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People who use drugs are at higher risk of HIV: directly through the sharing of injecting equipment, indirectly through associated risk behavior, and physiologically through the substances’ impact on the immune system. Drug users, especially people who inject drugs (PWID) are a bridge to the general population. The treatment of drug addiction and provision of harm reduction interventions have impact on HIV transmission and incidence. Addiction treatment reduces the frequency of drug-related risky behaviors and enhances access and adherence to HIV treatment, resulting in fewer new infections. However, the drug policies of many African countries are punitive and hostile to harm reduction programs. These fuel criminalization of drug use and discrimination against the drug user thereby preventing individuals with drug addiction from accessing treatment programs. There is need to formulate policies aimed at protecting the rights of people with drug addiction and address the ethical aspects of treatment. (Afr J Reprod Health 2014; 18[3]: 47-54)Keywords: Drug users, Drug addiction, Substance use, HIV infection, Africa

Despite consistent evidence, effective interventions and political declarations to reduce HIV infections among men who have sex with men (MSM), coverage of MSM programmes in sub-Saharan Africa (SSA) remains low. Punitive legal frameworks and hostile social circumstances and inadequate health systems further contribute to the high HIV burden among MSM in SSA. The authors use the Modified Social Ecological Model to discuss economic influences in relation to HIV and MSM in SSA. Nigerian, South African and Ugandan case studies are used to highlight economic factors and considerations related to HIV among MSM. The authors argue that criminalisation of consensual sexual practices among adults increases the frequency of human rights violations contributing to the incidence of HIV infections. Furthermore, marginalisation and disempowerment of MSM limits their livelihood opportunities, increases the prevalence of sex work and drug use and limits financial access to HIV services. Sexual and social networks are complex and ignoring the needs of MSM results in increased risks for HIV acquisition and transmission to all sexual partners with cumulative economic and health implications. The authors recommend a public health and human rights approach that employs effective interventions at multiple levels to reduce the HIV burden among MSM and the general population in SSA.

People who use drugs are at higher risk of HIV: directly through the sharing of injecting equipment, indirectly through associated risk behavior, and physiologically through the substances' impact on the immune system. Drug users, especially people who inject drugs (PWID) are a bridge to the general population. The treatment of drug addiction and provision of harm reduction interventions have impact on HIV transmission and incidence. Addiction treatment reduces the frequency of drug-related risky behaviors and enhances access and adherence to HIV treatment, resulting in fewer new infections. However, the drug policies of many African countries are punitive and hostile to harm reduction programs. These fuel criminalization of drug use and discrimination against the drug user thereby preventing individuals with drug addiction from accessing treatment programs. There is need to formulate policies aimed at protecting the rights of people with drug addiction and address the ethical aspects of treatment.

Estimating the size of populations most affected by HIV such as men who have sex with men (MSM) though crucial for structuring responses to the epidemic presents significant challenges, especially in a developing society. Using capture-recapture methodology, the size of MSM-SW in Nigeria was estimated in three major cities (Lagos, Kano and Port Harcourt) between July and December 2009. Following interviews with key informants, locations and times when MSM-SW were available to male clients were mapped and designated as "hotspots". Counts were conducted on two consecutive weekends. Population estimates were computed using a standardized Lincoln formula. Fifty-six hotspots were identified in Kano, 38 in Lagos and 42 in Port Harcourt. On a given weekend night, Port Harcourt had the largest estimated population of MSM sex workers, 723 (95% CI: 594-892) followed by Lagos state with 620 (95%CI: 517-724) and Kano state with 353 (95%CI: 332-373). This study documents a large population of MSM-SW in 3 Nigerian cities where higher HIV prevalence among MSM compared to the general population has been documented. Research and programming are needed to better understand and address the health vulnerabilities that MSM-SW and their clients face.

Estimating the size of populations most affected by HIV such as men who have sex with men (MSM) though crucial for structuring responses to the epidemic presents significant challenges, especially in a developing society. Using capture-recapture methodology, the size of MSM-SW in Nigeria was estimated in three major cities (Lagos, Kano and Port Harcourt) between July and December 2009. Following interviews with key informants, locations and times when MSM-SW were available to male clients were mapped and designated as “hotspots”. Counts were conducted on two consecutive weekends. Population estimates were computed using a standardized Lincoln formula. Fifty-six hotspots were identified in Kano, 38 in Lagos and 42 in Port Harcourt. On a given weekend night, Port Harcourt had the largest estimated population of MSM sex workers, 723 (95%CI: 594-892) followed by Lagos state with 620 (95%CI: 517-724) and Kano state with 353 (95%CI: 332-373). This study documents a large population of MSM-SW in 3 Nigerian cities where higher HIV prevalence among MSM compared to the general population has been documented. Research and programming are needed to better understand and address the health vulnerabilities that MSM-SW and their clients face. Afr J Reprod Health 2013 (Special Edition); 17[4]: 83-89).Keywords: Male sex worker, Capture-recapture, size estimation, population estimates, Men who have sex with men, Nigeria, Lagos, Kano, Port Harcourt.

This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 - 2.9, p0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 - 2.7, p = 0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria.

A study was undertaken among 395 intra-city commercial bus drivers, conductors and motor park attendants in a sub-urban community in Lagos, Nigeria. It was aimed at ascertaining the level of knowledge of the participants on sexually transmitted diseases including AIDS, their sexual practices and perceived vulnerability to these diseases and, in particular, their attitude to and use of condoms. A semi-structured interview schedule was used for data collection. The men were found to have a strongly woven network of sexual relationships. Their sexual network included, apart from their wives and regular partners, commercial sex workers, young female hawkers, schoolgirls, and market women within and outside the motor parks. More than two thirds (74.3%) of the men had multiple sex partners and many of them had had sexually transmitted diseases at one time or another. Condom ever-use rate was 65.6% but consistent and regular use rate with casual partners was 11.6%. Almost all the respondents (96.4%) knew themselves to be at high risk of contracting STDs, while 87.6% felt that it was impossible for them to “catch” AIDS. Poor knowledge of risk factors for STDs was exhibited, as many of them attributed their previous STDs to excessive exposure to the sun, having sex in the sun, and their partners remaining in the bath for too long. Intra-city commercial bus operators and men at motor parks are a high risk group for acquiring HIV infection. Their sexual networking with a variety of women within and outside the parks also seems to suggest that they play a major role in transmitting HIV infection in urban communities in Nigeria. There is a need for intervention programmes with a focus on men at motor parks and similar high risk groups. RESUME Une etude a ete menee au sein de 395 chauffeurs d'autobus, des receveurs et les assistants des gares d'autobus dans une communaute sous-urbaine a Lagos, Nigeria. Elle avait pour but de verifier le niveau de connaissance des participants par rapport aux maladies sexuellent transmissibles y compris le SIDA, leurs pratiques sexuelles et la vulnerabilite percue a ces maladies, surtout leur attitude envers leur utilisation des preservatifs. Les donnees ont ete collectes a l'aide d'un programme d'une interview structuree. On a decouvert que les hommes avaient un reseau de rapport sexuel bien tisse. A part leurs femmes et des partenaires sexuels regulieres, leur reseau sexuel comprenait des prosittuees, des jeunes colporteuses, des ecolieres, des marchandes a l'interieur et a l'exterieur de la gare d'autobus. Plus de deux tiers (74,3%) des hommes avaient de multiples partenaires sexuelles et beaucoup d'entre eux ont eu, a un moment ou un autre, des maladies sexuellement transmissibles. Le taux d'avoir jamais utilise les preservatifs etait de 65,6% alors que le taux par rapport a l'utilisation constamment et regulierement avec les partenaires occassionnelles etait de 11,6%. Presque tous les repondants (96,4%) savaient qu'ils couraient de haut risque de contracter les ISTs alors que 87,6% ont estime qu'il leur etait impossible d'“attraper” le SIDA. Ils ont fait preuve d'une faible connaissance des facteurs de risque face aux ISTs puisque beaucoup d'entre eux ont attribue leurs ISTs ulterieures au fait d'etre en contact excessif avec le soleil, d'avoir fait l'amour sous le soleil et que leurs partenaires sont restees longtemps dans le bain. Les chauffeurs d'atuobus qui disservent la ville et les hommes qui se trouvent dans les gares d'autobus constituent un groupe en grand danger d'attraper l'infection du VIH. Leur moullage de reseau sexuel avec une variete de femmes a l'interieur et a l'exterieur de la gare d'autobus semble suggerer qu'ils jouent un role important dans la propagation du VIH dans les communautes urbaines au Nigeria. Il faut des programmes d'intervention qui se concentrent sur les hommes dans les gares d'autobus et sur les autres groupes en grand danger pareil. Afr J Reprod Health Vol.9 (1) 2005: 78–87

This study was conducted to examine the knowledge, beliefs and attitudes of nurses and laboratory technologists towards people living with HIV/AIDS (PLWA) and the factors responsible for these attitudes. Information was elicited from 254 randomly selected nurses and laboratory technologists from 15 government owned health facilities in Lagos State with the use of a structured questionnaire. Results indicate that most of the respondents (96.3%) had moderate to good knowledge of HIV/AIDS. Respondents' level of knowledge was influenced by the level of formal education attained, length of practice, gender and attendance at refresher courses on HIV/AIDS (p0.05). In contrast, respondents' age, occupation and religion did not significantly influence their level of knowledge (p0.05). Attitude towards PLWA was poor. Some (55.9%) of the health workers felt that PLWAs are responsible for their illness, while 35.4% felt that they deserve the punishment for their sexual misbehaviours. Only 52.8% of the respondents expressed willingness to work in the same office with a PLWA, while only 18.0% would accept to visit or encourage their children to visit a PLWA, probably because of the fear of contagion. It is, therefore, essential that health care providers be properly informed in order to improve their quality of care for PLWAs.

This study was conducted to examine the knowledge, beliefs and attitudes of nurses and laboratory technologists towards people living with HIV/AIDS (PLWA) and the factors responsible for these attitudes. Information was elicited from 254 randomly selected nurses and laboratory technologists from 15 government owned health facilities in Lagos State with the use of a structured questionnaire. Results indicate that most of the respondents (96.3%) had moderate to good knowledge of HIV/AIDS. Respondents\' level of knowledge was influenced by the level of formal education attained, length of practice, gender and attendance at refresher courses on HIV/AIDS (p < 0.05). In contrast, respondents\' age, occupation and religion did not significantly influence their level of knowledge (p > 0.05). Attitude towards PLWA was poor. Some (55.9%) of the health workers felt that PLWAs are responsible for their illness, while 35.4% felt that they deserve the punishment for their sexual misbehaviours. Only 52.8% of the respondents expressed willingness to work in the same office with a PLWA, while only 18.0% would accept to visit or encourage their children to visit a PLWA, probably because of the fear of contagion. It is, therefore, essential that health care providers be properly informed in order to improve their quality of care for PLWAs. (Afr J Reprod Health 2003; 7[1]: 103–112) Résumé Attitudes des dispensateurs des soins médicaux envers les sidéens dans l\'etat de Lagos. Cette étude a été menée pour examiner la connaissance, les croyances et les attitudes des infirmières et des techniciens de laboratoires envers les sidéens et les facteurs qui en sont responsables. L\'information a été recueillie, à l\'aide d\'un questionnaire structuré, auprès de 254 infermières et techniciens de laboratoire selectionnés au hasard dans 15 hôpitaux gouvernementaux dans l\'Etat de Lagos. Les résultats ont montré que la plupart des interrogés (96,3%) ont une bonne connaissance du VIH/SIDA. Le niveau de connaissance chez les interrogés a été influencé par le niveau de l\'éducation formelle atteint, la durée de la pratique, les sexes et la fréquentation aux stages de recyclage sur le VIH/SIDA (p < 0,05). Par contre, l\'âge, le métier et la religion des interrogés n\'ont pas influencé, leur connaissance de manière significative, (p < 0,05). L\'attitude envers les sidéeens était mauvaise. Certaines (55,9%) parmi les infirmières estimaient que les sidéens étaient responsables de leur maladie alors que 35,4% estimaient qu\'ils méritaient la punition pour leurs mauvaises conduites sexuelles. Seuls 52,8% des interrogés ont exprimé la volonté de travailler dans le même bureau que les sidéens alors que 18% aimeraient visiter ou encourager leurs enfants de visiter les sidéens probablement de peur d\'être infectés. Il est donc bien nécessaire que les dispensateurs des soins médicaux soient bien informés afin d\'améliorer leur qualité de soins pour les sidéens. (Rev Afr Santé Reprod 2003; 7[1]: 103–112) Key Words: AIDS, HIV, attitude, health care providers, PLWA