The Epidemiology of HIV and Injection Practices Among People Who Inject Drugs in Nigeria: Results from the 2020 Integrated Biological and Behavioural Surveillance Survey

INTRODUCTION: People who inject drugs (PWID) are an important driver of the HIV epidemic in Nigeria. This study describes the HIV, demographic, and injection characteristics of PWID. METHODS: Cross-sectional integrated biological and behavioural survey conducted in 2020 across 12 states in Nigeria. HIV seroprevalence based on screening and confirmatory tests, and self-reported data on socio-demographic and injection/sharing practices. Multivariable logistic regression models estimated crude and adjusted odds ratios (A/ORs) and 95% confidence intervals (95% CIs) of factors associated with HIV prevalence, and injection and sharing practices. RESULTS: Among 4,358 participants, weighted HIV prevalence was 10.9%. Median age was 30 years (IQR: 25-35) with two-thirds reporting less than 75 months of injection drug use. 80% of participants reported injecting in the last month. Of those injecting in the last month, 21% reported injecting at least once a day, 15% reported "almost/every time" to sharing or lending syringes/needles, while 9% reported back/front-loading, sharing paraphernalia, or drawing up from a common container "almost/every time". In multivariable models, female sex (AOR: 1.6, 95% CI: 1.2-2.1) and less than secondary education (AOR: 1.4, 95% CI: 1.1-2.0) was associated with HIV. Riskier injection practices were associated with pentazocine (AOR: 1.7, 95% CI: 1.2-2.4) and crack cocaine (AOR: 2.0, 95% CI: 1.4-2.8) injection. CONCLUSIONS: HIV prevalence was high amongst study participants, as were riskier injection and sharing practices, with structural determinants like education being associated with both.