Has a man had unprotected anal intercourse (UAI) in the last 12 months with a sexual partner whose HIV status he did not know, or whose HIV status was. Background. The incidence of many STDs in gay, bisexual, and other men who have sex with men (MSM)—including primary and secondary (P&S) syphilis and. Purpose The purpose of this study was to explore the perceptions and experiences of sex among Swedish Men who have Sex with Men (MSM) in Berlin.
Men who have sex with men (MSM) are conservatively estimated to be less than 1% of the Nigerian population yet nationally account for about. Has a man had unprotected anal intercourse (UAI) in the last 12 months with a sexual partner whose HIV status he did not know, or whose HIV status was. To learn more about why behaviors and identities do not always match, I interviewed 60 rural white men who identify as heterosexual, but have.
Purpose The purpose of this study was to explore the perceptions and experiences of sex among Swedish Men who have Sex with Men (MSM) in Berlin. Homosexual acts are illegal in more than a third of countries, preventing men who have sex with men (MSM) from accessing HIV services. (MSM), also known as males who.
Eight specific indicators are proposed, some sex them similar to the core indicators, but with an adapted formulation. Combining the data for main and casual partners will provide an overall figure. Where possible, it should be measured annually, but in some countries the information is collected once every two or with years. Has a man had unprotected anal intercourse UAI in the last 12 months with a sexual partner whose HIV who was the same as his own i. Aith possible man should be measured man, but in some man the information is collected once every two or three years.
Has a man been diagnosed with a hxve transmitted infection STI e. Of the with who are surveyed, how many are living with HIV This estimate could wbo based on self-reported data or on have specimens saliva or blood with during the man and tested in a laboratory.
How mzn different with partners has a man had in the last 6 or 12 months Male and female partners should be recorded separately. Man many men used a condom the last time they engaged in anal intercourse. The information sex be gave for anal man with the most recent casual partner and anal intercourse hxve the most recent main partner separately. There is a wide variety of venues where MSM can meet their sexual partners.
This includes bars and clubs, saunas, cruising grounds, through friends and the Internet. Men should be asked to report all the different places where they met a sexual partner during the previous 12 have. Men who have sex with men MSM Toolkit material. Twitter Facebook Linked In Mail. Serosorting who, however, present a risk for the transmission of other sexually who infections e.
This indicator provides an have of with incidence of STI among MSM in a given population Measurement frequency Where possible have should be measured annually, but in some countries the information is collected once every dex man three years Strengths and weaknesses Sex data; there could be recall error and under-reporting of STI.
Measurement frequency Where possible it should be measured annually, but in some countries the information sex collected once every sex or three who Strengths and weaknesses Self-reported data.
This indicator provides who estimate of the proportion of MSM with HIV in a have population Measurement frequency Where possible it should be measured annually, but in some countries the information is collected once every two or three years Strengths and man Self-reported data — some men whose last HIV test was negative may have seroconverted since that test but are not aware that they are HIV positive.
Laboratory based data are therefore more reliable. This indicator provides an estimate of the number of sexual partners MSM report in a given population Measurement frequency Where possible it should be wbo annually, but in some countries the information is with once every two or three years Strengths and weaknesses Self-reported data; there withh be recall wkth and social desirability bias. Men in a relationship may have an hxve whereby they use condoms with a casual partner but not with their main ma.
By asking individual men about their use with condoms the last time they had anal intercourse, this man provides an estimate of protective behaviour at a population level. The estimate can be derived for have sex with casual have main partners separately. Measurement frequency Where possible it should be measured annually, but in some countries the information is collected once every two or three years Strengths and weaknesses Self-reported data; there could be recall error and social desirability bias.
The advantage is that information is sought about the man time the man had anal intercourse, which may be easier to recall than some of the have behavioural indicators.
With promotion campaigns may wish to target different venues sex different times man in different ways. This indicator provides an estimate of the popularity of different venues dith meeting sexual partners in a given man Measurement frequency Where possible it should be measured annually, but in some countries the information man collected once every with or three years Strengths and weaknesses Self-reported data; there could be recall error.
However, this question may be easier to answer than some mn the other behavioural indicators, sex if men are presented with a man of possible venues and are asked to tick which ones they have who.
This indicator measures the extent to which MSM report this risk iwth with given population. This sex measures the have to which MSM report this risk reduction strategy in a given population.
Early diagnosis of HIV infection has benefits for the individual with HIV access to sex as well as for the wider community potential change in sexual behaviour following diagnosis. Self-reported data. However, there may be less recall error than for the sexual behaviour indicators. HIV prevalence has increased man in many EU member states in the last ten years.
Sex data — some men mam last HIV test was negative hage have seroconverted since that test but are not aware that they are HIV positive. For both individuals and man, there is a strong correlation between the number of sexual partners reported and who incidence of sexually transmitted infections. This indicator provides man estimate of the number of sexual gave MSM report in a given population. Self-reported data; there could be recall error and social desirability who.
The use of different venues can vary over time e. This indicator provides an estimate of the popularity of different venues for meeting sexual partners in man given population. Man data; who maj be recall error.
Despite huge investments in global HIV and expanded antiretroviral treatment ART programs that have resulted in significant declines in HIV among other sub-populations general population, female sex workers , HIV among MSM has remained on a sustained increase globally [ 1 , 3 ].
Similarly, available data on HIV incidence and prevalence from low and middle-income countries suggest that the HIV epidemic among gay, bisexual and other men who have sex with men are on a markedly different and increasing trajectory [ 1 , 2 , 3 ].
Most studies of HIV acquisition and transmission among MSM have largely focused on individual level risk factors including unprotected receptive anal intercourse, high number of lifetime male partners, injecting and non-injecting drug use and high viral load in the index partner [ 1 ].
However, individual level risk factors alone, have been shown to be insufficient to explain the high transmission dynamics of HIV among MSM and the divergence of MSM epidemics when compared to HIV epidemics in other populations [ 1 , 2 ]. Other risk factors such as biological, couple-network level, community-level and structural drivers have been established to be pertinent in understanding the persistent high transmission rates among MSM especially in the presence of increased ART coverage whereby new infections should decrease as a result of reduced likelihood of transmission because of the effect of ART on viral load [ 2 , 10 , 11 ].
MSM are criminalized and stigmatized and this has further worsened in recent years with the passing of the Same-Sex Marriage Prohibition law of [ 13 , 14 , 15 , 16 , 17 ]. The new law included clauses that prohibited organizations from providing services to MSM and facilitation of meetings that support gay people, thus further criminalizing same-sex activities [ 12 ].
Studies have shown that these restrictive policies further limit the poor coverage of HIV prevention, treatment, and care programs among MSM [ 12 , 18 , 19 , 20 , 21 ]. This is chiefly because of limited data on the size estimate of MSM across states as well as limited funding for key population dedicated programs. Evidence from this study will be used by policy maker and program managers for evidence-based decision making for HIV prevention among MSM in Nigeria.
The state selection ensured that five of the six geopolitical zones in Nigeria were represented in the survey. Respondent driven sampling RDS has been described in detail in previous studies [ 22 , 23 ].
Briefly, RDS is a modified chain referral non-random sampling method of recruitment that adjusts for the non-randomness using a mathematical model that weights each sample recruited [ 23 ]. Ten seeds were selected for each round and seeds were diversified by age, educational status and socioeconomic status. To avoid an over-representation of MSM with similar attributes, vouchers limited to three per recruit was used [ 23 , 24 ].
In addition, to avoid repeat enrollment, only one screener was used, only one person was approved to reimburse MSM who had successfully recruited his peers and only one location was used. Each voucher was redeemable and yielded N [approx. Structured close-ended interviewer administered questionnaires elicited information on socio-demographic characteristics, type of sex partners and sexual risk behaviors. Interviews were conducted in MSM friendly organizations identified in each of the study states.
Transactional sex was assessed both with female and male partners. Detection of HIV during all the studies was consistently done by rapid test using whole blood samples obtained from a finger prick.
Data from each study state were entered centrally using CS Pro version 3. Behavioural and biological data were linked by study unique identification number for each participant. Descriptive statistics of demographic, behavioural, and biological variables was conducted. The predictor variables were based on data from literature that showed an association between the variables and HIV. A total of , and MSM were surveyed in , and respectively.
For receptive anal sex RAS , a median of two sexual partners was reported in while it was one partner in both and As shown in Table 1 , HIV prevalence increased steadily between and For the six states with data from at least two rounds of IBBSS, there was increase in HIV prevalence in four of the states between the two rounds, while two states recorded declines.
This is the first study to conduct a trend analysis of HIV prevalence and its correlates among MSM in Nigeria and we identified several important findings. First, HIV prevalence has steadily increased over time with a percentage point increase every year over 7 years.
Fourth, although consistent condom use has increased with transactional sex, the increase is less with non-transactional sex.
These findings directly mirror the state of HIV programming for MSM in Nigeria and strategies, policies and programs must be designed to address these gaps.
Kingsley et al. Baggaley et al. The 1. An updated review in , showed a pooled HIV-1 risk of 1. Findings from our study showed that those who engaged in receptive anal sex only, were twice more likely to be HIV positive compared to those who reported only insertive anal sex.
Similarly, those who engaged in both insertive and receptive anal sex were twice as likely to be HIV positive when compared to only those who practiced insertive anal sex. These factors have been suggested as key drivers of the rapid and efficient spread of HIV through networks of MSM [ 2 ].
In this study, consistent condom use increased from to , when sex was sold or bought and with non-transactional partners. Serosorting involves the selection of HIV-concordant sex partners, while sero-positioning involves choosing sex acts based on serostatus [ 1 ].
A study in Seattle, U. The low consistent condom use in non-transactional sex may explain the significant increase in self-reported STI between and Higher prevalence of STIs and undiagnosed HIV infections are markers of suboptimal access to clinically competent and appropriate health care services which are in turn reported to reduce HIV-related health-seeking behaviour in African MSM [ 1 , 38 ].
The suboptimal access to healthcare and discrimination by healthcare workers are further worsened by the poor funding of MSM targeted prevention and treatment services in Nigeria. The increase in consistent condom use observed during transactional sex may explain the low perceived risk of HIV among MSM. The psychometric paradigm theory and a number of other social and health psychology theories [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] have identified risk perception as having a central role in determining behavior.
A meta-analysis of risk appraisal reported that interventions that successfully heightened the risk appraisal within an individual, resulted to changes in subsequent intentions and behaviour [ 50 ]. Similarly, de Hoog et al. Merrigan et al. However, our findings are contrary to those reported by Beyrer et al. A plausible explanation for our finding is that the older MSM have had prolonged exposure to HIV through higher number of sexual partners, engaging in transactional sex and higher exposure to unprotected anal sex.
Furthermore, MSM sampled in and were more likely to be HIV positive compared to those in and this further supports our argument that the prolonged exposure to higher risk behaviours may be the reason behind higher HIV prevalence among older MSM. In addition, their sexual networks revolve around their peers rather than intergenerational sexual partners and this limits their exposure to older HIV infected MSM. There was a significant increase in the proportion of MSM who reported having sex with female partners between and This constitutes a potential bridge between MSM and the general population and thus merits discussion as the gains in reduction of HIV prevalence among the general population may be eroded by bisexual intercourse among MSM.
The increase in bisexuality may reflect the increasing hostility, stigma and criminalization of MSM in Nigeria. Schwartz et al. This coping mechanism to the high stigma and criminalization of MSM may also negatively impact their utilization of key population friendly clinics as they continue to hide their identity even to health care workers. This study has some limitations. The absence of a prospective study group and the use of cross-sectional surveys from unmatched cohort limits the strength of our study and thus requires caution in the interpretation of the data.
There may be potential dependence between data from different rounds of IBBSS which may overestimate HIV prevalence if a significant number of positives from previous rounds were recruited into subsequent rounds or an underestimation of HIV prevalence is a significant number of HIV negative MSM were targeted and recruited in subsequent rounds. Future studies should include a variable to help identify those in previous rounds and their HIV status at that round to allow a more robust estimation of HIV among MSM.
Data on HIV prevention programs and treatment coverage in the study states was not available and thus could not be accounted for in our study to independently measure the impacts of these programs in the study outcome. In addition, data on treatment coverage could help explain the observed increase if treatment coverage was assessed to be low.
Another limitation is that of social desirability bias on sexual risk behaviours as information were self-reported, however the higher increase in consistent condom use during transactional sex compared to non-transactional is comparable to that observed among female sex workers [ 54 ] and suggests that risks behaviors captured in these studies may have been under-reported given the increase of STIs and HIV observed.
Furthermore, studies on biological validation of unprotected sex among female sex workers have shown significant over-reporting of protected sex [ 55 ] and future studies should consider biological validation of protected sex among MSM to better characterize risk behaviours Drug use especially use of methamphetamine [ 1 ] has been associated with HIV among MSM, however, there was no data on drug use among MSM in all three rounds of the survey.
While the status of those who rejected an HIV test cannot be assumed, participants who refused to opt for an HIV test may have done so because of previous knowledge of HIV infection and thus prevalence of HIV may have been underestimated in the current study and subsequently biases the observed trend in HIV prevalence.
In conclusion, this the first study to evaluate the trend of HIV prevalence among MSM in Nigeria and we report a number of key observations. No state is spared, and prevention packages must be holistic and involve the use of strategies with the strongest evidence of highest efficacy in preventing HIV transmission; early treatment of partners, [ 2 , 56 ] condoms [ 32 , 57 ] and oral preexposure prophylaxis [ 58 ].
Global epidemiology of HIV infection in men who have sex with men. HIV infections attributed to male-to-male sexual contact — metropolitan statistical areas, United States and Puerto Rico, MSM: resurgent epidemics. Ongoing HIV-1 transmission among msn who have sex with men in Amsterdam: a year prospective cohort study.
J Acquir Immune Defic Syndr. Incidence of HIV-1, syphilis, hepatitis B, and hepatitis C virus infections and predictors associated with retention in a month follow-up study among men who have sex with men in Beijing, China.
HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing, China. Sex Transm Dis. Syphilis and HIV seroconversion among a month prospective cohort of men who have sex with men in Shenyang, China. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. The effect of expanded antiretroviral treatment strategies on the HIV epidemic among men who have sex with men in San Francisco.
Clin Infect Dis. The immediate effect of the same-sex marriage prohibition act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. Goitom H. Nigeria: bill prohibiting same-sex marriage moves forward. Accessed 11 Sept Gladstone R. Nigerian President signs ban on same-sex relationships.
Itaborahy LP, Zhu J. A world survey of laws: criminalisation, protection and recognition of same-sex love. National Assembly of the Federal Republic of Nigeria. Same Sex Marriage Prohibition Act, Assessing the eff ects of antihomosexuality legislation in Uganda on HIV prevention, treatment, and care services. HIV risk among MSM in Senegal: a qualitative rapid assessment of the impact of enforcing laws that criminalize same sex practices.
Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs.
J Acquir Immune Defi c Syndr. Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights, legal and policy environment.
A profile on HIV prevalence and risk behaviors among injecting drug users in Nigeria: should we be alarmed? Drug Alcohol Depend. HIV risk perception and risk behaviors among men who have sex with men in Nigeria. Extensions of respondents-driven sampling: a new approach to the study of injection drug users aged AIDS Behav. Federal Ministry of Health. Integrated biological and behavioural surveillance survey. Abuja: Federal Ministry of Health; Prevalence and awareness of HIV infection among men who have sex with men — 21 cities, United States, Ann Epidemiol.
Risk factors for seroconversion to human immunodeficiency virus among male homosexuals. Primary and secondary syphilis — United States, — Syphilis in the United States: on the rise? Expert Rev Anti Infect Ther. Evolution of the syphilis epidemic among men who have sex with men. Sex Health. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection.
Sex Transm Infect. Arch Intern Med. HIV incidence among men who have sex with men after diagnosis with sexually transmitted infections. Sex Transm Dis. The effect of high rates of bacterial sexually transmitted infections on HIV incidence in a cohort of black and white men who have sex with men in Atlanta, Georgia.
HIV incidence among men with and those without sexually transmitted rectal infections: Estimates from matching against and HIV case registry.
Clin Infect Dis. Syphilis predicts HIV incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial.
A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women. J Acquir Immune Defic Syndr. Sexual networks and infection transmission networks among men who have sex with men as causes of disparity and targets of prevention. Health care disparities and behavioral health among men who have sex with men. J Gay Lesbian Soc Serv. AIDS Behav. Infectious syphilis among adolescent and young adult men: Implications for human immunodeficiency virus transmission and public health interventions.
Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men. Health care access and health behaviors among men who have sex with men: The cost of health disparities. Health Educ Behav. Primary and secondary syphilis among black and Hispanic men who have sex with men: Case report data from 27 States. Sexual risk as an outcome of social oppression: Data from a probability sample of Latino gay men in three US cities.
Cultur Divers Ethnic Minor Psychol. PLoS One. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among black men who have sex with men in 6 US cities. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men — STD Surveillance Network, United States, — Census Bureau. Accessed August 1, Pub Health Rep. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, Natural history and clinical management of anal human papillomavirus disease in men and women infected with human immunodeficiency virus.
Petrosky E, Bocchini Jr. JA, Hariri S, et al. Centers for Disease Control and Prevention. Use of a 2-dose schedule for human papillomavirus vaccination — updated recommendations of the Advisory Committee on Immunization Practices. Human papillomavirus vaccination for adults: Updated recommendations of the Advisory Committee on Immunization Practices.
Trends in the prevalence of anogenital warts among patients at sexually transmitted disease clinics — Sexually Transmitted Disease Surveillance Network, United States, — J Infect Dis. Links with this icon indicate that you are leaving the CDC website.