Behavioural Surveillance Among High Risk Groups in a Generalized Epidemic Setting:

1. Behavioural Surveillance Among High Risk Groups in a Generalized Epidemic Setting: Implications from Nigeria’s 2007 Integrated Biological and Behavioural Surveillance Survey (IBBSS) Mike Merrigan, Director of Monitoring and Evaluation, Family Health International Nigeria Issa Kawu, Head of HIV Surveillance, Ministry of Health, Nigeria

2. The 2007 IBBSS Was Supported By:

3. Nigeria has a generalized epidemic. Until 2007, ANC surveys were the primary source of HIV prevalence data in the national surveillance system ANC HIV prevalence

4. In 2007 Nigeria’s first Integrated Biological and Behavioural Surveillance Survey (IBBSS) was conducted • Goal was to obtain HIV & syphilis prevalence, knowledge, behavioural and intervention-related exposure data among the following groups in 6 states of Nigeria: • FSW (brothel- and non-brothel-based) • MSM • IDU • Police • Armed forces • Transport workers (TW) • Cross-sectional survey with sample of 11,175 designed to yield state-level estimates • Generated data to compare with previous rounds of BSS; first time ever for HIV and Syphilis • Implemented by FMOH. FHI lead technical assistance partner, together with CDC

5. The results demonstrated that MARPs are disproportionately affected by HIV in Nigeria HIV prevalence

6. Behavioural data highlights important HIV transmission routes between MARPS and the general population

7. FSW - the majority had sex with boyfriends in past 12 months 4.5% of women and 8.2% of men report ever participating in transactional sex (NARHS+ 2008)

8. MSM - A large proportion had sex with a female partner in the past 6 months. Sex with a female partner occurred an average of 2-5 times per month among this group. * * Lagos had highest HIV prevalence among MSM of 25.4%

9. IDU – sexually active IDU also had different types of sexual partners, including sex workers

10. Condom use – FSW/MSM/IDU no more likely to use condoms with boy/girlfriends than male occupational groups

11. MARP’s are also no more likely to know their HIV status

12. Why? There are indications that MARPs are under-served by prevention programs Armed Forces Non-brothel-based FSW Exposure to different interpersonal prevention interventions last 12 months

13. Conclusions (1) • MARPs (FSW, MSM, IDU) are more affected by HIV than other groups in Nigeria’s generalized epidemic setting • There are behavioural linkages between MARPs and the general population – they have girlfriends/boyfriends, regular and casual partners • Condom use in non-commercial sex involving MARPs is not higher than in the general population • Therefore, even in a generalized epidemic setting (and depending on the size of populations involved), the risk behaviour of MARPs can be an important driver of further HIV transmission

14. Conclusions (2) • Finally, because MARPs in Nigeria are no more likely to know their HIV status or be reached by prevention interventions than members of less affected groups - Behavioral surveillance data on MARPs is also important for helping target intervention efforts more appropriately and evaluating progress

15. Acknowledgements www.fhi.org/en/HIVAIDS/pub/survreports/res_IBBSSNigeria2008.htm