Key Populations in Sub-Saharan Africa: Population Size Estimates and High Risk Behaviors

Abstract Background Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). Methods Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February–March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. Results 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: “I worry about getting infected with HIV”, item 4: “I am sure I will not get infected with HIV”, and item 8: “Getting HIV is something I have”) exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. Conclusion The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.

Download Full-text

Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study (Preprint)

10.2196/preprints.12118 ◽

2018 ◽

Author(s):

Reena H Doshi ◽

Kevin Apodaca ◽

Moses Ogwal ◽

Rommel Bain ◽

Ermias Amene ◽

...

Keyword(s):

Population Size ◽

Latent Class ◽

Latent Class Model ◽

Key Populations ◽

Size Estimation ◽

Public Health Response ◽

Hiv Epidemic ◽

Population Size Estimates ◽

Capture Recapture ◽

Size Estimates

BACKGROUND Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. OBJECTIVE The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. METHODS Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). RESULTS We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). CONCLUSIONS Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.

Download Full-text

An indirect estimation of the population size of students with high-risk behaviors in select universities of medical sciences: A network scale-up study

PLoS ONE ◽

10.1371/journal.pone.0195364 ◽

2018 ◽

Vol 13 (5) ◽

pp. e0195364 ◽

Cited By ~ 4

Author(s):

Homeira Sajjadi ◽

Zahra Jorjoran Shushtari ◽

Mohsen Shati ◽

Yahya Salimi ◽

Masoomeh Dejman ◽

...

Keyword(s):

High Risk ◽

Population Size ◽

Risk Behaviors ◽

Scale Up ◽

Medical Sciences ◽

High Risk Behaviors ◽

Indirect Estimation ◽

Network Scale ◽

Scale Up Study

Download Full-text

Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study

JMIR Public Health and Surveillance ◽

10.2196/12118 ◽

2019 ◽

Vol 5 (3) ◽

pp. e12118 ◽

Cited By ~ 5

Author(s):

Reena H Doshi ◽

Kevin Apodaca ◽

Moses Ogwal ◽

Rommel Bain ◽

Ermias Amene ◽

...

Keyword(s):

Population Size ◽

Latent Class ◽

Latent Class Model ◽

Key Populations ◽

Size Estimation ◽

Public Health Response ◽

Hiv Epidemic ◽

Population Size Estimates ◽

Capture Recapture ◽

Size Estimates

Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.

Download Full-text

Programmatic Mapping to Estimate Size, Distribution, and Dynamics of Key Populations in Kosovo (Preprint)

10.2196/preprints.11194 ◽

2018 ◽

Author(s):

Dafina Gexha Bunjaku ◽

Edona Deva ◽

Luljeta Gashi ◽

Pranvera Kaçaniku-Gunga ◽

Carly A. Comins ◽

...

Keyword(s):

Hiv Prevention ◽

Population Size ◽

Sex Work ◽

Sex Workers ◽

Large Scale ◽

National Level ◽

Key Populations ◽

Hiv Prevention Strategies ◽

Population Size Estimates ◽

Size Estimates

BACKGROUND The burden of an HIV epidemic in Kosovo lies among the key populations (KPs) of female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs). The available interventions for KPs are fragmented and lack sufficient and appropriate granularity of information needed to develop large-scale outreach programs. OBJECTIVE The aim of this study was to estimate the size and distribution of these populations to create evidence for developing action plans for HIV prevention. METHODS The programmatic mapping approach was used to collect systematic information from key informants, including geographic and virtual locations in 26 municipalities of Kosovo between February to April 2016. In level 1, information was gathered about KPs’ numbers and locations through 1537 key informant interviews within each municipality. Level 2 involved validating these spots by conducting another 976 interviews with KPs congregating at those spots. Population size estimates were calculated for each spot, and finally a national-level estimate was developed, which was corrected for duplication and overlaps. RESULTS Of the estimated 6814 MSM (range: 6445 to 7117), nearly 4940 operate through the internet owing to the large stigma and discrimination against same-sex relationships. Geo-based MSM (who operate through physical spots) congregate at a few spots with large spot sizes (13.3 MSM/spot). Three-fourths of the MSM are distributed in 5 major municipalities. Fridays and Saturdays are the peak days of operation; however, the number only increases by 5%. A significant number are involved in sex work, that is, provide sex to other men for money. PWIDs are largely geo-based; 4973 (range: 3932 to 6015) PWIDs of the total number of 5819 (range: 4777 to 6860) visit geographical spots, with an average spot size of 7.1. In smaller municipalities, they mostly inject in residential locations. The numbers stay stable during the entire week, and there are no peak days. Of the 5037 (range: 4213 to 5860) FSWs, 20% use cell phones, whereas 10% use websites to connect with clients. The number increases by 25% on weekends, especially in larger municipalities where sex work is mostly concentrated. Other than a few street-based spots, most spots are establishments run by pimps, which is reflective of the highly institutionalized, structured, and organized FSW network. CONCLUSIONS This study provides valuable information about the population size estimates as well as dynamics of each KP, which is the key to developing effective HIV prevention strategies. The information should be utilized to develop microplans and effectively provide HIV prevention services to various KPs.

Download Full-text

The SRM Approach to Family Assessment

European Journal of Psychological Assessment ◽

10.1027/1015-5759.21.4.216 ◽

2005 ◽

Vol 21 (4) ◽

pp. 216-225 ◽

Cited By ~ 21

Author(s):

William L. Cook

Keyword(s):

High Risk ◽

Risk Behaviors ◽

Social Relations ◽

Family Relationships ◽

Family Dynamics ◽

Family Assessment ◽

High Risk Behaviors ◽

Analysis Group ◽

The Social ◽

Direction Of Effects

Abstract. In family systems, it is possible for one to put oneself at risk by eliciting aversive, high-risk behaviors from others ( Cook, Kenny, & Goldstein, 1991 ). Consequently, it is desirable that family assessments should clarify the direction of effects when evaluating family dynamics. In this paper a new method of family assessment will be presented that identifies bidirectional influence processes in family relationships. Based on the Social Relations Model (SRM: Kenny & La Voie, 1984 ), the SRM Family Assessment provides information about the give and take of family dynamics at three levels of analysis: group, individual, and dyad. The method will be briefly illustrated by the assessment of a family from the PIER Program, a randomized clinical trial of an intervention to prevent the onset of psychosis in high-risk young people.

Download Full-text

Young African American Adults At High Risk for HIV, STDs Even In Absence of High-Risk Behaviors

PsycEXTRA Dataset ◽

10.1037/e574092006-001 ◽

2006 ◽

Keyword(s):

African American ◽

High Risk ◽

Risk Behaviors ◽

High Risk Behaviors ◽

African American Adults

Download Full-text

Depression Rates and Its Relation to High-Risk Behaviors Among Women Street-Sex Workers

PsycEXTRA Dataset ◽

10.1037/e664392012-001 ◽

2012 ◽

Author(s):

Lyllymar Colon ◽

Vivian Tamayo-Agrait ◽

Isaedmarie Febo ◽

Paola Piovanetti ◽

Michelle Pico ◽

...

Keyword(s):

High Risk ◽

Risk Behaviors ◽

Sex Workers ◽

High Risk Behaviors

Download Full-text

Correlation between attachment style and mental health with high risk behaviors in adolescences

Quarterly Journal of Psychology Educational and Social Sciences ◽

10.21859/psychol-020112 ◽

2018 ◽

Vol 2 (1) ◽

pp. 114-121

Author(s):

Mohammad Reza Asadi ◽

Zeinab Saeediaee ◽

Mehdi Mohammadi ◽

Mahdi Kheradmand

Keyword(s):

Mental Health ◽

High Risk ◽

Risk Behaviors ◽

Attachment Style ◽

High Risk Behaviors

Download Full-text

Estimating the population size of people who inject drugs in Ho Chi Minh City, Vietnam: A two-survey capture-recapture exercise (Preprint)

10.2196/preprints.16459 ◽

2019 ◽

Author(s):

Abu Abdul-Quader

Keyword(s):

Population Size ◽

Illicit Drugs ◽

People Who Inject Drugs ◽

Care Service ◽

Ho Chi Minh City ◽

Size Estimation ◽

Population Size Estimates ◽

Capture Recapture ◽

The City ◽

Size Estimates

BACKGROUND Population size estimation of people who inject drugs (PWID) in Ho Chi Minh City (HCMC), Vietnam relied on the UNAIDS Estimation and Projection Package and reports from the city police department. The two estimates vary widely. OBJECTIVE To estimate the population size of people who inject drugs in Ho Chi Minh City, Vietnam METHODS Using Respondent-driven sampling (RDS), we implemented two-source capture-recapture method to estimate the population size of PWID in HCMC in 2017 in 7 out of 24 districts. The study included men or women aged at least 18 years who reported injecting illicit drugs in the last 90 days and who had lived in the city the past six months. We calculated two sets of size estimates, the first assumed that all participants in each survey round resided in the district where the survey was conducted, the second, used the district of residence as reported by the participant. District estimates were summed to obtain an aggregate estimate for the seven districts. To calculate the city total, we weighted the population size estimates for each district by the inverse of the stratum specific sampling probabilities. RESULTS The first estimate resulted in a population size of 19,155 (95% CI: 17,006–25,039). The second one generated a smaller population size estimate of 12,867 (95% CI: 11,312–17,393). CONCLUSIONS The two-survey capture-recapture exercise provided two disparate estimates of PWID in HCMC. For planning HIV prevention and care service needs among PWID in HCMC, both estimates may need to be taken into consideration together with size estimates from other sources.

Download Full-text