Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in İstanbul and Ankara, Turkey

2021 ◽  
pp. sextrans-2020-054894
Author(s):  
Deniz Gokengin ◽  
Georgetta Aybek ◽  
Sevgi O Aral ◽  
James Blanchard ◽  
Demir Serter ◽  
...  
Keyword(s):  
Sex Workers ◽  
Hot Spots ◽  
Implementation Strategies ◽  
Peak Time ◽  
Sex Partners ◽  
Size Estimation ◽  
Programme Implementation ◽  
Night Time ◽  
Prevention Services ◽  
Sex With Men

ObjectivesDespite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies.MethodsFemale and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in İstanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots.ResultsFSWs were the largest KP identified in İstanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both İstanbul and Ankara.ConclusionsThis study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in İstanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest.

Dyspareunia, Signs of Epithelial Disruption, and HIV Serostatus in Female Sex Workers and Men Who Have Sex With Men in Nairobi: an Observational Study

2021 ◽  
Author(s):  
Bastian Fischer ◽  
Walter Godfrey Jaoko ◽  
Elvis Kirui ◽  
Bernard Muture ◽  
Isaac Madegwa ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Hiv Infection ◽  
Sex Workers ◽  
Sexual Debut ◽  
Sex Partners ◽  
Hiv Status ◽  
Intravaginal Practices ◽  
Sex With Men ◽  
Epithelial Disruption

Abstract Background: This study investigated HIV infection risk in men who have sex with men (MSM) and female sex workers (FSWs) by analysing signs of anal and vaginal epithelial trauma. It reconsidered the unique role of sexual abstinence for HIV seroconversion from a previous case-control analysis on FSWs in Nairobi who acquired HIV after previously fulfilling criteria of HIV resistance. The approach was based on a similarly unique role of intercourse frequency for anal dyspareunia. We considered confounding behavioural and individual HIV infection risks among the sex workers, who also assessed factors influencing discomfort and pain during sex from a subjective perspective. Methods: At two key population facilities in Nairobi, 322 FSWs and 231 MSM provided data on HIV infection status, sexual dysfunction, intercourse frequency and abstinence behaviour. Additional data addressed sexual debut, relationship status, lubricants, foreplay, the number of sex partners, condom use, group and anonymous sex, vaginal births, intravaginal practices, sex toys, other sexually transmitted infections, alcohol and drug use. Statistical tests included t-tests for the equality of means for abstinence gaps and intercourse frequencies, the number of sex partners, vaginal births, and age of sexual debut. Non-parametric tests were used to compare HIV status and the ordinal variables of sexual behaviour, individual factors, dyspareunia and signs of trauma scores. Subjective assessments of variables for sexual dysfunction were given as percentages of the assessment options. Results: Among FSWs, significant associations were found between HIV status and the longest abstinence gap for vaginal intercourse in the previous month, early sexual debut, foreplay, having anonymous partners, intravaginal practices, drugs and alcohol use, and all the sexual dysfunction or epithelial disruption signs. No significant association between HIV status and sexual dysfunction variables or sexual abstinence gaps could be found in the MSM sample. FSWs agreed that steady partnerships, regularity of intercourse, foreplay and lubrication or artificial lubricants alleviate discomfort and painful intercourse. Conclusions: Dyspareunia and epithelial trauma signs were highly prevalent in FSWs and MSM, indicating considerable limitations to sexual health. Complaint levels were positively associated with HIV infection, suggesting that reducing epithelial disruption may be a novel HIV prevention approach.

scholarly journals Mapping key population hotspots in Nigeria for targeted HIV program planning (Preprint)

2020 ◽  
Author(s):  
Julia Lo ◽  
Samuel U. Nwafor ◽  
Amee M. Schwitters ◽  
Andrew Mitchell ◽  
Victor Sebastian ◽  
...  
Keyword(s):  
Sex Workers ◽  
Program Planning ◽  
The United States ◽  
Size Estimation ◽  
Emergency Plan ◽  
Targeted Interventions ◽  
Key Population ◽  
The Social ◽  
Capture Recapture ◽  
Sex With Men

BACKGROUND With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). Reliable and accurate mapping of KP 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 FSW, MSM, and PWID hotspots in seven states of Nigeria to inform HIV prevention and service programming and in preparation for a multiple-source capture-recapture population size estimation effort. METHODS In August 2018, 261 trained data collectors from 36 KP-led community-based organizations (CBOs) in seven priority states in Nigeria mapped, validated, and profiled hotspots identified during the formative assessment and designated by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Hotspots were defined as physical venues where KP members frequent to socialize, seek clients and/or engage in KP-defining behaviors. Hotspots were visited by data collectors and each hotspot’s name, local government area (LGA), address, type, geographic coordinates, peak times of activity, and estimated number of KP members were recorded. The number of KP hotspots per LGA were tabulated from the final list of hotspots. RESULTS A total of 13,899 KP hotspots were identified and mapped in the seven states, including 1,297 in Akwa Ibom, 1,714 in Benue, 2,666 in Cross River, 2,974 in Lagos, 1,550 in Nasarawa, 2,494 in Rivers and 1,204 in the Federal Capital Territory. The most common hotspots were those frequented by FSW (69.0%), followed by PWID (19.6%), and MSM (11.3%). More hotspots were found in metropolitan LGAs and state capitals, although hotspots were identified in all LGAs visited. CONCLUSIONS A total of 13,899 KP hotspots in the seven states were identified; more than previously reported in similar studies in Nigeria. Close collaboration with KP-led CBOs facilitated identification of many new and previously undocumented KP hotspots in the seven states. The small number of MSM hotspots (n=1,577) relative to FSW (n=9,593) and PWID (n=2,729) hotspots may reflect the social pressure and stigma faced by this population since the 2014 Same Sex Marriage (Prohibition) Act (SSMPA), which makes it illegal to engage in intimate relationships, organize meetings of gays or patronize gay businesses. CLINICALTRIAL

scholarly journals Mapping and size estimation of female sex workers and men who have sex with men in Sri Lanka

2013 ◽  
Vol 3 (1) ◽  
pp. 47 ◽  
Author(s):  
DA Karawita ◽  
S Moses ◽  
I Emmanuel ◽  
I Shajy ◽  
N Edirisinghe ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Size Estimation ◽  
Female Sex ◽  
Sex With Men

scholarly journals Population Size Estimation Methods: Searching for the Holy Grail (Preprint)

2020 ◽  
Author(s):  
Joyce J Neal ◽  
Dimitri Prybylski ◽  
Travis Sanchez ◽  
Wolfgang Hladik
Keyword(s):  
Population Size ◽  
Sex Workers ◽  
Population Size Estimation ◽  
Estimation Methods ◽  
Size Estimation ◽  
Empirical Methods ◽  
Program Outcomes ◽  
Gold Standard Method ◽  
Response Planning ◽  
Sex With Men

UNSTRUCTURED Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Key Population Size Estimations.” We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information.

scholarly journals Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya

2020 ◽  
Vol 4 ◽  
pp. 131
Author(s):  
Faran Emmanuel ◽  
Japheth Kioko ◽  
Helgar Musyoki ◽  
Shem Kaosa ◽  
Martin Kyana Ongaro ◽  
...  
Keyword(s):  
Population Size ◽  
Hot Spot ◽  
Sexual Partners ◽  
Sex Partners ◽  
Size Estimation ◽  
Multi Stage ◽  
Male Sexual Partners ◽  
Sex With Men ◽  
Virtual Platform ◽  
Virtual Mapping

Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets.

Prepped for PrEP? Acceptability, continuation and adherence among men who have sex with men and transgender women enrolled as part of Vietnam's first pre-exposure prophylaxis program

Sexual Health ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 104 ◽  
Author(s):  
Kimberly Elizabeth Green ◽  
Long Hoang Nguyen ◽  
Huong Thu Thi Phan ◽  
Bao Ngoc Vu ◽  
Minh Hung Tran ◽  
...  
Keyword(s):  
Transgender Women ◽  
Sex Partners ◽  
Average Income ◽  
Prevention Services ◽  
Key Population ◽  
Multivariable Regression ◽  
Sex With Men ◽  
Public Clinics ◽  
Exposure Prophylaxis ◽  
Roll Out

Background HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) in Vietnam is high, whereas coverage of effective HIV prevention services has been inadequate. Studies have measured MSM and TGW demand for pre-exposure prophylaxis (PrEP) services, which led to the design of the first ever PrEP program in Vietnam, Prepped for PrEP (P4P). Methods: In March 2017, PrEP services were offered in Ho Chi Minh City as part of the P4P demonstration project, enabling same-day enrolment in three key population (KP)-led clinics and four public clinics. P4P aimed to assess acceptability and feasibility of PrEP services through calculating the rate of PrEP enrolment over time, and quarterly measures of continuation and adherence over an 18-month period. Results: A total of 1069 MSM and 62 TGW were enrolled in P4P. Average monthly PrEP enrolment among MSM increased five-fold from the first 3 months (March–June 2017) to the last 3 months of active enrolment (March–June 2018), whereas for TGW, no increased trend in PrEP enrolment per quarter was seen. Self-reported PrEP adherence was >90% at all time points among MSM, but varied from 11.1% to 88.9% among TGW. PrEP continuation was calculated at months 3, 6, 9, 12, 15 and 18. For MSM, it was 88.7% at month 3, 68.8% at month 12 and 46.6% at month 18, whereas for TGW, it was 87.1%, 54.8% and 52.8%, respectively. Multivariable regression identified that MSM with lower-than-average income (adjusted odds ratio (aOR) 2.38 (95% confidence interval (CI): 1.59–3.54), P = 0.000), aged >30 years (aOR 2.03 (95% CI: 1.30–3.40), P = 0.007) and with an increasing number of sex partners (aOR: 1.06 (1.01–1.11), P = 0.011) had greater odds of remaining on PrEP. For TGW, being aged >30 years was associated with continuing on PrEP (aOR 5.62 (95% CI: 1.05–29.9), P = 0.043). Conclusions: We found PrEP to be highly acceptable among MSM and moderately acceptable among TGW. Continuation rates were relatively high for the first roll-out of PrEP; however, those aged ≤30 years were much more likely to discontinue services. Scaling-up PrEP through differentiated and community-led and engaged PrEP service delivery will be key to effectively increase access and uptake over the next 5 years.

scholarly journals Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya

2020 ◽  
Vol 4 ◽  
pp. 131
Author(s):  
Faran Emmanuel ◽  
Japheth Kioko ◽  
Helgar Musyoki ◽  
Shem Kaosa ◽  
Martin Kyana Ongaro ◽  
...  
Keyword(s):  
Population Size ◽  
Hot Spot ◽  
Sexual Partners ◽  
Sex Partners ◽  
Size Estimation ◽  
Multi Stage ◽  
Male Sexual Partners ◽  
Sex With Men ◽  
Virtual Platform ◽  
Virtual Mapping

Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets.

scholarly journals Population Size Estimation Methods: Searching for the Holy Grail

10.2196/25076 ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. e25076
Author(s):  
Joyce J Neal ◽  
Dimitri Prybylski ◽  
Travis Sanchez ◽  
Wolfgang Hladik
Keyword(s):  
Population Size ◽  
Sex Workers ◽  
Population Size Estimation ◽  
Estimation Methods ◽  
Size Estimation ◽  
Empirical Methods ◽  
Program Outcomes ◽  
Gold Standard Method ◽  
Response Planning ◽  
Sex With Men

Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Key Population Size Estimations.” We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information.

scholarly journals The cost of community outreach HIV interventions: a case study in Thailand

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Kyaw Min Soe ◽  
Katharina Hauck ◽  
Sukhum Jiamton ◽  
Sukhontha Kongsin
Keyword(s):  
Sex Workers ◽  
Economies Of Scale ◽  
Unit Cost ◽  
Community Outreach ◽  
People Living With Hiv ◽  
Hiv Interventions ◽  
Prevention Services ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Sex With Men

Abstract Background There was an estimated 440,000 people living with HIV in Thailand in 2018. New cases are declining rapidly thanks to successful prevention programs and scaling up of anti-retroviral therapy (ART). Thailand aims to achieve its commitment to end the HIV epidemic by 2030 and implemented a cascade of HIV interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program. Methods This study focused on community outreach HIV interventions implemented by Non-Governmental Organizations (NGOs) under the RRTTR program in 27 provinces. We calculated unit cost per person reached for HIV interventions targeted at key-affected populations (KAPs) including men who have sex with men/ transgender (MSM/TG), male sex workers (MSW), female sex workers (FSW), people who inject drugs (PWID) and migrants (MW). We studied program key outputs, costs, and unit costs in variations across different HIV interventions and geographic locations in Thailand. We used these estimates to determine costs of HIV interventions and evaluate economies of scale. Results The interventions for migrants in Samut Sakhon was the least costly with a unit cost of 21.6 USD per person to receive services, followed by interventions for migrants in Samut Prakan 23.2 USD per person reached, MSM/TG in Pratum Thani 26.5USD per person reached, MSM/TG in Nonthaburi 26.6 USD per person reached and, MSM/TG in Chon Buri with 26.7 USD per person. The interventions yielded higher efficiency in large metropolitan and surrounding provinces. Harm reduction programs were the costliest compare with other interventions. There was association between unit cost and scale of among interventions indicating the presence of economies scale. Implementing HIV and TB interventions jointly increased efficiency for both cases. Conclusion This study suggested that unit cost of community outreach HIV and TB interventions led by CSOs will decrease as they are scaled up. Further studies are suggested to follow up with these ongoing interventions for identifying potential contextual factors to improve efficiency of HIV prevention services in Thailand.

scholarly journals Kuantim mi tu (“Count me too”): Using Multiple Methods to Estimate the Number of Female Sex Workers, Men Who Have Sex With Men, and Transgender Women in Papua New Guinea in 2016 and 2017 (Preprint)

2018 ◽  
Author(s):  
Damian Weikum ◽  
Angela Kelly-Hanku ◽  
Parker Hou ◽  
Martha Kupul ◽  
Angelyne Amos-Kuma ◽  
...  
Keyword(s):  
Population Size ◽  
Papua New Guinea ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Size Estimation ◽  
Successive Sampling ◽  
The Past ◽  
Unique Object ◽  
Sex With Men ◽  
Port Moresby

BACKGROUND Female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW) are at high risk of acquiring HIV in many settings, such as Papua New Guinea (PNG). An understanding of the approximate size of these populations can inform resource allocation for HIV services for FSW, MSM, and TGW. OBJECTIVE An objective of this multi-site survey was to conduct updated population size estimations (PSE) of FSW and MSM/TGW. METHODS Respondent-driven sampling (RDS) biobehavioral surveys of FSW and MSM/TGW were conducted in 3 major cities—(1) Port Moresby, (2) Lae, and (3) Mount Hagen—between June 2016 and December 2017. Eligibility criteria for FSW included: (1) ≥12 years of age, (2) born female, (3) could speak English or Tok Pisin (PNG Pidgin), and (4) had sold or exchanged sex with a man in the past six months. Eligibility for MSM/TGW included: (1) ≥12 years of age, (2) born male, (3) could speak English, or Tok Pisin, and (4) had engaged in oral or anal sex with another person born male in the past six months. PSE methods included unique object multiplier, service multiplier, and successive sampling-population size estimation (SS-PSE) using imputed visibility. Weighted data analyses were conducted using RDS-Analyst and Microsoft Excel. RESULTS Sample sizes for FSW and MSM/TGW in Port Moresby, Lae, and Mount Hagen included: (1) 673 and 400, (2) 709 and 352, and (3) 709 and 111 respectively. Keychains were used for the unique object multiplier method and were distributed 1 week before the start of each RDS survey. HIV service testing data were only available in Port Moresby and Mount Hagen and SS-PSE estimates were calculated for all cities. Due to limited service provider data and uncertain prior size estimation knowledge, unique object multiplier weighted estimations were chosen for estimates. In Port Moresby, we estimate that there are 16,053 (95% CI 8232-23,874) FSW and 7487 (95% CI 3975-11,000) MSM/TGW, approximately 9.5% and 3.8% of the female and male populations respectively. In Lae, we estimate that there are 6105 (95% CI 4459-7752) FSW and 4669 (95% CI 3068-6271) MSM/TGW, approximately 14.4% and 10.1% of the female and male populations respectively. In Mount Hagen, we estimate that there are 2646 (95% CI 1655-3638) FSW and 1095 (95% CI 913-1151) MSM/TGW using service multiplier and successive sampling, respectively. This is approximately 17.1% and 6.3% of the female and male populations respectively. CONCLUSIONS As the HIV epidemic in PNG rapidly evolves among key populations, PSE should be repeated to produce current estimates for timely comparison and future trend analysis.

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