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

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

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Background

Guys that have intercourse with males (MSM) are conservatively approximated to be significantly less than 1% regarding the population that is nigerian 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 methodology that is similar hence enables contrast. Behavioral information were acquired utilizing a organized pre-coded questionnaire. Variations in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to spot 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 was 24 years this year. About one-third of MSM in 2007 and 2014 and about two-fifths this year had involved with transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent this season to 23per cent in 2014 (p

Background

Globally, males that have intercourse with guys (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge assets in international HIV and expanded antiretroviral treatment (ART) programs which have led to significant declines in HIV among other sub-populations (basic population, feminine intercourse workers), 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 claim that the HIV epidemic among gay, bisexual as well as other males who possess intercourse with guys are for a markedly different and trajectory 1,2,3 that is increasing. In america, new HIV infections among MSM happens to be approximated to be increasing at 8% per year since 2001 1. In 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 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 degree risk facets including unprotected receptive rectal intercourse, large number of lifetime male lovers, inserting and non-injecting drug use and high viral load within the index partner 1. But, specific degree danger facets alone, have already been been shown to be inadequate to describe the high transmission characteristics of HIV among MSM while the divergence of MSM epidemics when comparing to HIV epidemics in other populations 1, 2. Other danger facets such as for instance biological, couple-network degree, community-level and structural motorists have already been founded become relevant in comprehending the persistent high transmission prices among MSM specially in the clear presence of increased ART coverage whereby brand brand brand new infections should decrease due to reduced probability of transmission due to the effectation of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively approximated to be lower than 1% associated with 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 aided by 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 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. Really few MSM-targeted HIV avoidance, therapy and care services occur in a restricted wide range of states in Nigeria. That is mainly due to restricted information regarding the size estimate of MSM across states in addition to limited financing for key population devoted programs. Information on MSM are mostly from three rounds associated with the population-based built-in Biological and Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to evaluate the noticeable improvement in HIV prevalence and figure out correlates of HIV among MSM in Nigeria. Proof with this research is employed 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 understanding 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 Rivers states had been included with the six states contained in the 2010 IBBSS. Their state selection ensured that five regarding the six geopolitical areas in 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 zones (Kano and Kaduna) contributed to your research.

Sampling recruitment and design

Each round of this IBBSS used respondent sampling that is driven into the concealed nature of MSM and therefore permits contrast between and across rounds. Respondent driven sampling (RDS) was described at length in past studies 22, 23. Shortly, RDS is a modified chain referral non-random sampling technique of recruitment that adjusts for the non-randomness making use of a mathematical model that loads 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 experience of another guy within the six months before the survey. Known MSM, designated as “seeds” began the chain associated with the recommendation use and network vouchers to recruit their peers in to the research. Ten seeds had been chosen for each circular and seeds had been diversified by age, educational status and socioeconomic status. In order to avoid an over-representation of MSM with comparable attributes, vouchers limited by three per recruit was utilized 23, 24. In addition, in order to avoid perform enrollment, just one screener ended up being utilized, just one individual ended up being authorized to reimburse MSM who had effectively 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 effective extra participant. Total payment ended up being limited by a maximum compensation of n2000 approximately $12 USD. Test size for the 2007 IBBSS had been believed 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, test size had been predicted to identify a 10% differ from the round that is subsequent.

Information collection

Structured interviewer that is close-ended questionnaires elicited information on socio-demographic faculties, variety 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 ended up being evaluated both with feminine and male lovers. Sort of rectal intercourse practiced ended up being classified as “insertive penile sex” or penile that is“receptive” into the past a few months. HIV danger 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 non-transactional intercourse had been examined by asking the concerns “how frequently did you or your male partner work with a condom each time you had intercourse within the last few 6 months? ” while condom use at final intercourse ended up being examined because of the concern “the last time you’d latin brides anal intercourse do you or your partner make use of a condom? ”. Transactional sex had been evaluated by asking “have you received gift or money in return for sex within the last few a few months? ” Written consent had been acquired from all participants for both behavioural and biological the different parts of the study.

Laboratory testing

Detection of HIV during most of the studies had been regularly carried out by quick test utilizing blood that is whole obtained from a little finger prick. In line with the nationwide HIV screening guideline, a synchronous algorithm of Determine (Alere healthcare, 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 ended up being verified if you use Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).

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