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Background

Guys who possess intercourse with guys (MSM) are conservatively believed to be not as much as 1% associated with population that is nigerian 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 season and eight states in 2014. Each round utilized methodology that is similar hence enables contrast. Behavioral information were acquired utilizing an organized pre-coded questionnaire. Variations in categorical factors had been examined with Chi Square. Logistic regression had been utilized to recognize facets related to HIV.

A complete 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 whilst it was 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 17per cent this season to 23per cent in 2014 (p

Background

Globally, males who possess intercourse with males (MSM) remain disproportionately infected and affected by HIV latin brides 1, 2. Despite huge opportunities in worldwide 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 on 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 as well as other males that have intercourse with males are on a markedly different and increasing trajectory 1,2,3. In america, brand brand brand new HIV infections among MSM was calculated to be increasing at 8% per year 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 during 2009 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.

Many studies of HIV purchase and transmission among MSM have actually mostly centered on individual degree risk facets including unprotected anal that is receptive, lot of lifetime male lovers, inserting and non-injecting medication usage and high viral load into the index partner 1. But, specific degree danger facets alone, have now been proved to be inadequate to spell out the high transmission characteristics of HIV among MSM and also the divergence of MSM epidemics compared to HIV epidemics in other populations 1, 2. Other danger factors such as for example biological, couple-network degree, community-level and structural motorists have now been established become pertinent in comprehending the persistent transmission that is high among MSM specially in the clear presence of increased ART protection whereby brand brand new infections should decrease as a consequence of reduced probability of transmission due to the effectation of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively predicted to be significantly less than 1% associated with Nigerian population yet nationally account fully for about 20per cent of brand new HIV infections 12. MSM are criminalized and stigmatized and this has further worsened in modern times because of 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 gay individuals, thus further criminalizing same-sex activities 12. Research reports have shown why these restrictive policies further restrict the coverage that is poor of avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few HIV that is MSM-targeted prevention therapy and care services occur in a finite wide range of states in Nigeria. This really is mainly due to restricted information in the size estimate of MSM across states along with restricted money for key population devoted programs. Information on MSM are mostly from three rounds for the Integrated that is population-based Biological Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to assess the improvement in HIV prevalence and figure out correlates of HIV among MSM in Nigeria. Proof using this scholarly research will soon be utilized by policy manufacturer and system managers 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 of this six zones that are geopolitical Nigeria had been represented when you look at the study. Hence, the west that is southLagos and Oyo), south east (Enugu), south south (streams), north central (FCT) and north west areas (Kano and Kaduna) contributed to your 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) is described in more detail in previous 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 had been male aged 16 years and above with a brief history of dental and/or anal sexual experience of another guy into the six months before the study. Known MSM, designated as “seeds” began the chain associated with recommendation use and network vouchers to recruit their peers to the research. Ten seeds were chosen for every circular and seeds were diversified by age, academic status and socioeconomic status. To prevent an over-representation of MSM with similar characteristics, vouchers limited by three per recruit was utilized 23, 24. In addition, in order 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 utilized. Each voucher had been yielded and redeemable N500 approx. $3 USD as a motivation for participating, with an extra N500 directed at a recruit for every effective participant that is additional. Total settlement had been restricted to a maximum settlement of n2000 approximately $12 USD. Test size when it comes to 2007 IBBSS ended up being projected according to a thought HIV prevalence of 15%, a design effectation of 2.0 and degree of accuracy of 0.05. When it comes to 2010 and 2014 IBBSS, test size had been approximated to identify a 10% vary from the subsequent round.

Information collection

Structured close-ended interviewer administered questionnaires elicited information on socio-demographic traits, kind of intercourse lovers and intimate risk actions. Interviews had been carried out in MSM organizations that are friendly in all the research states. Transactional sex ended up being evaluated both with female and male partners. Variety of rectal intercourse practiced ended up being classified as “insertive penile sex” or “receptive penile intercourse” into the past a few months. HIV danger perception had been evaluated by asking MSM “do you feel you may be susceptible 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 evaluated by asking the concerns “how frequently did you or your male partner work with a condom each time you had intercourse within the last few 6 months? ” while condom usage at final intercourse had been examined by the concern “the last time you’d rectal intercourse do you or your partner make use of condom? ”. Transactional sex ended up being examined by asking “have you received cash or present in return for intercourse in the last six months? ” Penned consent had been acquired from all individuals for both behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during most of the studies ended up being regularly carried out by fast test making use of blood that is whole acquired from the hand prick. In line with the HIV that is national testing, a synchronous algorithm of Determine (Alere healthcare, United States Of America) 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 by using Stat Pak (Chembio Diagnostic Systems, ny, USA).