Increasing HIV prevalence among men that have intercourse with guys in Nigeria: a trend analysis

Increasing HIV prevalence among men that have intercourse with guys in Nigeria: a trend analysis

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Background

Guys who have intercourse with males (MSM) are latin women dating conservatively predicted to be lower than 1% of this 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 utilized 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 season and eight states in 2014. Each round utilized similar methodology and therefore enables contrast. Behavioral information were acquired utilizing an organized pre-coded questionnaire. Variations in categorical variables had been examined with Chi Square. Logistic regression ended up being utilized to recognize facets associated with HIV.

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

Background

Globally, males who possess intercourse with guys (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge assets in worldwide HIV and expanded antiretroviral treatment (ART) programs which have lead to significant decreases in HIV among other sub-populations (basic populace, feminine intercourse employees), HIV among MSM has remained on a sustained increase globally 1, 3. The trend of HIV epidemic has been on a decline except among MSM 1 in high income countries. Similarly, available information on HIV incidence and prevalence from low and middle-income nations declare that the HIV epidemic among gay, bisexual along with other males who’ve intercourse with guys are for a markedly different and trajectory 1,2,3 that is increasing. In america, brand brand brand new HIV infections among MSM happens to be approximated to be increasing at 8% per year since 2001 1. Within 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 cohort studies conducted among MSM between 2005 and 2007, HIV acquisition ended up being reported to possess 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 specific level risk facets 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. Nevertheless, specific degree danger factors alone, have now been proved to be inadequate to describe the high transmission characteristics of HIV among MSM as well as the divergence of MSM epidemics in comparison with HIV epidemics various other populations 1, 2. Other danger facets such as for instance biological, couple-network degree, community-level and structural motorists were established become pertinent in knowing the persistent transmission that is high among MSM particularly in the clear presence of increased ART protection whereby brand brand new infections should decrease due to reduced odds of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively predicted to be lower than 1% associated with 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 modern times because of the passage of the Marriage that is same-Sex Prohibition 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. Extremely few MSM-targeted HIV avoidance, therapy and care services occur in a finite amount of states in Nigeria. This is certainly mainly due to restricted information regarding the size estimate of MSM across states in addition to limited capital for key population devoted programs. Information on MSM are mostly from three rounds of this Integrated that is population-based Biological Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to evaluate the noticeable improvement in HIV prevalence and discover correlates of HIV among MSM in Nigeria. Proof out of this research are going to 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 contained in the IBBSS. This year, after increased awareness 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 streams states had been put into the six states within the 2010 IBBSS. Their state selection ensured that five associated with six zones that are geopolitical Nigeria had been represented into the survey. Therefore, the the west (Lagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed towards the research.

Sampling design and recruitment

Each round of this IBBSS utilized respondent sampling that is driven to your concealed nature of MSM and so enables contrast between and across rounds. Respondent driven sampling (RDS) is described in more detail in past studies 22, 23. Quickly, RDS is a modified chain referral non-random sampling technique of recruitment that adjusts for the non-randomness employing a mathematical model that loads each sample recruited 23. Inclusion criteria had been male aged 16 years and above with a brief history of dental and/or anal intimate connection with another guy into the six months before the study. Known MSM, designated as “seeds” began the chain regarding the referral community and make use of vouchers to recruit their peers to the research. Ten seeds had been chosen for every circular and seeds had been diversified by age, academic status and status that is socioeconomic. To prevent an over-representation of MSM with comparable characteristics, vouchers restricted to three per recruit was utilized 23, 24. In addition, in order to prevent repeat enrollment, just one screener ended up being utilized, only 1 individual ended up being authorized to reimburse MSM that has successfully recruited his peers and just one location had been used. Each voucher ended up being redeemable and yielded N500 approx. $3 USD as a motivation for participating, with one more N500 provided to a recruit for every single successful extra participant. Total payment ended up being limited by a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS had been predicted considering an thought HIV prevalence of 15%, a design effectation of 2.0 and standard of accuracy of 0.05. When it comes to 2010 and 2014 IBBSS, test size ended up being believed to identify a 10% vary from the round that is subsequent.

Data collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, variety of intercourse lovers and sexual danger actions. Interviews had been carried out in MSM organizations that are friendly in all the research states. Transactional sex ended up being evaluated both with feminine and partners that are male. Kind of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or penile that is“receptive” in past times a few months. HIV danger perception ended up being evaluated by asking MSM you are at risk of infection with HIV? ” with response options being “yes or no”“do you feel. Consistent condom use with intimate lovers during transactional and non-transactional intercourse had been evaluated 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 had been examined because of the concern “the last time you’d rectal 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 permission had been acquired from all participants both for behavioural and biological aspects of the survey.

Laboratory testing

Detection of HIV during most of the studies ended up being regularly carried out by quick test utilizing whole bloodstream samples acquired from the little finger prick. On the basis of the HIV that is national testing, a synchronous algorithm of Determine (Alere health, 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 had been verified by using Stat Pak (Chembio Diagnostic techniques, New York, United States Of America).

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