Prevalence and factors associated with anogenital warts among sexual and gender minorities attending a trusted community health center in Lagos, Nigeria

Abstract

Anogenital warts caused by human papillomavirus are common in sexual and gender minorities (SGM). The prevalence of, and factors associated with warts were described for SGM with a high burden of HIV in Nigeria. Individuals who reported anal sex with men were enrolled in the TRUST/RV368 cohort. Participants completed an interviewer-led survey, provided biological samples, and had a physical examination. Specific to the Lagos site, clinic staff offered standardized warts treatment services. RDS-weighted multivariable logistic regression was used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors potentially associated with anogenital warts. Of 672 enrolled SGM, 478 (71%) engaged in warts services and had complete data. The median age (interquartile range) was 22 (20–26) years, 272 (52%) initiated sex before age 18, and 347 (79%) were cisgender men. Multiple male sexual partners in the previous year were reported by 448 (90%) of the participants, and 342 (66%) were living with HIV. Warts were diagnosed in 252 (54%), including anal warts in 234 (43%) and penile warts in 44 (8%); 26 (5%) had both anal and penile warts. Factors independently associated with warts included HIV (AOR:2.97; CI:1.44–6.14), engaging in receptive anal sex (AOR:3.49; CI:1.25–9.75), having multiple male sexual partners (AOR:7.26; CI:2.11–24.87), age at sexual debut (AOR:0.53; CI:0.28–0.98), and non-binary gender identity (AOR:0.20; CI:0.05–0.71). Warts were common among SGM in Nigeria, particularly those living with HIV. Administration of HPV vaccination before sexual debut or as a catch-up vaccination may prevent HPV-associated complications.

Prevalence and Epidemiological Characteristics of Anogenital Warts Among Recently Diagnosed HIV-Positive Women on Antiretroviral Therapy in Lagos, Nigeria

“…HPW who are single were more likely to have AGWs compared to those who were married. This observation aligns with the results reported in certain studies, yet it contradicts the findings reported in another study [ 9 , 14 ]. This phenomenon can likely be attributed to the increased vulnerability of unmarried women to engaging in risky sexual behaviors, such as having multiple sexual partners, engaging with partners who have multiple sexual partners, and having a high number of sexual partners [ 23 - 25 ], which are risk factors for AGW.…”

“…According to the available data, individuals with higher levels of education or occupations in professional fields tend to exhibit a reduced likelihood of experiencing AGW [21]. However, it is essential to note that these findings contradict the results of another study, where education and occupation did not impact the risk of developing AGW [14].…”

“…The sub-Saharan Africa region exhibits a notable prevalence of HPV and HIV infections, which plays a significant role in the heightened burden of AGW and its unfavorable outcomes in the region [ 13 , 14 , 16 ]. Furthermore, several factors have been identified as potential influencers of the burden of AGW among PLWHA.…”

“…Research has demonstrated that the presence of HPV infection significantly elevates the likelihood of acquiring HIV infection. Conversely, the presence of HIV infection intensifies the persistence of HPV infection and its progression to disease [11][12][13][14]. The interaction between these factors contributes to the increased prevalence of HPV infection and the significant burden of HPV-related diseases observed in people living with HIV and AIDS (PLWHA) [15].…”

Brief Report: Prevalence and Predictors of Concern About Anal Cancer Among Sexual and Gender Minorites Living With HIV in Abuja, Nigeria

“…It has become common knowledge that receptive anal sex is associated with many sexually transmitted infections, including HPV. 44,45 Many of the participants may have experienced rectal gonorrhea, chlamydia, and HPV-associated anal warts 46,47 ; all associated with increased anal symptoms that require medical attention. It may be that knowing an additional medical condition, such as anal cancer, heightens levels of worry.…”