Increasing HIV prevalence among males who possess intercourse with males in Nigeria: a trend analysis
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Guys who possess intercourse with guys (MSM) are conservatively approximated to be not as much as 1% associated with Nigerian population yet nationally account fully for about 20per cent of brand 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 integrated biological and behavioral surveillance survey (2007, 2010 and 2014) and covered three states in 2007, six states this season and eight states in 2014. Each round utilized similar methodology and therefore permits contrast. Behavioral information were acquired utilizing an organized pre-coded questionnaire. Variations in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to spot factors related to HIV.
An overall total of 879, 1545 and 3611 MSM were recruited in 2007, 2010 and 2014 correspondingly. Median age had been 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 season 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 intercourse with guys (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge opportunities in international HIV and expanded antiretroviral treatment (ART) programs which have led to 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 countries declare that the HIV epidemic among gay, bisexual along with other males that have intercourse with males are on a markedly different and increasing trajectory 1,2,3. In america, brand new HIV infections among MSM happens to be projected 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 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 centered on specific 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 within the index partner 1. Nonetheless, specific degree danger facets alone, have now been been shown to be inadequate to spell out 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 example biological, couple-network degree, community-level and structural motorists have now been founded become relevant in knowing the persistent transmission that is high among MSM particularly in the clear presence of increased ART protection whereby brand brand new infections should decrease because of reduced odds of transmission because of the aftereffect of ART on viral load 2, 10, 11.
MSM in Nigeria are conservatively approximated 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 the past few years with all 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 prevention, therapy, 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 finite quantity of states in Nigeria. This is certainly mainly as a result of limited information regarding the size estimate of MSM across states along with restricted capital for key population devoted programs. Information on MSM are mainly from three rounds of this Integrated that is population-based Biological 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 research is going to be utilized by policy manufacturer and system supervisors for evidence-based choice making for HIV prevention among MSM in Nigeria.
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. Hawaii selection ensured that five associated with six geopolitical areas in Nigeria were represented into 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 recruitment and design
Each round of this 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 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 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 oral and/or anal intimate experience of another guy into the six 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 to the research. 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 prevent an over-representation of MSM with similar attributes, vouchers limited by three per recruit was used 23, 24. In addition, in order to prevent perform enrollment, only 1 screener ended up being utilized, just one individual had been approved to reimburse MSM that has successfully recruited their peers and just one location ended up being used. Each voucher ended up being yielded and redeemable N500 approx. $3 USD as a incentive for participating, with one more N500 directed at a recruit for every effective participant that is additional. Total settlement ended up being restricted to a maximum settlement of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being approximated centered 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 approximated to identify a 10% vary from the subsequent round.
Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, style of intercourse lovers and intimate danger habits. Interviews had been carried out in MSM friendly businesses identified in each one of the research states. Transactional sex ended up being examined both with feminine and partners that are male. Sort of anal sex practiced had been classified as “insertive penile sex” or “receptive penile intercourse” in past times a few months. HIV danger perception ended up being examined by asking MSM have a glimpse at the hyperlink 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 sex that is non-transactional 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 6 months? ” while condom usage at last intercourse ended up being evaluated because of the concern “the last time you’d rectal intercourse did you or your partner make use of condom? ”. Transactional sex had been evaluated by asking “have you received gift or money in return for intercourse within the last few a few months? ” Written consent had been acquired from all individuals both for behavioural and biological aspects of the study.
Detection of HIV during all of the studies ended up being regularly carried out by fast test making use of blood that is whole acquired from the little finger prick. On the basis of 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 was verified by using Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).