Papers by Godwin Emmanuel
Introduction: People who inject drugs (PWIDs) living with HIV face high levels of stigma, violenc... more Introduction: People who inject drugs (PWIDs) living with HIV face high levels of stigma, violence, and rape due to their risky lifestyles, potentially facilitating the spread of HIV. This study assessed the level and type of stigma and violence among PWIDs attending Heartland Alliance in Akwa Ibom State and their coping mechanisms. Methods This descriptive cross-sectional study of 442 PWIDs receiving care at four one-stop shops in the state was conducted using mixed methods. Quantitative data were collected through pretested structured questionnaires and an adopted stigma scale, administered by trained research assistants using Computer Assisted Personal Interviewer (CAPI). For qualitative data, one focus group discussion (FGD) was held at each site with 8–10 purposively selected PWIDs, and transcripts were analysed thematically. Results Most respondents were male (78%) with a mean age of 32.7 ± 7 years. Pentazocine use was common (52%), and 18% shared needles, with 15% sharing blo...
Data collection tool for sexual practices, sexual behavior and HIV risk profile of key population... more Data collection tool for sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria (N = 488). (RTF 2339 kb)
eClinicalMedicine, 2022
Summary Background The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people wh... more Summary Background The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and partners of people living with HIV. Due to stigma and discrimination, these groups have low access to HIV testing services (HTS) and linkage to treatment is challenging. To address this gap, index partner testing, targeting sexual contacts and injecting partners of KP index clients, was introduced in 2017. Methods The study was a retrospective analysis of community-led HIV index partner testing-involving review of secondary data from partner notification services registers. Between October 1, 2018, and September 30, 2019, HIV testing as part of index partner testing services was offered at nightclubs, hotels, and community-based ART clinics in the states of Akwa Ibom, Cross River, and Lagos. Index testing was assisted by peer navigators. We used provider and passive Partner Notification (PN) methods. In-person and social network methods were used to recruit partners of KP. We described the implementation of index partner testing services as part of the national KP program, analyzed PN delivery models, and calculated HIV seropositivity among persons who underwent Index Partner Testing. One-Way ANOVA and Tukey-HSD test were performed to determine whether the differences in mean HIV seropositivity between partners are statistically significant. Findings PN was predominantly done through provider referral 5,159 (68.3%) and passive/client referral 2,278 (30.1%). A total of 3,119 index partners; 1,322 FSW (42.4%), 1,255 MSM (40.2%) and 542 PWID (17.4%) identified 8,989 sexual and injecting partners (index partner ratio 1:2.9). Among the partners, 7,556 (84.1%) were first-time testers, and 79.4% (5,999) of male partners tested. Of the 3,753 (49.7%) partners who tested HIV-positive, 3,492 (93.0%) were enrolled in HIV care. HIV seropositivity rate was 65.5% (1,021/1,557) among females and 45.5% (2,732/5,999) among males and was disproportionately higher among PWID injecting partners 99.1% (581/586), PWID sexual partners 98.9% (433/438) and MSM sexual partners 95.6% (605/633) in Cross river compared with 71.4% (575/805) in FSW sexual partners. Interpretations Including index partner testing as part of a community-led HTS can help improve HIV case-finding approach for KP, particularly for reaching first-time testers, male KP, and persons not yet diagnosed with HIV. Scale-up of index partner testing within community-led HTS is essential for achieving the United Nations 95–95–95 goals. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
SSRN Electronic Journal, 2021
Background: The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who injec... more Background: The HIV epidemic in Nigeria is concentrated in Key Populations (KP), people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and partners of people living with HIV. Due to stigma and discrimination, these groups have poor access to HIV testing services (HTS) and linkage to treatment is challenging. To address this gap, index case testing, targeting sexual contacts and injecting partners of KP index clients, was introduced in 2017.MethodsHTS was offered between October 1, 2018 and September 30, 2019 in nightclubs, hotels, or community-based ART clinics in Akwa Ibom, Cross River and Lagos states. Index testing was assisted by peer navigators. In-person and social network methods were used to mobilize partners of KP. We described the feasibility of implementing index testing, analyzed Partner Notification (PN) delivery models, and calculated HIV seropositivity among persons who underwent Index Testing. Findings: We found that a mixed appro...
BMC Public Health, 2020
Background Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effe... more Background Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effective HIV prevention tools. This study identified perspectives of MSM, FSW and policy makers on the needs for, barriers to, and challenges with pre-exposure HIV prophylaxis (PrEP); and the logistics required to support roll-out of PrEP for MSM and FSW in Nigeria. Methods Qualitative and quantitative data were collected through a cross-sectional study. The quantitative data were collected through an online survey administered to 519 MSM, FSW and transgender respondents. The qualitative data were collected through 22 focus group discussions with 140 MSM and 80 FSW, and a two-day consultative workshop with 65 participants. Two open-ended questions in the online survey were also a source of qualitative data. Results of the quantitative data were reported descriptively; the qualitative data were inductively examined with a content analytic approach to construct descriptive categories. The fin...
BMC Public Health, 2019
Background: There is little evidence on the need for differentiated HIV prevention services for m... more Background: There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. Methods: This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. Results: The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. Conclusion: HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.
Background To identify the proportion of FSW, MSM and PWID who had accessed HIV prevention servic... more Background To identify the proportion of FSW, MSM and PWID who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. Settings Four states in Nigeria Methods A mixed method approach was used to collect data from key populations in four states in Nigeria. Data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analysis was conducted for quantitative data. Results 49.4% of the 482 respondents, and 48.7% of the 485 respondents to the question, had received HIV and sexual and reproductive health services through the public health and peer-led facilities respectively. Significantly more respondents were ...
BMC International Health and Human Rights, 2019
Background: There have been several barriers in effectively engaging men who have sex with men fo... more Background: There have been several barriers in effectively engaging men who have sex with men for STI/HIV prevention and treatment programming in Nigeria including social stigma, policies, and laws criminalizing same-sex practices. The objective of this study was to describe the human rights context for MSM in Abuja and characterize factors associated with having had a genital ulcer disease in the previous 12 months, a health outcome associated with increased risk of HIV acquisition and transmission. Methods: A convenience sample of 297 men reporting ever having had anal intercourse with another man participated in the study in 2008. A structured survey instrument including sexual risk behaviour for STI/HIV, disclosure of sexual orientation, perceived and enacted human rights violations were performed. Descriptive and inferential data analyses were conducted using Stata11 software. Results: 36% reported having been discriminated due to sexual orientation and 17% reported being afraid to walk the streets of their community. Enacted rights violations included 41% having been blackmailed, 36% been beaten, 13% been denied housing, and 11% been jailed due to sexual orientation. Having been blackmailed due to sexual orientation (aOR 3.40, 95%CI: 1.35-8.56) was significantly associated with reporting having had a genital ulcer in the last 12 months. Having been beaten due to sexual orientation (aOR 2.36, 95%CI:0.96-5.82) was moderately significantly associated with reporting having had a genital ulcer in the last 12 months. Conclusions: High levels of experienced stigma, discrimination and human rights violations among MSM in Abuja was reported, constituting structural risks that are linked to sexual risk behaviour for STI/HIV. Given data on the high prevalence and incidence of HIV among MSM in Abuja, these findings reinforce the need for structural interventions to mediate access to STI/HIV prevention and treatment services.
AIDS Research and Human Retroviruses, 2012
The objective of the study was to characterize factors associated with consistent condom use amon... more The objective of the study was to characterize factors associated with consistent condom use among men who had sex with men (MSM) in Abuja, Nigeria. A convenience sample consisting of 297 MSM was recruited during 2008 using a combination of peer referral and venue-based sampling. Descriptive statistics with chi square and t-test were used for demographic, sexual identity, and practices variables. Univariate and multivariate logistic regressions were used to identify factors associated with consistent condom use with male partners in the past 6 months. Approximately more than half (53%, n = 155/290) reported always using condoms with male partner in the past 6 months and 43% (n = 95/219) reported always using condoms with female partners in the past 6 months. In all, 11% (n = 16/144) reported always engaging in safe sex defined as always using condoms with both male and female partners and always using a water-based condom compatible lubricant with male partners in the past 6 months. Independent associations with consistent condom use with male partners in the past 6 months were knowledge of at least one sexually transmitted infection (STI) that can be transmitted through unprotected anal intercourse (OR 2.47, 95% CI: 1.27-4.83, p < 0.01) and having been tested for HIV (OR 2.40, 95% CI: 1.27-4.54, p < 0.01). MSM who had been HIV tested at least once were more likely to use condoms consistently during anal intercourse in multivariate analyses. In addition, STI knowledge was also associated with consistent condom use during anal intercourse implying that interventions targeting high-risk practices are effective as HIV prevention for this high-risk group. Future directions include intervention research to determine the appropriate package of services for MSM in Nigeria. In addition, implementation science evaluations of how best to operationalize combination HIV prevention interventions for MSM given the criminalization and stigmatization of same-sex practices are crucial.
BMC Health Services Research, 2019
Background: The study objectives were to identify differences in HIV sexual risk behavior of men ... more Background: The study objectives were to identify differences in HIV sexual risk behavior of men who had sex with other men (MSM) resident in urban and rural Nigeria, their perspectives on need for HIV prevention services and perceived barriers and facilitators to access of HIV prevention services in private, public and peer-led health facilities. Method: Data were collected from MSM resident in urban and rural parts of River and Kaduna States. Qualitative assessment sought perspectives on barriers and facilitators of MSM uptake of HIV prevention services. In addition, a questionnaire was administered to seek information on HIV sexual risk behaviors (sexual abuse, age of sexual debut, multiple sexual partners and use of condom at last sexual intercourse), willingness to use and perceived barriers to access of HIV prevention services in public, private and peer-led health facilities, and willingness to use and perception about availability of structural intervention services. Differences in HIV sexual risk behaviors by residential location, and associations between sexual risk behavior and willingness to access HIV prevention services were determined. Results: More MSM resident in urban than rural areas engaged in three or more HIV sexual risk behaviors (25.9% vs 8.7%; p = 0.02). More respondents were willing to access HIV prevention service provided through peer-led health facilities. Less than 35% of respondents identified non-availability of free services as a barrier to HIV prevention service access in the three types of health facilities. More MSM with multiple sexual risk behaviors were willing to access services promoting mental and psychosocial health (p < 0.001), HIV positive peer support programs (p = 0. 002) and training on human rights and paralegal services (p < 0.001). Respondents opined that services that assured confidential HIV testing and mitigated structural drivers of HIV infection for MSM provided through peer-led facilities, will increase MSM's uptake of HIV prevention services. Conclusion: HIV risk reduction intervention services differentiated by rural and urban residence, may be needed for MSM. Services provided through peer-led facilities, that include mental and psychosocial health care, peer support, human rights and paralegal services will likely increase its use by MSM with more HIV sexual risk behaviors.
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Papers by Godwin Emmanuel