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Rising HIV prevalence among males who possess intercourse with guys in Nigeria: a trend analysis

17 Mar

Rising HIV prevalence among males who possess intercourse with guys in Nigeria: a trend analysis

Rising HIV prevalence among males who possess intercourse with guys in Nigeria: a trend analysis

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Background

Men who possess intercourse with men (MSM) are conservatively predicted to be significantly less than 1% regarding the Nigerian population yet 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 year and eight states in 2014. Each round used similar methodology and therefore permits contrast. Behavioral information were acquired making use of an organized pre-coded questionnaire. Variations in categorical factors had been examined with Chi Square. Logistic regression ended up being utilized to determine facets 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 ended up being 24 years this year. 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 year to 23per cent in 2014 (p

Background

Globally, males that have sex with males (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge assets in international HIV and expanded treatment that is antiretroviralART) programs which have lead to significant declines in HIV among other sub-populations (basic populace, feminine intercourse employees), HIV among MSM has remained for a sustained increase globally 1, 3. In high earnings nations, the trend of HIV epidemic has been for a decline except among MSM 1. Likewise, available information 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 possess intercourse with guys are for a markedly different and trajectory 1,2,3 that is increasing. In america, brand new HIV infections among MSM happens to be believed 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 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 mostly centered on specific degree risk facets including unprotected receptive rectal intercourse, large number of lifetime male lovers, inserting and non-injecting drug usage and high viral load within the index partner 1. Nevertheless, individual degree danger facets alone, have now been proved to be inadequate to spell out the high transmission characteristics of HIV among MSM as well as the divergence of MSM epidemics in comparison with 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 knowing the persistent transmission that is high among MSM particularly in the current presence of increased ART protection whereby brand brand brand hot latin brides 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 projected to be lower than 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 last few years with all 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 businesses from supplying solutions to MSM and facilitation of meetings that support homosexual individuals, thus further criminalizing same-sex activities 12. Research reports have shown why these restrictive policies further limit the poor coverage of HIV avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few MSM-targeted HIV avoidance, therapy and care solutions occur in a restricted amount of states in Nigeria. This will be mainly due to limited information regarding the size estimate of MSM across states in addition to restricted capital for key population dedicated programs. Information on MSM are mainly 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 noticeable improvement in HIV prevalence and discover correlates of HIV among MSM in Nigeria. Proof using this scholarly research should be employed by policy manufacturer and system supervisors for evidence-based choice making for HIV prevention among MSM in Nigeria.

Study sites

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. Hawaii selection ensured that five of this six geopolitical areas in Nigeria had been represented within the study. Hence, 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 sampling that is driven into the concealed nature of MSM and so permits contrast between and across rounds. Respondent sampling that is drivenRDS) is described at length in past studies 22, 23. Fleetingly, 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 was male aged 16 years and above with a brief history of dental and/or anal intimate connection with another man within the six months before the study. Known MSM, designated as “seeds” began the chain associated with recommendation network and make use of vouchers to recruit their peers in to the research. Ten seeds had been chosen for every circular and seeds had been diversified by age, educational 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, to prevent repeat enrollment, just one screener had been utilized, only 1 individual had been approved to reimburse MSM that has effectively recruited their peers and only one location ended up being utilized. Each voucher ended up being redeemable and yielded N500 approx. $3 USD as a motivation for participating, with an extra N500 provided to a recruit for every effective participant that is additional. Total settlement ended up being limited by a compensation that is maximum of approximately $12 USD. Sample size when it comes to 2007 IBBSS was calculated centered on an thought HIV prevalence of 15%, a design aftereffect of 2.0 and standard of accuracy of 0.05. For the 2010 and 2014 IBBSS, test size ended up being believed to identify a 10% vary from the round that is subsequent.

Information collection

Structured interviewer that is close-ended questionnaires elicited information on socio-demographic traits, form of intercourse lovers and intimate danger actions. Interviews had been carried out in MSM friendly companies identified in all the research states. Transactional sex ended up being examined both with feminine and partners that are male. Variety of rectal intercourse practiced had been classified as “insertive penile intercourse” or “receptive penile intercourse” in past times a few months. HIV danger perception had been examined by asking MSM “do you’re feeling you might be susceptible 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 make use of condom each time you had intercourse within the last 6 months? ” while condom usage at final intercourse had been examined by the concern “the last time you’d rectal intercourse did you or your partner work with a condom? ”. Transactional sex had been examined by asking “have you received cash or present in return for intercourse within the last six months? ” Written consent had been acquired from all individuals for both behavioural and biological aspects of the survey.

Laboratory testing

Detection of HIV during all of the studies ended up being regularly carried out by fast test utilizing blood that is whole acquired from the hand prick. On the basis of the HIV that is national testing, a parallel algorithm of Determine (Alere healthcare, United States Of America) and Unigold (Trinity Biotech, Plc, Bray, Ireland) had been utilized to spot HIV sero-positivity while status of discordant tests ended up being verified by using Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).

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