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Individual and Sexual Network Predictors of HIV Incidence Among Men Who Have Sex With Men in Nigeria

Nowak, Rebecca G. PhD*; Mitchell, Andrew BA*; Crowell, Trevor A. MD, PhD†,‡; Liu, Hongjie PhD§; Ketende, Sosthenes MSc; Ramadhani, Habib O. PhD*; Ndembi, Nicaise PhD; Adebajo, Sylvia MBBS, PhD#; Ake, Julie MD, MSc; Michael, Nelson L. MD, PhD; Blattner, William A. MD*; Baral, Stefan D. MD; Charurat, Manhattan E. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1, 2019 - Volume 80 - Issue 4 - p 444–453
doi: 10.1097/QAI.0000000000001934
Clinical Science

Background: To date, HIV incidence studies among men who have sex with men (MSM) across sub-Saharan Africa have focused on studying sexual risk practices with less focus on sexual networks.

Setting: TRUST/RV368 conducted in Abuja and Lagos, Nigeria, recruited MSM using respondent-driven sampling and followed HIV-negative men for incident infection over 4 years.

Methods: Four-hundred forty-one HIV-uninfected MSM underwent a parallel rapid HIV testing algorithm every 3 months for up to 18 months. HIV incidence per 100 person-years (PY) and 95% confidence intervals (CIs) were estimated using Poisson regression. Individual and network characteristics were examined using multivariable Cox-proportional hazards regression adjusted and unadjusted for respondent-driven sampling weights.

Results: Among cohort members with a median age of 23 years [interquartile range (IQR): 20–27], 81 HIV infections occurred over 527 PY (incidence 15.4/100 PY; 95% CI: 12.3 to 19.0). The incidence rate was highest among 16–19 year olds as compared to those 25 years or older (30.9/100 PY; 95% CI: 22.1 to 45.3 vs. 6.9/100 PY; 95% CI: 4.2 to 10.9, respectively). Individual determinants included receptive partnerships, condomless sex, no history of testing for HIV, and rectal gonorrhea. Sexual networks were larger and consisted of an older sexual partner, although there was no clustering by recruitment networks.

Conclusions: These HIV incidence data reinforce the unmet HIV prevention needs among young MSM in Nigeria. Even in the context of emerging HIV diagnostic and prevention strategies, structural challenges including stigma and criminalization of same-sex practices highlight the need for novel implementation approaches in the context of MSM-friendly services.

*Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD;

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD;

Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD;

§Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD;

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Institute of Human Virology Nigeria, Abuja, Nigeria; and

#Population Council Nigeria, Abuja, Nigeria.

Correspondence to: Rebecca Nowak, PhD, Department of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD 21201 (e-mail:

Presented as a poster presentation at the ninth IAS Conference on HIV Science; July 23–26, 2017; Paris, France.

T.A.C. has received a speaker fee from Gilead Sciences. The research reported in this publication was supported by funding the US National Institutes of Health [R01 MH099001, R01 AI120913, and R01 MH110358]; the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the US Department of Defense [W81XWH-11-2-0174]; Fogarty Epidemiology Research Training for Public Health Impact in Nigeria program [D43TW010051]; and the President's Emergency Plan for AIDS Relief through a cooperative agreement between the Department of Health and Human Services/Centers for Disease Control and Prevention, Global AIDS Program, and the Institute for Human Virology—Nigeria [NU2GGH002099]. The remaining authors have no funding or conflicts of interest to disclose.

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The content is solely the responsibility of the authors and should not be construed to represent the positions of the National Institutes of Health, the US Army or the Department of Defense, or the Department of Health and Human Services. The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70.

The members of TRUST/RV368 Study Group are listed in Appendix 1.

Received June 04, 2018

Accepted November 26, 2018

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