Evaluating changes in the prevalence of female genital mutilation/cutting among 0-14 years old girls in Nigeria using data from multiple surveys: A novel Bayesian hierarchical spatio-temporal model.

Female genital mutilation/cutting (FGM/C) is considered a public health and human rights concern, mainly concentrated in Africa, and has been targeted for elimination under the sustainable development goals. Interventions aimed at ending the practice often rely on data from household surveys which employ complex designs leading to outcomes that are not totally independent, thus requiring advanced statistical techniques. Combining data from multiple surveys within robust statistical framework holds promise to provide more precise estimates due to increased sample size, and accurately identify 'hotspots' and allow for assessment of changes over time. In this study, rich datasets from six (6) successive waves of the Nigeria Demographic and Health Surveys and Multiple Indicator Cluster Surveys undertaken between 2003 and 2016/17, were combined and analyzed in order to better assess changes in the likelihood and prevalence of FGM/C among 0-14-year old girls in Nigeria. We used Bayesian hierarchical regression models which explicitly accounted for the inherent spatial and temporal autocorrelations within the data while simultaneously adjusting for variations due to different survey methods and the effects of linear and non-linear covariates. Parameters were estimated using Markov chain Mote Carlo techniques and model fit assessments were based on Deviance Information Criterion. Results show that prevalence of FGM/C among 0-14 years old girls in Nigeria varied over time and across geographical locations and peaked in 2008 with a shift from South to North. A girl was more likely to be cut if her mother was cut, supported FGM/C continuation, or had no higher education. The effects of mother's age, wealth and type of residence (urban-rural) were no longer significant in 2016. These results reflect the gains of interventions over the years, but also echo the belief that FGM/C is a social norm thus requiring tailored all-inclusive interventions for the total abandonment of FGM/C in Nigeria.

Comparison of audio computer assisted self-interview and face-to-face interview methods in eliciting HIV-related risks among men who have sex with men and men who inject drugs in Nigeria.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria.

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6-9.4), less education (OR 2.0, 95% CI = 1.4-3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6-3.2), being an insertive partner (OR 3.0, 95% CI = 1.9-4.5), being HIV-negative (OR 1.6, 95% CI = 1.1-2.5), living in Lagos (OR 2.3, 95% CI = 1.7-2.2), being Muslim (OR 1.7, 95% CI = 1.1-2.5), and being away from home (OR 1.5, 95% CI = 1.0-2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5-10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5-3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9-4.9), being away from home (AOR = 1.6; 95% CI = 1.1-2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0-2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.