[show abstract][hide abstract] ABSTRACT: Face-to-face (FTF) interviews are the most frequently used means of obtaining information on sexual and drug injecting behaviours from men who have sex with men (MSM) and men who inject drugs (MWID). However, accurate information on these behaviours may be difficult to elicit because of sociocultural hostility towards these populations and the criminalization associated with these behaviours. Audio computer assisted self-interview (ACASI) is an interviewing technique that may mitigate social desirability bias in this context.
This study evaluated differences in the reporting of HIV-related risky behaviours by MSM and MWID using ACASI and FTF interviews. Between August and September 2010, 712 MSM and 328 MWID in Nigeria were randomized to either ACASI or FTF interview for completion of a behavioural survey that included questions on sensitive sexual and injecting risk behaviours. Data were analyzed separately for MSM and MWID. Logistic regression was run for each behaviour as a dependent variable to determine differences in reporting methods.
MSM interviewed via ACASI reported significantly higher risky behaviours with both women (multiple female sexual partners 51% vs. 43%, p = 0.04; had unprotected anal sex with women 72% vs. 57%, p = 0.05) and men (multiple male sex partners 70% vs. 54%, p≤0.001) than through FTF. Additionally, they were more likely to self-identify as homosexual (AOR: 3.3, 95%CI:2.4-4.6) and report drug use in the past 12 months (AOR:40.0, 95%CI: 9.6-166.0). MWID interviewed with ACASI were more likely to report needle sharing (AOR:3.3, 95%CI:1.2-8.9) and re-use (AOR:2.2, 95%CI:1.2-3.9) in the past month and prior HIV testing (AOR:1.6, 95%CI 1.02-2.5).
The feasibility of using ACASI in studies and clinics targeting key populations in Nigeria must be explored to increase the likelihood of obtaining more accurate data on high risk behaviours to inform improved risk reduction strategies that reduce HIV transmission.
PLoS ONE 01/2014; 9(1):e81981. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Estimating the size of populations most affected by HIV such as men who have sex with men (MSM) though crucial for structuring responses to the epidemic presents significant challenges, especially in a developing society. Using capture-recapture methodology, the size of MSM-SW in Nigeria was estimated in three major cities (Lagos, Kano and Port Harcourt) between July and December 2009. Following interviews with key informants, locations and times when MSM-SW were available to male clients were mapped and designated as "hotspots". Counts were conducted on two consecutive weekends. Population estimates were computed using a standardized Lincoln formula. Fifty-six hotspots were identified in Kano, 38 in Lagos and 42 in Port Harcourt. On a given weekend night, Port Harcourt had the largest estimated population of MSM sex workers, 723 (95%CI: 594-892) followed by Lagos state with 620 (95%CI: 517-724) and Kano state with 353 (95%CI: 332-373). This study documents a large population of MSM-SW in 3 Nigerian cities where higher HIV prevalence among MSM compared to the general population has been documented. Research and programming are needed to better understand and address the health vulnerabilities that MSM-SW and their clients face. Afr J Reprod Health 2013 (Special Edition); 17: 83-89). Résumé Estimer la taille des populations les plus touchées par le VIH, comme les hommes ayant des rapports sexuels avec des hommes (HSH) bien que crucial pour la structuration des réponses à l'épidémie, présente des défis importants, surtout dans une société en développement. En utilisant la méthode de capture-recapture, le nombre des prostitués hommes-HSH au Nigeria a été estimé dans trois grandes villes (Lagos, Kano et Port Harcourt) entre juillet et décembre 2009. Grâce à des entretiens avec des informateurs clés, les emplacements et les heures où les hommes prostitués-HSH étaient à la disposition des clients masculins ont été élaborés et désignés comme « points chauds». Des comptages ont été effectués pendant deux week-ends consécutifs. Les estimations de population ont été calculées en utilisant une formule de Lincoln standardisée. Cinquante-six points névralgiques ont été identifiés à Kano, 38 à Lagos et 42 à Port Harcourt. Une nuit d'un week-end donné, Port Harcourt avait la plus grande population estimée des hommes prostitués-HSH, 723 (CI : 594 -892 95 %), suivi de l'Etat de Lagos avec 620 (CI : 517 -724 95%) et l'Etat de Kano avec 353 (95 % CI : 332 -373). Cette étude documente une grande population des hommes prostitués-HSH dans 3 villes nigérianes où la prévalence élevée du VIH parmi les HSH par rapport à la population générale a été documentée. La recherche et la programmation sont nécessaires pour mieux comprendre et aborder les vulnérabilités de la santé auxquelles font face les prostitués-HSH et leurs clients. Afr J Reprod Health 2013 (Edition Spéciale); 17: 83-89). Mots-clés: hommes prostitués, capturer-recapturer, estimation de l'ampleur, estimations de la population, les hommes qui ont des rapports sexuels avec des hommes, Nigeria, Lagos, Kano, Port Harcourt.
African Journal of Reproductive Health 12/2013; 17(4):83-89.
[show abstract][hide abstract] ABSTRACT: There is little research on injecting drug use in Nigeria. We investigated the prevalence of HIV, hepatitis B and C, and sexually transmitted infections (STIs) among male injection drug users (IDUs) in Lagos. Male IDUs (N 328) were recruited through respondent-driven sampling. Participants completed an interview about their sexual and injecting risk behaviours and were tested for hepatitis B surface antigen (HBV), hepatitis C antibody (HCV), HIV and syphilis, as well as genital chlamydia and gonorrhoea infections. Three-quarters of IDUs (74) reported injecting drugs in the past one month although most did not share needles (92) and the majority obtained sterile needles from pharmacists (87). Estimated HBV, HCV, HIV, syphilis, gonorrhoea and chlamydia prevalences were 7.8, 7.7, 0.9, 1.9, 0.0, and 3.7, respectively. The burden of HIV is presently low among IDUs in Lagos. Changes in accessibility to sterile needles at pharmacists would likely have a deleterious effect on IDUs' health. HBV vaccination and HCV prevention programmes for IDUs are urgently needed.
International Journal of STD & AIDS 07/2013; · 1.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background
HIV counseling and testing (HCT) remains the cornerstone of HIV programming and given the reduced donor funds for HIV services, it is imperative to use the most cost effective methods. We evaluated the cost-effectiveness of three HCT strategies for male most-at-risk-population (M-MARPS) in Nigeria.
Three HCT strategies were implemented between July 2009 and July 2012 among men who have sex with men (MSM) and injecting drug users (IDUs). The first strategy (S1) was facility based with community mobilization component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third strategy (S3) involved mobile M-MARPS peers conducting HCT. Cost and output data for HCT services were retrospectively collected from financial and program records. Financial costs of providing HCT were estimated from a health provider perspective and classified as capital or recurrent costs. Variation in duration of each strategy was controlled by using the last six months of each strategy. Effectiveness was measured as the number of HIV positive clients per strategy while Incremental Cost Effective Ratio (ICER) was calculated using S1 as the base model. The strategy with the lowest ICER was considered most cost-effective.
A total of 1,988, 14,726 and 14,895 male MARPs received HCT through the S1, S2 and S3 methods respectively with the proportion of first time testers being 88%, 84% and 90%. HIV prevalence (effectiveness) was 9%, 3%, and 13% respectively. The average cost for delivering HCT per client after controlling for variation in duration was $41 for S1, $9 for S2 and $6 for S3. ICER for S2 and S3 were 204 and 3 respectively.
Peer mediated HIV Counseling and Testing (S3) was the most cost effective method in providing HCT to M-MARPS as well as in reaching first time testers and identifying HIV positive clients. Our study highlights the feasibility of training MARPS in providing HCT services on a large-scale. Engaging members of a target community is essential in optimizing the cost and delivery of HCT to M-MARPs in Nigeria.
[show abstract][hide abstract] ABSTRACT: Background
Some studies have shown that greater perceived vulnerability to HIV is associated with less involvement in risk taking. We evaluated prevalence and correlates of HIV risk perception among men who have sex with men (MSM) in Nigeria.
A cross sectional study using respondent driven sampling (RDS) was conducted in six Nigerian states in 2010. MSM underwent interviewer-administered surveys. HIV risk perception was assessed as a binary outcome with "0/1" assigned to those whose response was "no risk"/"yes, feel at risk" respectively. Weighted HIV risk perception and sexual risk behaviors were calculated using an RDS analytic tool. Logistic regression was used to determine correlates of HIV risk perception, stratified by state.
The total number of MSM ranged from 217 in Abuja to 314 in Cross River state. Median age ranged from 22 years in Cross River state to 26 years in Kano. Less than two-fifths had comprehensive knowledge of HIV. Median age of sexual debut was <18 years except for Kano and Oyo states. HIV risk perception ranged from 10% in Cross River state to 58% in Kaduna state and was 38%, 44%, 19% and 20% in Kano, Lagos, Abuja and Oyo states respectively. HIV risk perception was significantly higher among those who had ever had an HIV test compared to those that had never had an HIV test in Cross River (14% vs.4.1%;p=0.002), FCT (28%vs.14%;p=0.023), Kano (63% vs.11%;p<0.001), Lagos (58% vs.28%;p ≤0.001) and Oyo states (36% vs.13%;p ≤0.001). Factors associated with HIV risk perception include purchasing sex (AOR:3.1, 95% CI:1.00-9.38) and no exposure to peer educator (AOR:0.2, 95% CI:0.04-0.61) in Cross River; no comprehensive knowledge of HIV (AOR:0.22, 95% CI:0.1-0.7) and receptive anal partners (AOR:8.9, 95% CI:2.1-37.8) in Abuja; attaining at least secondary level education in Kano (AOR:4.5, 95% CI:1.8-11.5); no comprehensive HIV knowledge (AOR:2.6, 95% CI:1.0-6.7) in Lagos and selling sex (AOR:4.7, 95% CI:1.4-16.2) in Oyo state.
This study shows that HIV risk perception and comprehensive HIV knowledge are very low among MSM in Nigeria. Heterogeneity in associated factors suggests that targeted interventions are needed to increase HIV risk perception in the different states. The role of HCT in increasing risk perception needs further evaluation.
[show abstract][hide abstract] ABSTRACT: Objective: Injecting drug use is now recognized as a significant risk factor for HIV in sub- Saharan Africa. We evaluated prevalence and correlates of HIV among young (18-24 years) injecting drug users (IDUs) in Nigeria.
Methods: A cross sectional study using respondent driven sampling (RDS) was conducted in five Nigerian states in 2010. Current IDUs underwent interviewer-administered surveys and HIV tests. Logistic regression was used to determine correlates of HIV infection, stratified by state.
Results: Total numbers of IDUs ranged from 43 in Oyo to 84 in Cross River state (CR). Median duration of injecting drug ranged from 2 months in Federal Capital Territory (FCT) to 24 months in Kano. HIV prevalence was highest in Kano (4.8%) and was 2.4% Kaduna, Oyo 4.7%, FCT 2.5% and CR 3.6%. Prevalence of all injecting risk behaviors was highest in FCT, ranging from 22% to 79% for use of prefilled syringe and sharing of needles, respectively. Over 80% of respondents were sexually active but consistent condom use was less than 50% with girlfriends and less than 70% during casual sex. Injecting risk behaviors were not associated with HIV in all states surveyed
Conclusions: Median duration of injecting drugs was 24 months suggesting that majority of the respondents were relatively new injectors. HIV prevalence, though low, was higher than national estimates (4.1%) in Kano and Kaduna. Efforts must be geared towards preventing the initiation of drug use and managing new initiators . Additionally, HIV prevention intervention must focus on both injecting and sexual risk behaviors among youth. Further research is needed to understand the HIV transmission dynamics among young IDUs.
[show abstract][hide abstract] ABSTRACT: Background: Alcohol has been associated with risky sexual behavior. Comprehensive data on the impact of alcohol on risky behaviors among female sex workers in Nigeria is lacking. We estimated frequency of alcohol use and risk behaviors among female sex workers in Nigeria.
Methods: Data on female sex workers were collected from Integrated Biological and Behavioral Surveillance (IBBSS) in 9 cities in Nigeria in 2010 and evaluated in a cross sectional analysis. Chi square tests of comparison for differences between categorical variables and logistic regression analyses were conducted.
Results: Of total of 4,394 FSWs surveyed, 49% were less than 25 years, 8% were currently married and 42% had at least primary level education. Prevalence of alcohol use was 77% with daily use of alcohol at 27%. HIV prevalence was 25% and alcohol use was higher among HIV negative FSWs (27% vs. 24%;p≤0.01). Daily use of alcohol was highest (35%) among those who never used a condom with their boyfriends compared to those who used condoms occasionally (28%) and those who used every time (25%), p≤0.001, however for consistent condom use with clients, daily use of alcohol was highest among those who used a condom every time (29%) compared to occasional condom use (25%) and those who never use a condom (14%; p ≤ 0.01). Daily alcohol consumption was significantly associated with consistent condom use with clients (AOR:1.5, 95%CI:1.15-1.90;p=0.002) and inconsistent condom use condom use with boyfriends.
Conclusion: Daily alcohol use among FSWs is moderate, however its association with inconsistent condom use with boyfriends suggests an urgent need for HIV prevention programs addressing alcohol use both to mitigate the transmission of HIV within FSWs and the general population and also the medical complications of heavy alcohol use. Further research is needed to evaluate drug use and risk behaviors in Nigeria.
[show abstract][hide abstract] ABSTRACT: BACKGROUND:: This study provides population-based estimates of HIV prevalence and factors associated with HIV infection among MSM in three large cities in Nigeria. We aimed to increase the knowledge base of the evolving HIV epidemic among MSM, highlight risk factors that may fuel the epidemic, and inform future HIV prevention packages. METHODS:: A total of 712 MSM, aged 18 and older, living in Abuja, Ibadan and Lagos were recruited using respondent-driven sampling. Participants completed a behavioral questionnaire and tested for HIV. Population-based estimates were obtained using RDSAT software. Factors associated with HIV infection were ascertained using multiple logistic regression, adjusting for RDSAT individualized weights. RESULTS:: A high proportion of MSM reported high-risk behaviors, including unprotected anal sex with men (30-50%), unprotected vaginal sex with women (40%), bisexual behavior (30-45%) and never been tested for HIV (40-55%). The population-based estimates of HIV among MSM in the 3 cities were 34.9%, 11.3% and 15.2%, respectively. In Abuja, HIV was significantly associated with unprotected sex and transactional sex. In Ibadan, HIV was significantly associated with unprotected sex and self-identified bisexual. In Lagos, HIV was significantly associated with older age. CONCLUSION:: HIV prevalence among MSM in the three cities was 4 to 10 times higher than the general population prevalence and was behaviorally linked. In response to a complex set of risks and disadvantages that put African MSM at a greater risk of HIV infection, future interventions targeting MSM should focus on a comprehensive approach that combines behavioral, biomedical and structural interventions.
[show abstract][hide abstract] ABSTRACT: This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 - 2.9, p < 0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 - 2.7, p = 0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria.
African Journal of Reproductive Health 12/2012; 16(4):21-8.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to evaluate whether a new low-cost strategy for the introduction of magnesium sulphate (MgSO(4)) for preeclampsia and eclampsia in low-resource areas will result in improved maternal and perinatal outcomes. Doctors and midwives from ten hospitals in Kano, Nigeria, were trained on the use of MgSO(4). The trained health workers later conducted step-down trainings at their health facilities. MgSO(4), treatment protocol, patella hammer, and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analyzed using SPSS software. From February 2008 to January 2009, 1,045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9 % (95 % CI 18.7-23.2) to 2.3 % (95 % CI 1.5-3.5). The perinatal mortality rate was 12.3 % as compared to 35.3 % in a center using diazepam. Introduction of MgSO(4) in low-resource settings led to improved maternal and fetal outcomes in patients presenting with severe pre-eclampsia and eclampsia. Training of health workers on updated evidence-based interventions and providing an enabling environment for their practice are important components to the attainment of the Millenium Development Goals (MDG) in developing countries.
Maternal and Child Health Journal 09/2012; · 2.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND:: Female sex workers (FSWs) account for about 20% of new HIV infections in Nigeria. We estimated the change in HIV prevalence and sexual risk behaviors between two consecutive rounds of integrated biological and behavioral surveillance surveys (IBBSS) and determined correlates of HIV transmission among FSWs. METHODS:: In 2007 and 2010, HIV prevalence and risk behavior data on brothel-based (BB) and non brothel-based (NBB) FSWs from the IBBSS were evaluated in 6 Nigerian states. Logistic regression was used to identify correlates of HIV infection. RESULTS:: A total of 2897 and 2963 FSWs were surveyed in 2007 and 2010, respectively. Overall HIV prevalence decreased in 2010 compared to 2007 [20% vs. 33%; p<0.001], with similar magnitude of declines among BB-FSW [23% vs. 37%; p<0.0001] and NBB-FSW [16% vs. 28%; p<0.0001]. Consistent condom use with boyfriends in the last 12 months was lower in 2010 compared to 2007 overall [23% vs. 25%; p=0.02] and among BB-FSWs [17% vs. 23%;p<0.01] while NBB-FSWs showed a marginal increase [30% vs. 27%;p=0.08]. FSWs residing in the Federal Capital Territory [AOR:1.74 (1.34 - 2.27)] and Kano state [AOR:2.07(1.59 - 2.70)] were more likely to be HIV-positive while FSWs recruited in 2010 [AOR:0.81(0.77 - 0.85)] and those who had completed secondary education [AOR:0.70(0.60 - 0.80)] were less likely to be HIV-positive. CONCLUSION:: Results suggest significant progress in reducing the burden of HIV among FSWs in Nigeria, although low condom use with boyfriends continued to be a potential bridge between FSWs and the general population. Venue-based prevention programs are needed to improve safer sex practices among BB-FSWs.
[show abstract][hide abstract] ABSTRACT: Despite clear emphasis through the Millennium Development Goals, the problem of high maternal mortality persists especially within low and middle income countries. Various studies report remarkably high maternal mortality rates in northern Nigeria, where maternal mortality rates exceed 1,000 deaths per 100,000 live births and eclampsia contributes approximately 40% of maternal deaths. Across Nigeria, diazepam is routinely used for the management of eclampsia. Prior to February 2008, diazepam was widely used for the management of eclampsia in Kano State (within northern Nigeria) with case fatality rate being over 20%. While magnesium sulphate (MgSO4) is recognized as the most effective drug for the management of eclampsia; this study aims to compare MgSO4 therapy with diazepam therapy in terms of case fatality rates and costs.
This retrospective study, including 1045 patients with eclampsia and pre-eclampsia during the years 2008 and 2009, reports a drop in case fatality rates from 20.9% (95% CI: 18.7, 23.2) to 2.3% (95% CI: 1.4, 3.2) among eclampsia patients following the MgSO4 intervention. The study observed no significant difference in the cost of using MgSO4 therapy compared to diazepam therapy.
The study found a remarkable reduction in case fatality rate due to eclampsia in those who received MgSO4 therapy with minimal increase in costs when compared to diazepam therapy. Concerted efforts should be focused on properly introducing MgSO4 into emergency obstetric protocols especially within developing countries to reduce maternal mortality and also impact on health system performance.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: Injecting drug use is now recognized as a significant risk factor for HIV in sub-Saharan Africa. We evaluated prevalence and correlates of HIV among injecting drug users (IDUs) in Nigeria. METHODS: A cross sectional design using respondent driven sampling was conducted in six states in 2010. Weighted HIV prevalence and injecting risk behaviors calculated using RDS analytic tool. Logistic regression was used to determine correlates of HIV infection, stratified by state. RESULTS: Total numbers of IDUs ranged from 197 in Lagos to 273 in Cross River and Oyo states. HIV prevalence was highest in Federal Capital Territory (FCT) at 9.3%, Kaduna 5.8%, Oyo 5.1%, Kano 4.9%, CR 3.3% and Lagos 3.0%. Although >90% of participants were male, females had higher HIV prevalence in all states surveyed except FCT (range: 7.4% in CR to 37.7% in Kano). Logistic regression showed that females were significantly more likely to be HIV positive in Kano [OR=33.2, 95% CI: 6.8-160.4], Oyo [AOR=15.9, 95% CI: 3.69-68.51], Lagos [OR=15.5, 95% CI: 2.41-99.5] and Kaduna states [AOR=19.6, 95% CI: 4.4-87.6]. For injecting risk behavior, only receptive sharing was associated with HIV [AOR=7.6, 95% CI: 1.2-48.7] and [AOR=0.2, 95% CI: 0.04-0.92] in Oyo and Kaduna states respectively. CONCLUSIONS: Considerable heterogeneity in the prevalence of HIV and associated risk behaviors exist among IDUs across Nigeria. Females had higher HIV prevalence among IDUs in five of six states, suggesting a need for targeted interventions for this hidden subgroup. Further research is needed to understand HIV transmission dynamics of IDUs in Nigeria. Community-based opioid substitution therapy and needle exchange programs should be implemented without delay.
Drug and alcohol dependence 07/2012; · 3.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Comprehensive data on female injecting drug users in Nigeria is lacking. We estimated HIV prevalence and injecting risk behaviors among female IDUs in Nigeria.
Methods: Data on female IDUs were collected from Integrated Biological and Behavioral Surveillance (IBBSS) in 6 cities in Nigeria between 2007 and 2010 and evaluated in a cross sectional analysis. Descriptive statistics, including 95% confidence intervals (CI) and Chi square tests of comparison for differences between categorical variables were conducted.
Results: Of a total of 122 female IDUs that were surveyed, 50% had completed secondary education and 38% were currently married. Overall HIV prevalence was 62.2% (95%CI:53.0-71.3) while it was significantly higher in 2010 (79%) compared to 2007 (20%; p<0.001). Mean age was 29 years and about a third had engaged in transactional sex. Only 35% (95%CI:26.1-43.3) had comprehensive knowledge of HIV. Median duration of injecting drugs was 4years (IQR:2-7years) while median age at first injection was 24years (IQR:20-29years). Prevalence of injecting risk behavior in the last one month prior to the survey was 13.5% (95%CI:7.2-19.7) for use of pre-filled syringe, 14.0% (95%CI: 6.4-21.2) receptive sharing, 20.1% (95%CI:13.2-28.6) for those who shared cooker/vial/container, 12.3% (95%CI:6.1-18.4) frontloading/backloading/splitting, and 21.5% (95%CI:13.6-29.4) for drawing from a common container. Injecting risk behavior was significantly higher among those who had engaged in transactional sex (48% vs 28%;p<0.05). HIV prevalence was significantly higher among those who engaged in receptive sharing (75% vs 54%;p=0.024) but was similar in other risk behavior; use of pre-filled syringe (p=0.506), frontloading/backloading/splitting (p=0.516), shared cooker/vial/container (p=0.620) and drawing from a common container (p=0.852).
Conclusion: Female IDUs bear a very high burden of HIV and may present a bridge to the general population. Except for receptive sharing, injecting risk behavior was not associated with HIV suggesting that injecting risk behavior may not be a significant route of HIV transmission among female IDU. Further research is urgently needed to understand factors driving the epidemic within this group.
[show abstract][hide abstract] ABSTRACT: This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 – 2.9, p<0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 – 2.7, p=0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria (Afr J Reprod Health 2012; 16: 21-28). Résumé Cette étude a évalué le niveau de l'homophobie intériorisée et les facteurs qui y sont liés chez les hommes qui ont des rapports sexuels avec des hommes (HSH) au Nigeria. A l'aide d'un échantillonnage basé sur les interviews, les HSH ont été recrutés à Lagos et à Ibadan entre les mois de juillet et septembre, 2006. L'homophobie intériorisée a été évaluée par un indice négatif composite en utilisant une échelle de 11 items. Au total, 1.125 HSH ont été interviewés. À peu près 44,4% se sont identifiés comme des homosexuels tandis que 55% se considéraient comme des bisexuels. Environ un tiers des interviewés ont signalé l'homophobie intériorisée. En se servant des hommes homosexuels comme référence, les interviewés qui se sont identifiés comme bisexuels avaient deux fois plus la possibilité [AOR 2,1; IC 95: 1,6 -2,9, p <0,001] de signaler l'homophobie intériorisée. Ceux qui étaient séropositifs avaient également deux fois plus la possibilité de signaler l'homophobie intériorisée par rapport à ceux qui étaient séronégatifs [AOR: 1,8; IC à 95%: 1,2 -2,7, p = 0,004]. Etant donné que l'homophobie intériorisée empêche l'acceptation de la prévention de la programmation du VIH, l'identification des HSH qui éprouvent l'homophobie intériorisée fait partie intégrante de la réussite de la prévention de la programmation du VIH au Nigéria (Afr J Reprod Health 2012; 16: 21-28).
[show abstract][hide abstract] ABSTRACT: Background
Alternative HIV counselling and testing (HCT) delivery models, such as mobile HTC, have been shown to increase access to and uptake of HCT. We evaluated the effects of three strategies in increasing uptake of HCT among male most-at-risk population (M-MARPS).Methods
Three HCT strategies implemented between July, 2009, and July, 2012, among men who have sex with men and injecting drug users in three states in Nigeria were evaluated in a longitudinal analysis. The first strategy (S1) was facility based with a community mobilisation component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third (S3) involved mobile M-MARPS peers conducting the HCT. Segmented linear regression was used to assess the effect of different strategies on uptake of HCT among M-MARPS.FindingsA total of 1988, 14 726, and 14 895 M-MARPS received HCT through S1, S2, and S3 methods, respectively. Overall, S3 (12·7%; 1853 of 14 622) identified the highest proportion of HIV-positive M-MARPS compared with S1 (9·0%; 177 of 1956) and S2 (3·3%; 480 of 14 671; p<0·0001). Also S3 (13·2%; 1729 of 13 074) identified the highest proportion of new HIV diagnosis compared with S1 (8·2%; 132 of 1618) and S2 (2·9%; 355 of 12 034), respectively (p<0·0001). For the total number of M-MARPS reached by each strategy, there was no immediate (271; p=0·539) or long-term change (53; p=0·334) in the total number of clients reached by S2 compared with S1. Compared with S2, S3 showed a significant immediate decrease (3068; p=0·029) but a sustained long-term increase (822; p=0·007) in the total number of M-MARPS reached with HCT.InterpretationPeer-mediated HCT (S3) had the highest impact on the total number of M-MARPS reached, identifying HIV-positive M-MARPS and new testers. Since HCT is a key intervention strategy for effective HIV/AIDS control, training M-MARPS peers to provide HCT is a high-impact approach in delivering HCT to M-MARPS.FundingThis study was supported by the Population Council's Men's Health Network Nigeria project with funds from the Centers for Disease Control and Prevention (CDC) through CDC Cooperative Agreement No.1U2GPS001066-01. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The funders had no role in data collection, interpretation, writing, or decision to submit this article for publication. None of the authors has been paid to write this article by a pharmaceutical company or other agency. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.