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

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Background

Guys that have intercourse with males (MSM) are conservatively predicted to be not as much as 1% of this 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 survey (2007, 2010 and 2014) and covered three states in 2007, six states this season and eight states in 2014. Each round utilized methodology that is similar therefore enables contrast. Behavioral information were acquired utilizing an organized questionnaire that is pre-coded. Variations in categorical variables had been examined with Chi Square. Logistic regression had been utilized to spot facets connected with 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 season. 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 17per cent this season to 23per cent in 2014 (p

Background

Globally, males that have intercourse 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 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 declare that the HIV epidemic among gay, bisexual along with other males that have intercourse with guys are for a markedly different and trajectory 1,2,3 that is increasing. In the united states, new HIV infections among MSM happens to be predicted to be increasing at 8% per year since 2001 1. Within the Amsterdam Cohort research among MSM, HIV acquisition 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 carried out 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 largely dedicated to specific level risk facets including unprotected receptive anal sex, lot of lifetime male lovers, inserting and non-injecting medication usage and high viral load within the index partner 1. Nevertheless, specific degree risk facets alone, have now been proved to be inadequate to describe the high transmission characteristics of HIV among MSM and also the divergence of MSM epidemics compared to HIV epidemics various 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 pertinent in comprehending the persistent high transmission prices among MSM particularly in the current presence of increased ART protection whereby brand new infections should decrease due to reduced probability of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively approximated 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 past few years because of 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 services 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 poor protection of HIV prevention, 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 finite wide range of states in Nigeria. This really is mainly due to limited information regarding the size estimate of MSM across states in addition to limited capital for key population devoted programs. Information on MSM are mostly from three rounds regarding 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 figure out correlates of HIV among MSM in Nigeria. Proof using this scholarly research will likely be employed by policy manufacturer and system supervisors for evidence-based decision making for HIV prevention among MSM in Nigeria.

Study sites

In 2007, just three states – Lagos, Kano and Cross River, had been contained in the IBBSS. This season, following increased understanding of the share of MSM towards the HIV epidemic, an extra three states had been contained in the IBBSS – the Federal Capital Territory (FCT), Kaduna and Oyo, while in 2014, Enugu and streams states had been included with the six states within the 2010 IBBSS. Hawaii selection ensured that five for the six geopolitical areas in Nigeria had been represented when you look at the study. Therefore, the the west (Lagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed towards the research.

Sampling recruitment and design

Each round regarding the IBBSS used respondent driven sampling provided towards the concealed nature of MSM and so enables contrast between and across rounds. Respondent driven sampling (RDS) was described at length 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 utilizing 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 contact that is sexual another guy within the six months ahead of the study. Known MSM, designated as “seeds” began the chain of this referral use and network vouchers to recruit their peers in to the research. Ten seeds had been chosen for every circular and seeds had been diversified by age, academic status and status that is https://www.bestrussianbrides.org/latin-brides socioeconomic. To prevent an over-representation of MSM with comparable attributes, vouchers limited by three per recruit was utilized 23, 24. In addition, to prevent perform enrollment, only 1 screener ended up being utilized, only 1 individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location had been used. Each voucher ended up being redeemable and yielded N500 approx. $3 USD being a motivation for participating, with one more N500 directed at a recruit for every single effective participant that is additional. Total payment had been limited by a compensation that is maximum of approximately $12 USD. Test size when it comes to 2007 IBBSS had been projected predicated on 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 ended up being projected to identify a 10% vary from the round that is subsequent.

Information collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, form of intercourse lovers and sexual danger actions. Interviews had been carried out in MSM organizations that are friendly in each one of the research states. Transactional sex had been examined both with feminine and male lovers. Sort of rectal intercourse practiced had been classified as “insertive penile intercourse” or “receptive penile sex” in past times a few months. HIV danger perception ended up being examined by asking MSM you are at risk of infection with HIV? ” with response options being “yes or no”“do you feel. Consistent condom use with intimate partners during transactional and sex that is non-transactional evaluated by asking the concerns “how often did you or your male partner make use of a condom each time you had intercourse within the last few 6 months? ” while condom use at final intercourse had been evaluated by the concern “the last time you’d anal intercourse do you or your partner work with a condom? ”. Transactional sex ended up being examined by asking “have you received cash or present in exchange for intercourse within the last few a few months? ” Penned permission had been obtained from all individuals for both behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during most of the studies had been regularly carried out by fast test utilizing whole bloodstream samples acquired from the little finger prick. In line with the HIV that is national testing, a synchronous algorithm of Determine (Alere healthcare, USA) and Unigold (Trinity Biotech, Plc, Bray, Ireland) had been utilized to spot HIV sero-positivity while status of discordant tests had been verified by using Stat Pak (Chembio Diagnostic Systems, ny, United States Of America).