Increasing HIV prevalence among males who possess intercourse with guys in Nigeria: a trend analysis

Increasing HIV prevalence among males who possess intercourse with guys in Nigeria: a trend analysis

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Background

Guys who’ve intercourse with guys (MSM) are conservatively believed to be lower than 1% associated with the 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 permits contrast. Behavioral information were acquired utilizing a organized questionnaire that is pre-coded. Variations in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to recognize facets connected 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 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 17percent this season to 23% in 2014 (p

Background

Globally, males who possess sex with males (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge assets in international HIV and expanded treatment that is antiretroviralART) 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. In high earnings nations, the trend of HIV epidemic is 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 sex with guys are on 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. 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 during 2009 4, 5 while in China, from prospective cohort studies carried out 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 specific degree risk facets including unprotected anal that is receptive, large number of lifetime male lovers, inserting and non-injecting medication usage and high viral load when you look at the index partner 1. Nevertheless, individual degree danger factors alone, have now been proved to be inadequate to describe the high transmission characteristics of HIV among MSM and also the 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 happen founded become relevant in comprehending the persistent transmission that is high among MSM particularly in the clear presence of increased ART protection whereby brand brand new infections should decrease because of reduced probability of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively calculated to be not as much as 1% associated with the Nigerian population yet nationally account fully for about 20per cent of brand new HIV infections 12. MSM are criminalized and stigmatized and this has further worsened in modern times with all 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 reports have shown why these restrictive policies further restrict the poor protection of HIV avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few MSM-targeted HIV prevention, treatment and care services occur in a finite amount of states in Nigeria. This can be mainly as a result of restricted information regarding the size estimate of MSM across states in addition to restricted money for key population devoted programs. Information on MSM are mostly from three rounds regarding 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 figure out correlates of HIV among MSM in Nigeria. Evidence with this research are employed by policy manufacturer and program supervisors for evidence-based choice making for HIV prevention among MSM in Nigeria.

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In 2007, only three states – Lagos, Kano and Cross River, latin beauties dating site had been within the IBBSS. This year, following increased understanding of the share of MSM to your HIV epidemic, yet another three states had been contained in the IBBSS – the Federal Capital Territory (FCT), Kaduna and Oyo, whilst in 2014, Enugu and streams states had been included with the six states within the 2010 IBBSS. Their state selection ensured that five for the six geopolitical areas in Nigeria had been represented into the survey. Hence, the west that is southLagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west zones (Kano and Kaduna) contributed into the research.

Sampling design and recruitment

Each round associated with the IBBSS utilized respondent driven sampling provided into the concealed nature of MSM and therefore enables contrast between and across rounds. Respondent driven sampling (RDS) is described at length in past studies 22, 23. Fleetingly, 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 brief history of dental and/or anal intimate connection with another guy into the half a year before the study. Known MSM, designated as “seeds” began the chain associated with referral use and network vouchers to recruit their peers in to the research. Ten seeds had been selected for every circular and seeds were diversified by age, academic status and status that is socioeconomic. In order to avoid 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, just one screener ended up being utilized, just one individual had been authorized to reimburse MSM that has successfully recruited their peers and just one location ended up being utilized. Each voucher had been yielded and redeemable N500 approx. $3 USD being a motivation for participating, with an extra N500 directed at a recruit for every single successful participant that is additional. Total settlement had been limited by a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being calculated predicated on 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, sample size had been projected to detect a 10% differ from the round that is subsequent.

Information collection

Structured close-ended interviewer administered questionnaires elicited information about socio-demographic traits, kind of intercourse lovers and intimate danger habits. Interviews had been carried out in MSM friendly companies identified in each one of the research states. Transactional sex was evaluated both with feminine and male lovers. Sort of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or “receptive penile sex” in past times a few months. HIV danger perception ended up being examined 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 examined by asking the concerns “how frequently did you or your male partner use a condom each time you had intercourse within the last few 6 months? ” while condom usage at last 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 ended up being evaluated by asking “have you received gift or money in return for intercourse within the last few a few months? ” Penned permission ended up being acquired from all individuals both for behavioural and biological the different parts of the study.

Laboratory testing

Detection of HIV during all of the studies had been regularly carried out by fast test utilizing whole bloodstream samples acquired from the finger prick. In line with the nationwide HIV evaluation guideline, a synchronous algorithm of Determine (Alere health, United States Of America) and Unigold (Trinity Biotech, Plc, Bray, Ireland) had been utilized to recognize HIV sero-positivity while status of discordant tests had been verified if you use Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).

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