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

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

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Background

Guys who possess sex with guys (MSM) are conservatively calculated to be lower than 1% regarding the Nigerian population yet nationally account fully for about 20per cent of brand new HIV disease. We estimated the trend in HIV prevalence and determined correlates of HIV illness 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 year and eight states in 2014. Each round utilized methodology that is similar therefore permits contrast. Behavioral information were acquired making use of an organized questionnaire that is pre-coded. Variations in categorical factors were evaluated with Chi Square. Logistic regression had been used to spot facets connected with HIV.

An overall total 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 although 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 that have intercourse with guys (MSM) remain disproportionately infected and affected by HIV 1, 2. Despite huge opportunities in worldwide HIV and expanded treatment that is antiretroviralART) programs which have lead to significant decreases in HIV among other sub-populations (basic populace, female intercourse employees), HIV among MSM has remained for a sustained increase globally 1, 3. In high earnings nations, the trend of HIV epidemic was for a decrease except among MSM 1. Likewise, 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 possess intercourse with guys are on a markedly different and increasing trajectory 1,2,3. In america, brand brand new HIV infections among MSM is believed to be increasing at 8% per year since 2001 1. When you look at 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 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 receptive rectal intercourse, high number of lifetime male lovers, inserting and non-injecting medication usage and high viral load when you look at the index partner 1. Nevertheless, specific degree danger facets alone, have now been proved to be insufficient to describe the high transmission dynamics of HIV among MSM together with divergence of MSM epidemics in comparison with HIV epidemics in other populations 1, 2. Other danger facets such as for example biological, couple-network degree, community-level and structural motorists have already been founded become relevant in comprehending the persistent high transmission rates among MSM particularly in the presence of increased ART protection whereby brand brand brand new infections should decrease due to reduced probability of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively approximated to be significantly less than 1% regarding the Nigerian population yet 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 last few years because of the passage through of the Same-Sex Marriage Prohibition law of 2014 13,14,15,16,17. The brand new legislation included 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 reports have shown 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 restricted quantity of states in Nigeria. This is certainly chiefly as a result of restricted information regarding the size estimate of MSM across states along with restricted money for key population devoted programs. Information on MSM are mainly from three rounds associated with the population-based incorporated Biological and Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to assess the improvement in HIV prevalence and discover correlates of HIV among MSM in Nigeria. Proof with 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 contained in the IBBSS. An additional three states were included in the IBBSS – the Federal Capital Territory (FCT), Kaduna and Oyo, while in 2014, Enugu and Rivers states were added to the six states included in the 2010 IBBSS in 2010, following increased awareness of the contribution of MSM to the HIV epidemic. Their state selection ensured that five for the six geopolitical areas in Nigeria had been represented within the survey. Hence, the the west (Lagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed to your research.

Sampling design and recruitment

Each round associated with the IBBSS utilized respondent driven sampling provided towards the hidden nature of MSM and therefore permits contrast between and across rounds. Respondent driven sampling (RDS) happens to be described at length in past studies 22, 23. Shortly, RDS is really a modified chain referral non-random sampling technique of recruitment that adjusts for the non-randomness utilizing a mathematical model that weights each sample recruited 23. Inclusion criteria ended up being male aged 16 years and above with a history of dental and/or anal intimate experience latin women dating of another guy in the a few months ahead of the study. Known MSM, designated as “seeds” began the chain regarding the recommendation use and network vouchers to recruit their peers in to the study. Ten seeds had been chosen for every circular and seeds were diversified by age, educational status and socioeconomic status. 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 perform enrollment, only 1 screener had been utilized, just one person had been authorized to reimburse MSM that has effectively recruited their peers and just one location had been utilized. Each voucher ended up being redeemable and yielded N500 approx. $3 USD as a motivation for participating, with one more N500 directed at a recruit for every single effective participant that is additional. Total settlement ended up being restricted to a maximum settlement of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being calculated according to a thought HIV prevalence of 15%, a design effect of 2.0 and standard of accuracy of 0.05. When it comes to 2010 and 2014 IBBSS, sample size ended up being approximated to detect a 10% vary from the subsequent round.

Data collection

Structured interviewer that is close-ended questionnaires elicited information about socio-demographic faculties, kind of intercourse lovers and intimate danger habits. Interviews had been carried out in MSM friendly businesses identified in each one of the research states. Transactional sex ended up being evaluated both with feminine and partners that are male. Kind of anal sex practiced had been classified as “insertive penile intercourse” or “receptive penile intercourse” in past times a few months. HIV risk perception had been 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 sex that is non-transactional 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 use at final intercourse had been evaluated because of the concern “the last time you’d anal intercourse did you or your partner work with a condom? ”. Transactional sex ended up being examined by asking “have you received cash or present in exchange for intercourse in the past a few months? ” Penned consent had been acquired from all individuals both for behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during all of the studies had been regularly carried out by fast test utilizing blood that is whole acquired from a hand prick. In line with the HIV that is national testing, a synchronous algorithm of Determine (Alere health, United States Of America) and Unigold (Trinity Biotech, Plc, Bray, Ireland) had been utilized to spot HIV sero-positivity while status of discordant tests ended up being verified if you use Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).

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