Increasing HIV prevalence among males that have intercourse with males in Nigeria: a trend analysis
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Background
Guys who possess intercourse with guys (MSM) are conservatively projected to be not as much as 1% for the 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 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 therefore permits contrast. Behavioral information were acquired utilizing an organized questionnaire that is pre-coded. Variations in categorical factors had been examined with Chi Square. Logistic regression ended up being utilized to determine facets related to HIV.
A complete of 879, 1545 and 3611 MSM were 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 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 17percent this season to 23per cent in 2014 (p
Background
Globally, males who possess intercourse with guys (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge assets in worldwide HIV and expanded antiretroviral treatment (ART) programs which have triggered significant declines in HIV among other sub-populations (basic population, feminine intercourse workers), 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 data on HIV incidence and prevalence from low and middle-income nations claim that the HIV epidemic among gay, bisexual as well as other males who possess intercourse with males are on a markedly different and increasing trajectory 1,2,3. In america, new HIV infections among MSM happens to be predicted to be increasing at 8% per year since 2001 1. When you look at 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 studies that are cohort 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 centered on specific degree risk facets including unprotected anal that is receptive, large number of lifetime male partners, injecting and non-injecting medication usage and high viral load when you look at the index partner 1. Nonetheless, specific degree danger facets alone, have already been proved to be inadequate to spell out the high transmission characteristics of HIV among MSM therefore 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 pertinent in understanding the persistent high transmission prices among MSM particularly in the current presence of increased ART protection whereby brand brand new infections should decrease as a consequence of reduced odds of transmission due to the effectation of ART on viral load 2, 10, 11.
MSM in Nigeria are conservatively approximated to be lower than 1% of this Nigerian population yet nationally account 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 through of the Marriage that is same-Sex Prohibition of 2014 13,14,15,16,17. The brand new law included 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 that these restrictive policies further restrict the poor protection of HIV avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Extremely few HIV that is MSM-targeted prevention therapy and care solutions exist in a small wide range of states in Nigeria. This might be mainly due to restricted information regarding the size estimate of MSM across states along with restricted money for key population committed 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 study aimed to evaluate the noticeable improvement in HIV prevalence and figure out correlates of HIV among MSM in Nigeria. Proof with this scholarly research is going to be utilized by policy manufacturer and program 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, were within the IBBSS. This hot latin brides year, after increased knowing of the share of MSM towards the HIV epidemic, yet another 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 within the 2010 IBBSS. The state selection ensured that five of this six geopolitical zones in Nigeria had been represented when you look at the study. Therefore, the west that is southLagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west zones (Kano and Kaduna) contributed to your research.
Sampling design and recruitment
Each round associated with IBBSS utilized respondent driven sampling given into the concealed nature of MSM and therefore enables contrast between and across rounds. Respondent driven sampling (RDS) happens to be described in detail 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 utilizing 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 within 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 socioeconomic status. In order to prevent an over-representation of MSM with comparable characteristics, vouchers limited by three per recruit was used 23, 24. In addition, to prevent perform enrollment, only 1 screener had been utilized, only 1 individual ended up being authorized to reimburse MSM who had effectively recruited their peers and just one location ended up being utilized. Each voucher ended up being yielded and redeemable N500 approx. $3 USD being a motivation for participating, with an extra N500 provided to a recruit for every effective additional participant. Total settlement ended up being restricted to a maximum settlement of n2000 approximately $12 USD. Test size for the 2007 IBBSS ended up being predicted centered on a thought HIV prevalence of 15%, a design aftereffect of 2.0 and standard of precision of 0.05. For the 2010 and 2014 IBBSS, test size had been 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 traits, variety of intercourse lovers and intimate danger actions. Interviews had been conducted 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. Sort of rectal intercourse practiced had been classified as “insertive penile intercourse” or “receptive penile intercourse” into the past a few months. HIV danger perception had been evaluated by asking MSM “do you’re feeling you may be prone to disease with HIV? ” with reaction choices being “yes or no”. Consistent condom use with intimate lovers during transactional and non-transactional intercourse ended up being evaluated by asking the concerns “how often did you or your male partner make use of condom each time you had sex within the last few 6 months? ” while condom usage at final intercourse ended up being evaluated because of the concern “the last time you’d rectal intercourse did you or your partner work with a condom? ”. Transactional sex ended up being evaluated by asking “have you received money or present in return for intercourse within the last few 6 months? ” Penned permission had been acquired from all individuals for both behavioural and biological the different parts of the study.
Laboratory testing
Detection of HIV during all of the studies had been regularly carried out by fast test utilizing blood that is whole acquired from the little finger prick. On the basis of the HIV that is national testing, a synchronous algorithm of Determine (Alere healthcare, USA) and Unigold (Trinity Biotech, Plc, Bray, Ireland) ended up being utilized to determine 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).