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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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Guys who possess intercourse with guys (MSM) are conservatively predicted to be significantly less 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 methodology that is similar hence enables comparison. Behavioral information were acquired making use of an organized pre-coded questionnaire. Variations in categorical factors had been examined with Chi Square. Logistic regression was utilized to spot factors related to 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 year had involved with transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent this season to 23per cent in 2014 (p


Globally, males that have sex with males (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge opportunities in international 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 on 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 data on HIV incidence and prevalence from low and middle-income nations declare that the HIV epidemic among gay, bisexual as well as other males who’ve intercourse with guys are on a markedly different and increasing trajectory 1,2,3. In the united states, brand brand new HIV infections among MSM was approximated to be increasing at 8% per year since 2001 1. Within 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 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 individual degree risk facets including unprotected anal that is receptive, large number of lifetime male lovers, inserting and non-injecting medication use and high viral load into the index partner 1. But, specific degree danger facets alone, have already been been shown to be inadequate to spell out the high transmission dynamics of HIV among MSM while the divergence of MSM epidemics in comparison with HIV epidemics in other populations 1, 2. Other risk facets such as for instance biological, couple-network degree, community-level and structural motorists have now been founded become relevant in comprehending the persistent high transmission prices among MSM particularly in the clear presence of increased ART protection whereby brand brand new infections should decrease because of reduced possibility of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively predicted to be not as much as 1% of this 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 modern times using 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 indicates why these restrictive policies further restrict the poor coverage of HIV avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Extremely few MSM-targeted HIV avoidance, therapy and care solutions occur in a finite quantity of states in Nigeria. That is mainly as a result of restricted data from the size estimate of MSM across states in addition to restricted money for key population committed programs. Information on MSM are mostly from three rounds for the Integrated that is population-based Biological 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 using this research will likely 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 regarding the six zones that are geopolitical 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 into the research.

Sampling design and recruitment

Each round associated with IBBSS used respondent driven sampling given towards the concealed nature of MSM and so permits contrast between and across rounds. Respondent driven sampling (RDS) happens to be described at length 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 loads each sample recruited 23. Inclusion criteria had been male aged 16 years and above with a brief history of oral and/or anal contact that is sexual another man into the a few months before the study. Known MSM, designated as “seeds” began the chain of this recommendation use and network vouchers to recruit their peers to the research. Ten seeds had been chosen for every circular and seeds had been diversified by age, academic status and socioeconomic status. 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, only 1 individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location ended up being utilized. Each voucher ended up being yielded and redeemable N500 approx. $3 USD as a motivation for participating, with one more N500 provided to a recruit for every effective extra participant. Total settlement ended latin brides at bestrussianbrides.org up being limited by a compensation that is maximum of approximately $12 USD. Sample size when it comes to 2007 IBBSS had been approximated predicated on a thought HIV prevalence of 15%, a design aftereffect of 2.0 and amount of accuracy of 0.05. For the 2010 and 2014 IBBSS, test size ended up being predicted to identify a 10% differ from the subsequent round.

Information collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, sort of intercourse partners and intimate danger habits. Interviews had been carried out in MSM organizations that are friendly in all the research states. Transactional sex had been evaluated both with feminine and partners that are male. Kind of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or “receptive penile intercourse” into the past a few months. HIV danger perception had been 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 non-transactional intercourse had been evaluated by asking the concerns “how frequently did you or your male partner use a condom each time you had intercourse within the last few six months? ” while condom use at final sex had been assessed by the concern “the last time you had anal intercourse did you or your partner make use of a condom? ”. Transactional sex ended up being examined by asking “have you received gift or money in return for intercourse within the last few six months? ” Written consent ended up being acquired from all individuals for both behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during most of the studies ended up being regularly carried out by fast test making use of whole bloodstream samples acquired from the little finger 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 determine 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).