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Background

Guys that have intercourse with males (MSM) are conservatively approximated to be lower than 1% for the 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 survey (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 therefore permits contrast. Behavioral information were acquired using an organized pre-coded questionnaire. Variations in categorical factors had been evaluated with Chi Square. Logistic regression had been utilized to spot facets connected with 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 although it ended up being 24 years this year. 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’ve intercourse with guys (MSM) remain disproportionately affected and infected by HIV 1, 2. Despite huge opportunities in worldwide HIV and expanded treatment that is antiretroviralART) programs which have triggered significant decreases in HIV among other sub-populations (basic population, feminine intercourse workers), HIV among MSM has remained on a sustained increase globally 1, 3. In high earnings nations, the trend of HIV epidemic is on a decrease except among MSM 1. Likewise, available information on HIV incidence and prevalence from low and middle-income countries declare that the HIV epidemic among gay, bisexual along with other males who possess intercourse with guys are on a markedly different and trajectory 1,2,3 that is increasing. In america, brand new HIV infections among MSM happens to be calculated to be increasing at 8% per year since 2001 1. Within the Amsterdam Cohort Study 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 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 receptive rectal intercourse, lot of lifetime male lovers, inserting and non-injecting drug usage and high viral load into the index partner 1. Nevertheless, specific degree risk 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 compared 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 already been founded become relevant 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 due to reduced probability of transmission due to the aftereffect of ART on viral load 2, 10, 11.

MSM in Nigeria are conservatively predicted to be lower than 1% for the Nigerian population yet nationally account for about 20per cent of brand new HIV infections 12. MSM are criminalized and stigmatized and also this link this has further worsened in the last few years because of the passage through 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 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 limit the coverage that is poor of avoidance, therapy, and care programs among MSM 12, 18,19,20,21. Really few MSM-targeted HIV avoidance, therapy and care solutions occur in a finite quantity of states in Nigeria. This will be mainly as a result of limited data from the size estimate of MSM across states in addition to limited capital for key population committed programs. Information on MSM are mainly from three rounds associated with population-based built-in Biological and Behavioural Surveillance Survey (IBBSS) conducted in, 2007, 2010, and 2014. This research aimed to assess the noticeable improvement in HIV prevalence and figure out correlates of HIV among MSM in Nigeria. Proof with this study may 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, were 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 associated with six zones that are geopolitical 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 to your research.

Sampling recruitment and design

Each round associated with IBBSS utilized respondent driven sampling provided to your concealed nature of MSM and therefore permits contrast between and across rounds. Respondent driven sampling (RDS) was described in more detail in previous studies 22, 23. Fleetingly, 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 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 intimate connection with another guy into the six months before the study. Known MSM, designated as “seeds” began the chain of this 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, educational status and socioeconomic status. In order to prevent an over-representation of MSM with comparable attributes, vouchers restricted to three per recruit was utilized 23, 24. In addition, to prevent perform enrollment, just one screener ended up being used, only 1 individual had been authorized to reimburse MSM that has effectively recruited their peers and just one location ended up being used. Each voucher was yielded and redeemable N500 approx. $3 USD being a motivation for participating, with an extra N500 directed at a recruit for every single effective participant that is additional. Total payment had been restricted to a maximum payment of n2000 approximately $12 USD. Test size for the 2007 IBBSS was projected centered on a 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 calculated to identify a 10% vary from the subsequent round.

Data collection

Structured close-ended interviewer administered questionnaires elicited information about socio-demographic traits, sort of intercourse lovers and intimate danger habits. Interviews had been carried out in MSM organizations that are friendly in each one of the research states. Transactional sex had been evaluated both with feminine and male lovers. Kind of rectal intercourse practiced ended up being classified as “insertive penile intercourse” or “receptive penile intercourse” in past times a few months. HIV danger perception had been examined by asking MSM “do you’re feeling you will be vulnerable to illness with HIV? ” with reaction options being “yes or no”. Consistent condom use with intimate lovers during transactional and non-transactional sex had been 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 6 months? ” while condom usage at final intercourse had been evaluated because of the concern “the last time you’d rectal intercourse did 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 a few months? ” Penned consent ended up being acquired from all individuals both for behavioural and biological aspects of the study.

Laboratory testing

Detection of HIV during all of the studies had been regularly carried out by rapid test utilizing blood that is whole acquired from a little finger prick. On the basis of the HIV that is national testing, a synchronous algorithm of Determine (Alere health, 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 had been verified by using Stat Pak (Chembio Diagnostic techniques, ny, United States Of America).