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Background
Guys that have intercourse with guys (MSM) are conservatively calculated to be lower than 1% associated with the Nigerian population yet nationally account 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 study (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 hence permits contrast. Behavioral information were acquired utilizing a structured pre-coded questionnaire. Variations in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to spot facets related to HIV.
A complete of 879, 1545 and 3611 MSM were recruited in 2007, 2010 and 2014 correspondingly. Median age was 22 years for 2007 and 2014 whilst 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 17% this season to 23per cent in 2014 (p
Background
Globally, males that have intercourse with guys (MSM) remain disproportionately infected and affected by HIV 1, 2. Despite huge assets in worldwide HIV and expanded treatment that is antiretroviralART) programs which have led to significant declines in HIV among other sub-populations (basic populace, female 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 claim that the HIV epidemic among gay, bisexual as well as other men who possess intercourse with guys are on a markedly different and increasing trajectory 1,2,3. In the united states, brand brand brand new HIV infections among MSM is approximated 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 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 mostly dedicated to specific degree risk facets including unprotected receptive rectal intercourse, large number of lifetime male lovers, inserting and non-injecting medication usage and high viral load within the index partner 1. Nevertheless, specific degree danger facets alone, have now been been shown to be inadequate to spell out the high transmission characteristics of HIV among MSM and also the divergence of MSM epidemics in comparison to HIV epidemics various 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 high transmission prices among MSM especially in the current presence of increased ART protection whereby brand brand 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 approximated to be not as much as 1% regarding the 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 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 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 restrict the poor protection of HIV prevention, therapy, and care programs among MSM 12, 18,19,20,21. Extremely few MSM-targeted HIV avoidance, therapy and care solutions occur in a finite number of states in Nigeria. It is mainly due to restricted information on the size estimate of MSM across states along with restricted money for key population committed 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 scholarly research is likely to 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 hot latin brides com. 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 geopolitical areas in Nigeria had been represented within the study. Hence, the west that is southLagos and Oyo), south east (Enugu), south south (Rivers), north central (FCT) and north west zones (Kano and Kaduna) contributed into the research.
Sampling design and recruitment
Each round of this IBBSS used respondent sampling that is driven to your concealed nature of MSM and therefore permits contrast between and across rounds. Respondent sampling that is drivenRDS) happens to be described at length in past studies 22, 23. Quickly, RDS is really a modified chain referral sampling that is non-random of recruitment that adjusts for the non-randomness making use of a mathematical model that weights each sample recruited 23. Inclusion criteria ended up being male aged 16 years and above with a brief history of oral and/or anal intimate connection with another man when you look at the half a year ahead of the study. Known MSM, designated as “seeds” began the chain associated with the recommendation 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 socioeconomic status. 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 ended up being utilized, just one individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location ended up being used. Each voucher had been yielded and redeemable N500 approx. $3 USD as a motivation for participating, with an extra N500 provided to a recruit for every effective extra participant. Total payment had been limited by a maximum settlement of n2000 approximately $12 USD. Test size when it comes to 2007 IBBSS had been calculated according to an thought HIV prevalence of 15%, a design aftereffect of 2.0 and degree of accuracy of 0.05. For the 2010 and 2014 IBBSS, test size ended up being approximated to identify a 10% vary from the round that is subsequent.
Data collection
Structured close-ended interviewer administered questionnaires elicited information about socio-demographic traits, sort of intercourse partners and intimate danger habits. Interviews had been carried out in MSM friendly companies identified in each one of the research states. Transactional sex had been examined both with feminine and male lovers. Kind of rectal intercourse practiced had been categorized as “insertive penile sex” or penile that is“receptive” within the past a few months. HIV danger perception had been examined 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 sex that is non-transactional examined by asking the concerns “how frequently did you or your male partner make use of a condom each time you had intercourse within the last few 6 months? ” while condom usage at final intercourse ended up being examined by the question “the last time you had anal intercourse do you or your partner work with a condom? ”. Transactional sex had been examined by asking “have you received gift or money in return for intercourse within the last six months? ” Penned permission ended up being acquired from all individuals for both behavioural and biological aspects of the study.
Laboratory testing
Detection of HIV during all of the studies ended up being regularly carried out by quick test making use of blood that is whole acquired from a hand prick. On the basis of the HIV that is national testing, a synchronous algorithm of Determine (Alere health, USA) and Unigold (Trinity Biotech, Plc, Bray, Ireland) ended up being utilized to recognize HIV sero-positivity while status of discordant tests had been verified by using Stat Pak (Chembio Diagnostic techniques, New York, United States Of America).