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Background
Guys that have intercourse with males (MSM) are conservatively projected to be not as much as 1% of this 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 utilized methodology that is similar hence allows for comparison. Behavioral information were acquired utilizing an organized questionnaire that is pre-coded. Variations in categorical variables had been evaluated with Chi Square. Logistic regression had been used 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 had been 24 years this year. 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 17percent this year to 23per cent in 2014 (p
Background
Globally, males who possess 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 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. In high earnings nations, the trend of HIV epidemic was for a decrease except among MSM 1. 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 guys are for a markedly different and trajectory 1,2,3 that is increasing. In the united states, brand brand new HIV infections among MSM was calculated to be increasing at 8% per year since 2001 1. Into 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 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 individual degree risk factors including unprotected receptive anal sex, large number of lifetime male lovers, inserting and non-injecting medication usage and high viral load when you look at the index partner 1. Nonetheless, specific degree danger factors alone, have now been shown to be inadequate to describe the high transmission characteristics of HIV among MSM and also the divergence of MSM epidemics in comparison to HIV epidemics in other populations 1, 2. Other danger facets such as for example biological, couple-network degree, community-level and structural drivers have already been established become relevant in comprehending the persistent high transmission prices among MSM particularly in the current presence of increased ART protection whereby brand brand new infections should decrease because of reduced probability of transmission due to the aftereffect of ART on viral load 2, 10, 11.
MSM in Nigeria are conservatively believed to be significantly less than 1% associated with population that is nigerian nationally account for about 20per cent of brand new HIV infections 12. MSM are criminalized and stigmatized and also this has further worsened in modern times utilizing 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 indicates why these restrictive policies further limit the coverage that is poor of avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few MSM-targeted HIV avoidance, therapy and care services occur in a finite wide range of states in Nigeria. This really is chiefly as a result of restricted information in the size estimate of MSM across states along with restricted financing for key population devoted programs. Information on MSM are mostly from three rounds of this population-based Integrated Biological and Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to evaluate the noticeable change in HIV prevalence and discover correlates of HIV among MSM in Nigeria. Proof using this scholarly study may be employed 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 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 associated with six zones that are geopolitical Nigeria were represented when you look at 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 regarding the IBBSS utilized respondent sampling that is driven into the hidden nature of MSM and so permits comparison between and across rounds. Respondent sampling that is drivenRDS) happens to be described at length in past studies 22, 23. Shortly, 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 history of dental and/or anal intimate connection with another guy into the half a year ahead of the study. Known MSM, designated as “seeds” began the chain for the recommendation community and make use of 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 avoid an over-representation of MSM with comparable characteristics, vouchers limited by three per recruit was used 23, 24. In addition, to prevent perform enrollment, just one screener had been utilized, just one individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location was utilized. Each voucher had been redeemable and yielded N500 approx. $3 USD as a motivation for participating, with one more N500 directed at a recruit for every effective extra participant. Total settlement ended up being limited by a maximum settlement of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being projected according to an assumed HIV prevalence of 15%, a design aftereffect of 2.0 and latin mail bride degree of precision of 0.05. For the 2010 and 2014 IBBSS, sample size ended up being projected to detect a 10% differ from the round that is subsequent.
Information collection
Structured interviewer that is close-ended questionnaires elicited information on socio-demographic faculties, sort of sex lovers and intimate danger behaviors. Interviews had been carried out in MSM organizations that are friendly in all the research states. Transactional sex ended up being examined both with feminine and male lovers. Variety of rectal intercourse practiced had been classified as “insertive penile intercourse” or “receptive penile intercourse” within the past 6 months. HIV danger perception had been examined by asking MSM “do you are feeling you may be vulnerable to illness with HIV? ” with reaction choices being “yes or no”. Consistent condom use with intimate partners during transactional and non-transactional intercourse had been examined by asking the questions “how frequently did you or your male partner make use of condom each time you had sex within the last 6 months? ” while condom use at final intercourse ended up being evaluated because of the question “the last time you’d anal intercourse did you or your partner make use of condom? ”. Transactional sex had been evaluated by asking “have you received cash or present in return for intercourse within the last six months? ” Written permission 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. 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 had been verified if you use Stat Pak (Chembio Diagnostic techniques, ny, USA).
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