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

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Background

Guys who’ve intercourse with males (MSM) are conservatively predicted to be lower than 1% of this Nigerian population yet nationally account fully for about 20per cent of brand new HIV illness. 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 similar methodology and therefore enables contrast. Behavioral data were acquired making use of an organized pre-coded questionnaire. Variations in categorical factors had been examined with Chi Square. Logistic regression had been utilized to determine 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 whilst it ended up being 24 years this year. 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 year to 23per cent in 2014 (p

Background

Globally, males who possess intercourse with guys (MSM) remain disproportionately infected and affected by HIV 1, 2. Despite huge assets in worldwide HIV and expanded antiretroviral treatment (ART) programs which have triggered significant decreases in HIV among other sub-populations (general populace, feminine sex employees), HIV among MSM has remained on a sustained increase globally 1, 3. In high earnings nations, the trend of HIV epidemic was on a decrease except among MSM 1. Likewise, available data on HIV incidence and prevalence from low and middle-income nations claim that the HIV epidemic among gay, bisexual along with other males that have intercourse with males are for a markedly different and increasing trajectory 1,2,3. In the united states, brand brand brand new HIV infections among MSM happens to be calculated to be increasing at 8% per year since 2001 1. When you look at the Amsterdam Cohort Study 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 centered on specific degree risk facets including unprotected receptive rectal intercourse, large number of lifetime male lovers, inserting and non-injecting medication usage and high viral load within the index partner 1. But, specific degree danger facets alone, have now been been shown to be inadequate to describe the high transmission characteristics of HIV among MSM together with divergence of MSM epidemics in comparison to HIV epidemics in other populations 1, 2. Other danger facets such as for example biological, couple-network degree, community-level and structural motorists have now been founded become relevant in knowing the persistent transmission that is high among MSM particularly in the current presence of increased ART protection whereby brand new infections should decrease because of reduced probability of transmission due to the effectation of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively calculated to be not as much as 1% for the 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 reports have shown why these restrictive policies further limit the poor protection of HIV avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few HIV that is MSM-targeted prevention therapy and care solutions occur in a small wide range of states in Nigeria. That is mainly as a result of restricted information regarding the size estimate of MSM across states in addition to restricted money for key population committed programs. Information on MSM are mainly 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 with this scholarly research may be 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, 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 associated with six geopolitical areas in Nigeria had been represented within the study. Therefore, 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 of this IBBSS utilized respondent driven sampling provided to your concealed nature of MSM and therefore enables comparison between and across rounds. Respondent sampling that is drivenRDS) happens to be described in more detail in past studies 22, 23. Shortly, RDS is a modified chain referral sampling that is non-random 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 contact that is sexual another guy within the six months before the study. Known MSM, designated as “seeds” began the chain for the recommendation community and make use of vouchers to recruit their peers in to the latin dating sites research. Ten seeds had been chosen for every circular and seeds were diversified by age, educational status and socioeconomic status. In order to avoid an over-representation of MSM with similar attributes, 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 person ended up being authorized to reimburse MSM who had effectively recruited his peers and just one location had been utilized. Each voucher had been yielded and redeemable N500 approx. $3 USD as a motivation for participating, with one more N500 directed at a recruit for every effective participant that is additional. Total settlement had been restricted to a maximum payment of n2000 approximately $12 USD. Test size when it comes to 2007 IBBSS had been calculated centered on an 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, test size had been believed to identify a 10% vary from the subsequent round.

Information collection

Structured close-ended interviewer administered questionnaires elicited information about socio-demographic faculties, sort of intercourse lovers and intimate danger habits. Interviews had been carried out in MSM organizations that are friendly in each one of the research states. Transactional sex had been evaluated both with feminine and partners that are male. Variety of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or “receptive penile intercourse” within the past a few months. HIV danger perception ended up being evaluated by asking MSM “do you’re feeling you will be prone to disease with HIV? ” with reaction options being “yes or no”. Consistent condom use with sexual partners during transactional and sex that is non-transactional evaluated by asking the concerns “how often did you or your male partner make use of a condom each time you had intercourse within the last few 6 months? ” while condom usage at final intercourse ended up being evaluated because of the concern “the last time you’d rectal intercourse do you or your partner make use of a condom? ”. Transactional sex had been examined by asking “have you received gift or money in return for sex in the final six months? ” Penned permission had been acquired from all individuals for both behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during all of the studies ended up being consistently carried out by quick test utilizing whole bloodstream samples acquired from a hand prick. On the basis of the nationwide HIV assessment guideline, a synchronous algorithm of Determine (Alere healthcare, 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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