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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’ve intercourse with males (MSM) are conservatively projected to be not as much as 1% of this 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 similar methodology and hence enables contrast. Behavioral data were obtained making use of a organized questionnaire that is pre-coded. Differences in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to determine facets related to HIV.

An overall total of 879, 1545 and 3611 MSM were recruited in 2007, 2010 and 2014 respectively. Median age was 22 years for 2007 and 2014 whilst it had been 24 years this season. About one-third of MSM in 2007 and 2014 and about two-fifths this year had engaged in transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent this year to 23per cent in 2014 (p


Globally, men that have intercourse with males (MSM) remain disproportionately infected and affected by HIV 1, 2. Despite huge opportunities in worldwide HIV and expanded treatment that is antiretroviralART) programs that have triggered significant decreases in HIV among other sub-populations (basic populace, feminine intercourse employees), 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 claim that the HIV epidemic among gay, bisexual as well as other males that have intercourse with males are on a markedly different and increasing trajectory 1,2,3. In america, brand brand new HIV infections among MSM happens to be projected 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 conducted among MSM between 2005 and 2007, HIV purchase had been reported to own 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 level risk facets including unprotected anal that is receptive, large number of lifetime male lovers, injecting and non-injecting medication usage and high viral load when you look at the index partner 1. Nevertheless, individual degree danger facets alone, have already been been shown to be insufficient to spell out the high transmission characteristics of HIV among MSM therefore the divergence of MSM epidemics in comparison to HIV epidemics in other populations 1, 2. Other danger facets such as for instance biological, couple-network level, community-level and structural motorists have now been established 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 calculated to be not as much as 1% of this 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 past few years because of the passage through 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 services to MSM and facilitation of meetings that support homosexual people, thus further criminalizing same-sex activities 12. Research indicates why these restrictive policies further restrict the poor protection of HIV avoidance, treatment, 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 quantity of states in Nigeria. That is mainly due to limited information from the size estimate of MSM across states along with restricted money for key population devoted programs. Information on MSM are mostly from three rounds for the population-based incorporated Biological and Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to evaluate the improvement in HIV prevalence and figure out correlates of HIV among MSM in Nigeria. Proof out of this study will undoubtedly be employed by policy maker 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. 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 for the six zones that are geopolitical Nigeria had been represented within the study. Hence, 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 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) happens to be described in more detail in past studies 22, 23. Shortly, RDS is really a modified chain referral non-random sampling technique of recruitment that adjusts for the non-randomness employing 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 connection with another guy within the a few months ahead of the study. Known MSM, designated as “seeds” began the chain associated with the recommendation use and network vouchers to recruit their peers in to the study. Ten seeds had been chosen 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, only 1 screener ended up being used, just one person had been authorized to reimburse MSM that has effectively recruited his peers and just one location ended up being utilized. Each voucher ended up being redeemable and yielded N500 approx. $3 USD as a motivation for participating, with one more N500 provided to a recruit for every single effective participant that is additional. Total payment ended up being limited by a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS was believed according to an thought HIV prevalence of 15%, a design effectation of 2.0 and amount of accuracy of 0.05. For the 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, 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 was examined 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” into the past a few months. HIV danger perception ended up being examined by asking MSM “do you’re feeling you will be prone to disease with HIV? ” with reaction choices being “yes or no”. Consistent condom use with intimate lovers during transactional and sex that is non-transactional evaluated by asking the concerns “how frequently did you or your male partner work with a condom each time you had intercourse in the final 6 months? ” while condom usage at final intercourse had been assessed because of the concern “the last time you had anal intercourse do you or your partner work with a condom? ”. Transactional sex had been evaluated by asking “have you received cash or present in return for intercourse within the last few a few months? ” Written permission was acquired from all participants both for behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during all of the studies ended up being regularly carried out by quick test making use of blood that is whole obtained from a hand prick. In line with the nationwide HIV evaluation guideline, a synchronous algorithm of Determine (Alere health, United States Of America) and Unigold (Trinity Biotech, Plc, Bray, Ireland) ended up being used 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).