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

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Background

Guys that have sex with males (MSM) are conservatively calculated to be lower than 1% for the population that is nigerian nationally account fully for about 20per cent of new HIV illness. 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 utilizing a organized questionnaire that is pre-coded. Variations in categorical factors had been evaluated with Chi Square. Logistic regression ended up being utilized to determine 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 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 in transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent this year to 23per cent in 2014 (p

Background

Globally, men that have intercourse with males (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge opportunities in worldwide HIV and expanded antiretroviral treatment (ART) programs which have triggered 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. The trend of HIV epidemic has been on a decline except among MSM 1 in high income countries. 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 who’ve intercourse with males are on a markedly different and increasing trajectory 1,2,3. In the USA, brand new HIV infections among MSM happens to be calculated to be increasing at 8% per year since 2001 1. Into 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 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 largely dedicated to individual 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. 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 compared 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 established to be relevant in comprehending the persistent high transmission rates among MSM particularly in the clear presence of increased ART protection whereby brand new infections should decrease due to reduced odds of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively projected to be lower than 1% associated with 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 the last few years with all the passage of the Marriage that is same-Sex Prohibition of 2014 13,14,15,16,17. The brand new legislation included clauses that prohibited companies from supplying solutions to MSM and facilitation of meetings that support homosexual individuals, thus further criminalizing same-sex activities 12. Studies 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. Extremely few MSM-targeted HIV avoidance, therapy and care solutions occur in a restricted wide range of states in Nigeria. This really is mainly due to restricted information in the size estimate of MSM across states in addition to restricted financing for key population devoted programs. Information on MSM are mostly from three rounds associated with 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 discover correlates of HIV among MSM in Nigeria. Proof out of this scholarly research will likely to be employed by policy manufacturer and system supervisors for evidence-based decision making for HIV prevention among MSM in Nigeria.

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In 2007, just three states – Lagos, Kano and Cross River, had been within the IBBSS. This year, after increased knowing of the share of MSM to your HIV epidemic, one more 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 of this six geopolitical areas in Nigeria were 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 design and recruitment

Each round for the IBBSS utilized respondent driven sampling provided to your concealed nature of MSM and so enables contrast between and across rounds. Respondent sampling that is drivenRDS) happens to be described in more detail in past studies 22, 23. Fleetingly, RDS is really a modified chain referral sampling that is non-random of recruitment that adjusts for the non-randomness employing 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 sexual experience of another guy into the six months ahead of the survey. Known MSM, designated as “seeds” began the chain of this recommendation use and network vouchers to recruit their peers in to the research. Ten seeds had been selected for every circular and seeds had been diversified by age, academic status and status that is socioeconomic. In order to avoid an over-representation of MSM with comparable characteristics, 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 had been authorized to reimburse MSM that has effectively recruited their peers and just one location had been used. Each voucher had been latin mail order brides yielded and redeemable N500 approx. $3 USD being a motivation for participating, with one more N500 directed at a recruit for every effective participant that is additional. Total payment had been restricted to a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being believed predicated on a thought HIV prevalence of 15%, a design aftereffect of 2.0 and degree of precision of 0.05. When it comes to 2010 and 2014 IBBSS, test size ended up being believed to identify a 10% differ from the round that is subsequent.

Information collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic faculties, style of sex 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 partners that are male. Kind of rectal intercourse practiced had been classified as “insertive penile intercourse” or penile that is“receptive” in past times 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 partners during transactional and non-transactional intercourse ended up being evaluated by asking the concerns “how frequently did you or your male partner make use of condom each time you had intercourse within the last 6 months? ” while condom usage at last intercourse had been examined because of the concern “the last time you’d anal intercourse do you or your partner make use of a condom? ”. Transactional sex ended up being evaluated by asking “have you received cash or present in return for intercourse within the last few a few months? ” Penned permission had been obtained from all individuals for both behavioural and biological the different parts of the study.

Laboratory testing

Detection of HIV during most of the studies ended up being regularly carried out by quick test making use of blood that is whole acquired from a hand prick. On the basis of the HIV that is national testing, 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 had been verified by using Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).