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Background

Guys who possess intercourse with males (MSM) are conservatively calculated to be not as much as 1% for the Nigerian population yet nationally account fully for about 20% of brand new HIV disease. We estimated the trend in HIV prevalence and determined correlates of HIV illness 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 similar methodology and hence permits contrast. Behavioral information were acquired making use of a structured 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.

An overall total of 879, 1545 and 3611 MSM had been recruited in 2007, 2010 and 2014 correspondingly. Median age was 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 with transactional intercourse. HIV prevalence increased from 14% in 2007 to 17per cent in 2010 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 international HIV and expanded antiretroviral treatment (ART) programs which have led to significant decreases in HIV among other sub-populations (basic populace, feminine intercourse employees), HIV among MSM has remained on a sustained increase globally 1, 3. In high earnings nations, the trend of HIV epidemic was for a decrease except among MSM 1. Similarly, available information on HIV incidence and prevalence from low and middle-income nations claim that the HIV epidemic among gay, bisexual along with other men that have intercourse with guys are for a markedly different and increasing trajectory 1,2,3. In america, new HIV infections among MSM was calculated to be increasing at 8% per annum 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 studies that are cohort 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.

Most studies of HIV purchase and transmission among MSM have mostly centered on specific level risk facets www.myukrainianbrides.org/latin-brides including unprotected anal that is receptive, lot of lifetime male partners, inserting and non-injecting medication usage and high viral load into the index partner 1. But, specific degree risk facets alone, have already been been shown to be insufficient to describe the high transmission characteristics of HIV among MSM therefore the divergence of MSM epidemics when comparing to HIV epidemics various other populations 1, 2. Other danger factors such as for instance biological, couple-network degree, community-level and structural motorists have already been founded 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 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 calculated to be not as much as 1% associated with the 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 the past few years because of the passage through of the Same-Sex Marriage Prohibition law of 2014 13,14,15,16,17. The brand new legislation included clauses that prohibited businesses from providing 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 restrict the coverage that is poor of avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Extremely few HIV that is MSM-targeted prevention therapy and care services occur in a restricted number of states in Nigeria. This might be mainly as a result of restricted 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 associated with 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 will likely be utilized 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 contained in 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 of this six zones that are geopolitical Nigeria had been represented within 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 towards the research.

Sampling design and recruitment

Each round of this IBBSS utilized respondent sampling that is driven to your concealed nature of MSM and so enables contrast between and across rounds. Respondent driven sampling (RDS) happens to be described at length in past studies 22, 23. Shortly, 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 ended up being male aged 16 years and above with a brief history of dental and/or anal sexual connection with another guy within the a few 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 in to the research. Ten seeds had been selected for every circular and seeds were 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 utilized 23, 24. In addition, in order to avoid perform enrollment, only 1 screener ended up being utilized, only 1 individual ended up being authorized to reimburse MSM that has effectively recruited his peers and just one location had been utilized. Each voucher ended up being redeemable and yielded N500 approx. $3 USD as a motivation for participating, with an extra N500 directed at a recruit for every single effective extra participant. Total payment had been restricted to a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS had been believed predicated on a thought HIV prevalence of 15%, a design effectation of 2.0 and standard of precision of 0.05. When it comes to 2010 and 2014 IBBSS, test size was approximated to identify a 10% vary from the subsequent round.

Information collection

Structured close-ended interviewer administered questionnaires elicited information about socio-demographic faculties, style of intercourse lovers and intimate danger actions. Interviews were conducted in MSM friendly companies identified in all the research states. Transactional sex ended up being assessed both with feminine and male lovers. Kind of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or “receptive penile intercourse” into the past a few months. HIV danger perception ended up being evaluated 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 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 sex within the last 6 months? ” while condom usage at final intercourse had been examined by the concern “the last time you had rectal intercourse did you or your partner make use of a condom? ”. Transactional sex ended up being evaluated by asking “have you received gift or money in return for intercourse in the final six months? ” Penned consent had been acquired from all individuals for both behavioural and biological the different parts of the study.

Laboratory testing

Detection of HIV during most of the studies had been regularly carried out by fast test making use of blood that is whole obtained from the little finger prick. In line with the nationwide HIV screening guideline, 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, ny, United States Of America).