajectory 1,2,3 that is increasing. In the united states, brand new HIV infections among MSM happens to be approximated to be increasing at 8% per year since 2001 1. Into the Amsterdam Cohort research among MSM, HIV purchase increased from 1.0 per 100 person-years in 1992 to 2.0 per 100-person years in ’09 4, 5 while in China, from prospective studies that are cohort among MSM between 2005 and 2007, HIV purchase had been reported to own increased from 2.6 to 5.6 per 100 person-years 6,7,8,9.

Many studies of HIV purchase and transmission among MSM have actually mostly dedicated to individual degree risk factors including unprotected anal that is receptive, large number of lifetime male lovers, inserting and non-injecting medication usage and high viral load into the index partner 1. Nonetheless, specific degree risk factors alone, happen been shown to be inadequate to spell out the high transmission dynamics of HIV among MSM additionally the divergence of MSM epidemics compared to HIV epidemics in other populations 1, 2. Other danger facets such as for example biological, couple-network degree, community-level and structural motorists are established become pertinent in knowing the persistent transmission that is high among MSM particularly in the clear presence of increased ART coverage whereby brand new infections should decrease due to reduced possibility of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively predicted to be significantly less than 1% of this population that is nigerian nationally account fully for about 20per cent of brand new HIV infections 12. MSM are criminalized and stigmatized and also this has further worsened in the past few years because of the passage through of the Same-Sex Marriage Prohibition law of 2014 13,14,15,16,17. The law that is new clauses that prohibited companies from supplying solutions to MSM and facilitation of meetings that support homosexual individuals, thus further criminalizing same-sex activities 12. Research indicates why these restrictive policies further restrict the coverage that is poor of avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few MSM-targeted HIV avoidance, therapy and care solutions occur in a finite amount of states in Nigeria. This is certainly mainly as a result of restricted information from the size estimate of MSM across states along with limited money for key population devoted programs. Data on MSM are mostly from three rounds associated with the Integrated that is population-based Biological Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to evaluate the improvement in HIV prevalence and discover correlates of HIV among MSM in Nigeria. Proof using this research may be utilized by policy manufacturer and system supervisors for evidence-based choice making for HIV prevention among MSM in Nigeria.

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In 2007, just three states – Lagos, Kano and Cross River, had been within the IBBSS. This year, after increased understanding of the share of MSM to your HIV epidemic, yet another three states had been within the IBBSS – the Federal Capital Territory (FCT), Kaduna and Oyo, whilst in 2014, Enugu and Rivers states had been put into the six states within the 2010 IBBSS. Their state selection ensured that five of this six geopolitical areas in Nigeria had been represented when you look at the study. Thus, the west that is southLagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed into the research.

Sampling recruitment and design

Each round regarding the IBBSS utilized respondent sampling that is driven to your concealed nature of MSM and therefore enables contrast between and across rounds. Respondent driven sampling (RDS) happens to be described at length in previous studies 22, 23. Quickly, RDS is a modified chain referral sampling that is non-random of recruitment that adjusts for the non-randomness employing a mathematical model that loads each sample recruited 23. Inclusion criteria ended up being male aged 16 years and above with a brief history of dental and/or anal contact that is sexual another guy within the six months before the study. Known MSM, designated as Clicking Here “seeds” began the chain associated with referral use and network vouchers to recruit their peers to the research. Ten seeds were chosen for each circular and seeds had been diversified by age, educational status and status that is socioeconomic. To prevent an over-representation of MSM with comparable characteristics, vouchers limited by three per recruit was used 23, 24. In addition, in order to avoid perform enrollment, only 1 screener ended up being utilized, just one individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location had been used. Each voucher had been yielded and redeemable N500 approx. $3 USD as a motivation for participating, with an additional N500 directed at a recruit for every single successful extra participant. Total settlement had been restricted to a compensation that is maximum of approximately $12 USD. Sample size for the 2007 IBBSS ended up being predicted predicated on a thought HIV prevalence of 15%, a design effectation of 2.0 and amount of accuracy of 0.05. When it comes to 2010 and 2014 IBBSS, test size had been calculated to detect a 10% vary from the subsequent round.

Information collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, style of intercourse lovers and intimate danger actions. Interviews were carried out in MSM friendly companies identified in all the research states. Transactional sex ended up being evaluated both with feminine and partners that are male. Sort of rectal intercourse practiced had been classified as “insertive penile intercourse” or penile that is“receptive” in past times a few months. HIV danger perception had been examined by asking MSM “do you’re feeling you may be prone to illness with HIV? ” with reaction choices being “yes or no”. Consistent condom use with intimate lovers during transactional and non-transactional intercourse was examined by asking the concerns “how frequently did you or your male partner make use of condom each time you had intercourse within the last 6 months? ” while condom usage at final intercourse ended up being evaluated because of the concern “the last time you’d anal intercourse do you or your partner work with a condom? ”. Transactional sex had been evaluated by asking “have you received gift or money in return for intercourse within the last few a few months? ” Written consent was acquired from all individuals for both behavioural and biological the different parts of the study.

Laboratory testing

Detection of HIV during most of the studies had been consistently carried out by quick test utilizing blood that is whole acquired from the little finger prick. In line with the nationwide HIV evaluating guideline, a synchronous algorithm of Determine (Alere healthcare, United States Of America) and Unigold (Trinity Biotech, Plc, Bray, Ireland) ended up being utilized to recognize HIV sero-positivity while status of discordant tests ended up being verified if you use Stat Pak (Chembio Diagnostic techniques, New York, United States Of America).

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