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

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

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Background

Guys that have 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 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 year and eight states in 2014. Each round utilized similar methodology and hence permits contrast. Behavioral information were acquired making use of an organized questionnaire that is pre-coded. Variations in categorical variables had been evaluated with Chi Square. Logistic regression had been utilized 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 whilst it was 24 years this year. About one-third of MSM in 2007 and 2014 and about two-fifths this year had involved with transactional sex. HIV prevalence increased from 14% in 2007 to 17per cent this season to 23% in 2014 (p

Background

Globally, males that have intercourse with males (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge opportunities in international HIV and expanded antiretroviral treatment (ART) programs which have lead to significant decreases in HIV among other sub-populations (basic populace, female sex 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 along with other males that have intercourse with males are on a markedly different and trajectory 1,2,3 that is increasing. In the united states, brand brand new HIV infections among MSM is predicted 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 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 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 individual level risk facets including unprotected receptive anal sex, lot of lifetime male lovers, inserting and non-injecting drug usage and high viral load within the index partner 1. But, specific degree danger facets alone, happen proved to be inadequate to describe the high transmission characteristics of HIV among MSM in addition to divergence of MSM epidemics in comparison to HIV epidemics various 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 transmission that is high among MSM particularly in the current presence of increased ART protection whereby brand brand new infections should decrease as a consequence of reduced possibility of transmission due to the effectation of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively believed 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 also this has further worsened in the past few years using the passage 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 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 small amount of states in Nigeria. That is mainly due to restricted information in the size estimate of MSM across states in addition to restricted financing for key population committed programs. Information on MSM are mostly from three rounds of this population-based built-in Biological and 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 scholarly research is likely to be utilized by policy maker and system managers for evidence-based choice making for HIV prevention among MSM in Nigeria.

Study sites

In 2007, just three states – Lagos, Kano and Cross River, had been within the IBBSS. This season, after increased knowing of the share of MSM towards the 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 put into the six states contained in the 2010 IBBSS. Hawaii selection ensured that five associated with six zones that are geopolitical Nigeria had been represented into the study. Therefore, the west that is southLagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed towards the research.

Sampling recruitment and design

Each round for the IBBSS utilized respondent sampling that is driven to your concealed nature of MSM and so permits contrast between and across rounds. Respondent driven sampling (RDS) was 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 making use of 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 contact that is sexual another guy within the a few months before the study. Known MSM, designated as “seeds” began the chain for 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 were diversified by age, academic status and socioeconomic status. In order to avoid an over-representation of MSM with click this comparable characteristics, vouchers limited by three per recruit was utilized 23, 24. In addition, to prevent perform enrollment, only 1 screener ended up being used, only 1 individual ended up being 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 an extra N500 directed at a recruit for every effective participant that is additional. Total settlement had been limited by a maximum payment of n2000 approximately $12 USD. Test size when it comes to 2007 IBBSS ended up being projected predicated on a thought HIV prevalence of 15%, a design effectation of 2.0 and standard of accuracy of 0.05. For the 2010 and 2014 IBBSS, test size had been approximated to identify a 10% vary from the subsequent round.

Information collection

Structured interviewer that is close-ended questionnaires elicited information about socio-demographic traits, sort of intercourse lovers and sexual danger habits. 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 had been classified as “insertive penile intercourse” or “receptive penile intercourse” in past times a few months. HIV danger perception was examined by asking MSM “do you are feeling you might be vulnerable to illness with HIV? ” with reaction choices being “yes or no”. 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 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 by the question “the last time you’d anal sex 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 intercourse within the last six months? ” Written consent had been obtained from all individuals for both behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during most of the studies had been regularly carried out by quick test making use of whole blood samples acquired from the finger prick. In line with the national HIV evaluation guideline, a synchronous algorithm of Determine (Alere healthcare, 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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