Prevalence and Correlates of HIV, Syphilis, Hepatitis B, Hepatitis C Infections and Sexual Behaviours of Men who have Sex with Men in Two Cities in Nigeria

Globally, men who have sex with men (MSM) continue to be disproportionately affected by the HIV pandemic. However, prior to this study, very little was known about the magnitude and factors that heighten MSM's vulnerabilities to HIV and other STIs in Nigeria. A cross-sectional survey was administered to 1,125 consenting MSM in Lagos and Ibadan recruited through modified respondent driven strategy. Sero-prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV) and syphilis and levels of unprotected anal intercourse (UAI) were determined using data adjusted for network size and unweighted data for the pooled sample. Correlates of HIV, HBV, HCV and UAI were examined using multiple logistic regression analyses. Results revealed relatively young sexually active men who engaged in multiple concurrent sexual relationships with both men and women. More than half of the men self-identified as bisexual, and 44.4% as homosexual. High levels of risky sexual behaviours were demonstrated with over two-thirds of MSM in Ibadan (65.5%) and Lagos (69.7%) reporting UAI with their male partners in the previous 6 months. Correlates of URAI included homosexual identity, older age, lack of social support, and douching. Prevalence of previously undiagnosed HIV infection were four times higher in Lagos 12.7% (95% CI 10.6-15.0), and Ibadan 11.2% (95% CI 5.7-16.2) than the national HIV prevalence among Nigerian men. Prevalence of HBV (10.1% and 18.0%); HCV (2.8% and 4.3%) and current active syphilis (0.03%) infections in Lagos and Ibadan respectively were also high. Correlates of HIV were URAI and UIAI with men and women, condom breakage, homosexual identity, increasing age, employment, sexual activities with non-African white men and internalized homophobia. Bisexual identity, UIAI with male sex partners, and low self-esteem were associated with HBV infection. Correlates of HCV were URAI and reported sex with men who had lower educational status. This study confirms the existence of MSM who engage in risky behaviours with very limited access to appropriate HIV and STI prevention services.Ph.D

Attitudes of Health Care Providers to Persons Living With HIV/AIDS in Lagos State

This study was conducted to examine the knowledge, beliefs and attitudes of nurses and laboratory technologists towards people living with HIV/AIDS (PLWA) and the factors responsible for these attitudes. Information was elicited from 254 randomly selected nurses and laboratory technologists from 15 government owned health facilities in Lagos State with the use of a structured questionnaire. Results indicate that most of the respondents (96.3%) had moderate to good knowledge of HIV/AIDS. Respondents\' level of knowledge was influenced by the level of formal education attained, length of practice, gender and attendance at refresher courses on HIV/AIDS (p 0.05). Attitude towards PLWA was poor. Some (55.9%) of the health workers felt that PLWAs are responsible for their illness, while 35.4% felt that they deserve the punishment for their sexual misbehaviours. Only 52.8% of the respondents expressed willingness to work in the same office with a PLWA, while only 18.0% would accept to visit or encourage their children to visit a PLWA, probably because of the fear of contagion. It is, therefore, essential that health care providers be properly informed in order to improve their quality of care for PLWAs. (Afr J Reprod Health 2003; 7[1]: 103–112) Résumé Attitudes des dispensateurs des soins médicaux envers les sidéens dans l\'etat de Lagos. Cette étude a été menée pour examiner la connaissance, les croyances et les attitudes des infirmières et des techniciens de laboratoires envers les sidéens et les facteurs qui en sont responsables. L\'information a été recueillie, à l\'aide d\'un questionnaire structuré, auprès de 254 infermières et techniciens de laboratoire selectionnés au hasard dans 15 hôpitaux gouvernementaux dans l\'Etat de Lagos. Les résultats ont montré que la plupart des interrogés (96,3%) ont une bonne connaissance du VIH/SIDA. Le niveau de connaissance chez les interrogés a été influencé par le niveau de l\'éducation formelle atteint, la durée de la pratique, les sexes et la fréquentation aux stages de recyclage sur le VIH/SIDA (p < 0,05). Par contre, l\'âge, le métier et la religion des interrogés n\'ont pas influencé, leur connaissance de manière significative, (p < 0,05). L\'attitude envers les sidéeens était mauvaise. Certaines (55,9%) parmi les infirmières estimaient que les sidéens étaient responsables de leur maladie alors que 35,4% estimaient qu\'ils méritaient la punition pour leurs mauvaises conduites sexuelles. Seuls 52,8% des interrogés ont exprimé la volonté de travailler dans le même bureau que les sidéens alors que 18% aimeraient visiter ou encourager leurs enfants de visiter les sidéens probablement de peur d\'être infectés. Il est donc bien nécessaire que les dispensateurs des soins médicaux soient bien informés afin d\'améliorer leur qualité de soins pour les sidéens. (Rev Afr Santé Reprod 2003; 7[1]: 103–112) Key Words: AIDS, HIV, attitude, health care providers, PLW

Attitudes of health care providers to persons living with HIV/AIDS in Lagos State, Nigeria

This study was conducted to examine the knowledge, beliefs and attitudes of nurses and laboratory technologists towards people living with HIV/AIDS (PLWA) and the factors responsible for these attitudes. Information was elicited from 254 randomly selected nurses and laboratory technologists from 15 government owned health facilities in Lagos State with the use of a structured questionnaire. Results indicate that most of the respondents (96.3%) had moderate to good knowledge of HIV/AIDS. Respondents' level of knowledge was influenced by the level of formal education attained, length of practice, gender and attendance at refresher courses on HIV/AIDS (p 0.05). Attitude towards PLWA was poor. Some (55.9%) of the health workers felt that PLWAs are responsible for their illness, while 35.4% felt that they deserve the punishment for their sexual misbehaviours. Only 52.8% of the respondents expressed willingness to work in the same office with a PLWA, while only 18.0% would accept to visit or encourage their children to visit a PLWA, probably because of the fear of contagion. It is, therefore, essential that health care providers be properly informed in order to improve their quality of care for PLWAs. (Afr J Reprod Health 2003; 7[1]: 103–112) RÉSUMÉ Attitudes des dispensateurs des soins médicaux envers les sidéens dans l'etat de Lagos. Cette étude a été menée pour examiner la connaissance, les croyances et les attitudes des infirmières et des techniciens de laboratoires envers les sidéens et les facteurs qui en sont responsables. L'information a été recueillie, à l'aide d'un questionnaire structuré, auprès de 254 infermières et techniciens de laboratoire selectionnés au hasard dans 15 hôpitaux gouvernementaux dans l'Etat de Lagos. Les résultats ont montré que la plupart des interrogés (96,3%) ont une bonne connaissance du VIH/SIDA. Le niveau de connaissance chez les interrogés a été influencé par le niveau de l'éducation formelle atteint, la durée de la pratique, les sexes et la fréquentation aux stages de recyclage sur le VIH/SIDA (p < 0,05). Par contre, l'âge, le métier et la religion des interrogés n'ont pas influencé, leur connaissance de manière significative, (p < 0,05). L'attitude envers les sidéeens était mauvaise. Certaines (55,9%) parmi les infirmières estimaient que les sidéens étaient responsables de leur maladie alors que 35,4% estimaient qu'ils méritaient la punition pour leurs mauvaises conduites sexuelles. Seuls 52,8% des interrogés ont exprimé la volonté de travailler dans le même bureau que les sidéens alors que 18.0% aimeraient visiter ou encourager leurs enfants de visiter les sidéens probablement de peur d'être infectés. Il est donc bien nécessaire que les dispensateurs des soins médicaux soient bien informés afin d'améliorer leur qualité de soins pour les sidéens. (Rev Afr Santé Reprod 2003; 7[1]: 103–112

Effects of the COVID-19 pandemic on HIV service delivery and viral suppression: Findings from the SHARP program in Northern Nigeria.

During the COVID-19 pandemic, HIV programs scaled up differentiated service delivery (DSD) models for people living with HIV (PLHIV). We evaluated the effects of COVID-19 on HIV service delivery and viral suppression in facilities in Northern Nigeria, and determined factors associated with viral suppression among adolescents and adults. We analysed a cross-sectional survey data from facility heads, and retrospective, routinely collected patient data from 63 facilities for PLHIV ≥10 years old in care between April 2019-March 2021, defining study periods as "pre-COVID-19" (before April 2020) and "during COVID-19" (after April 2020). For the pre-COVID and the COVID-19 periods we compared uptake of antiretroviral therapy (ART) refills of ≥3 months (MMD3), and ≥6 months (MM6), missed appointments, viral load (VL) testing, VL testing turnaround time (TAT) and viral suppression among those on ART for ≥6 months using two proportions Z-test and t-tests. We fit a multivariable logistic regression model to determine factors associated with maintaining or achieving viral suppression. Of 84,776 patients, 58% were 5 years, 93% from facilities with community-based ART refill, a higher proportion were on MMD3 (95% versus 74%, p<0.001) and MMD6 (56% versus 22%, p<0.001) during COVID-19 than pre-COVID-19, and a higher proportion had VL testing during COVID-19 (55,271/69,630, [84%]) than pre-COVID-19 (47,747/68,934, [73%], p<0.001). Viral suppression was higher during COVID-19 pandemic compared to the pre-COVID era (93% [51,196/55,216] versus 91% [43,336/47,728], p<0.001), and there was a higher proportion of missed visits (40% [28,923/72,359] versus 39% [26,304/67,365], p<0.001) and increased VL TAT (mean number of days: 38 versus 36, p<0.001) during COVID-19 pandemic and pre-COVID period respectively. Factors associated with maintaining or achieving suppression during COVID-19 were receiving MMD3 and MMD6 refills (OR: 2.8 [95% CI: 2.30-3.47] and OR: 6.3 [95% CI: 5.11-7.69], respectively) and attending clinics with community-based ART refill (OR: 1.6 [95% CI: 1.39-1.87]). The program in Northern Nigeria demonstrated resilience during the COVID-19 pandemic and adoption of MMD had a positive impact on HIV care. Though VL TAT and missed clinic visits slightly increased during the pandemic, VL testing improved and viral suppression moved closer to 95%. Adoption of MMD and community-based models of care at scale are recommended for future pandemic preparedness

Multi-month dispensing before and during the COVID-19 pandemic.

Multi-month dispensing before and during the COVID-19 pandemic.</p

Characteristics of study participants.

During the COVID-19 pandemic, HIV programs scaled up differentiated service delivery (DSD) models for people living with HIV (PLHIV). We evaluated the effects of COVID-19 on HIV service delivery and viral suppression in facilities in Northern Nigeria, and determined factors associated with viral suppression among adolescents and adults. We analysed a cross-sectional survey data from facility heads, and retrospective, routinely collected patient data from 63 facilities for PLHIV ≥10 years old in care between April 2019-March 2021, defining study periods as “pre-COVID-19” (before April 2020) and “during COVID-19” (after April 2020). For the pre-COVID and the COVID-19 periods we compared uptake of antiretroviral therapy (ART) refills of ≥3 months (MMD3), and ≥6 months (MM6), missed appointments, viral load (VL) testing, VL testing turnaround time (TAT) and viral suppression among those on ART for ≥6 months using two proportions Z-test and t-tests. We fit a multivariable logistic regression model to determine factors associated with maintaining or achieving viral suppression. Of 84,776 patients, 58% were 5 years, 93% from facilities with community-based ART refill, a higher proportion were on MMD3 (95% versus 74%, p</div

Factors associated with a positive change in viral suppression over COVID-19 periods.

Factors associated with a positive change in viral suppression over COVID-19 periods.</p

Inclusivity in global research.

During the COVID-19 pandemic, HIV programs scaled up differentiated service delivery (DSD) models for people living with HIV (PLHIV). We evaluated the effects of COVID-19 on HIV service delivery and viral suppression in facilities in Northern Nigeria, and determined factors associated with viral suppression among adolescents and adults. We analysed a cross-sectional survey data from facility heads, and retrospective, routinely collected patient data from 63 facilities for PLHIV ≥10 years old in care between April 2019-March 2021, defining study periods as “pre-COVID-19” (before April 2020) and “during COVID-19” (after April 2020). For the pre-COVID and the COVID-19 periods we compared uptake of antiretroviral therapy (ART) refills of ≥3 months (MMD3), and ≥6 months (MM6), missed appointments, viral load (VL) testing, VL testing turnaround time (TAT) and viral suppression among those on ART for ≥6 months using two proportions Z-test and t-tests. We fit a multivariable logistic regression model to determine factors associated with maintaining or achieving viral suppression. Of 84,776 patients, 58% were 5 years, 93% from facilities with community-based ART refill, a higher proportion were on MMD3 (95% versus 74%, p</div

Viral load testing, viral suppression and missed appointments pre- and during COVID.

Viral load testing, viral suppression and missed appointments pre- and during COVID.</p