Key Population Hotspots in Nigeria for Targeted HIV Program Planning: Mapping, Validation, and Reconciliation

Abstract

Background With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. Objective We aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort. Methods In August 2018, 261 trained data collectors from 36 key population–led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President’s Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population–defining behaviors. Hotspots were visited by data collectors, and each hotspot’s name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots. Results A total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals. Conclusions The number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population–led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.

Social venues and HIV vulnerability of young venue workers: a cluster analysis of data from a national-level cross-sectional survey of social venues in Uganda

“…Venues for social interaction are public places where one can go to relax, have fun, drink alcohol or find a sexual partner. These venues are common hotspots for populations at a higher risk of HIV exposure 4. An increasing body of literature suggests that venues for social interactions influence HIV transmission or acquisition in two ways.…”

“…Previous research, both qualitative and quantitative, has given considerable attention to venues where people meet sexual partners. Studies, including some in Africa, have mapped and characterised these venues,4 26–29 while others have examined sexual behaviours and HIV seroprevalence of workers and customers at venues for social interaction 2 6 8 11 12. Relatedly, other studies have assessed availability of HIV preventive interventions at venues for social interaction and provided a case for support for venue-based HIV programmes 2 30–32.…”

Barriers to the uptake of oral pre-exposure prophylaxis among young key populations in Nigeria

“…2 The survey used a multi-stage probability sampling approach. A fixed number of hotspots (specific locations or areas where KP frequent to socialize or seek clients, or engaged in sexual acts or drug use) 13 were randomly selected after stratifying the listed spots by KP group, local government areas, and the number of KP per spot. The hotspots served as the primary sampling units (PSU).…”

Key Population Size Estimation to Guide HIV Epidemic Responses in Nigeria: Bayesian Analysis of 3-Source Capture-Recapture Data

“…The unique objects were distributed in hotspots, defined as venues where key population members congregate or engage in sexual or injecting behaviors. With the most recent lists (from 2013 and 2015) produced by efforts to map key population hotspots [ 15 , 16 ] as a foundation, we engaged 261 key population members from 36 key population–led, community-based organizations in the 7 states for a comprehensive review and update of hotspot information during August 2018 [ 36 ]. Local government areas were grouped into 3 zones per state to manage staff, equipment, and travel for the mapping activity, which facilitated better control over missing or duplicate hotspot visits.…”

“…We sampled key population members from hotspots based on the mapping and validation activity completed immediately prior to 3S-CRC sampling [ 36 ].…”