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

Abstract

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.

Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye

“…[38] In addition, MSM using GSN apps are difficult to access through conventional methods because they usually are not visible on geo-spots. 11 An important finding in the study was that while Arabic speaking participants also reported high-risk sexual behaviors and were vulnerable to STIs and HIV just like their Turkish-speaking counterparts they were less aware of PrEP and had a significantly lower rate of STI and HIV testing. There may be many factors accounting for this.…”

“…Although there is significant discrepancy between reported numbers and cohort data from Turkiye, the number of new HIV infections acquired by sex between males has increased significantly in the last decade and MSM are considered among the major key populations with a high risk of HIV infection and the main driver of the epidemic in the country. 2,8–11,28 While the incidence and prevalence of HIV infection among MSM in the country is unknown, several small-scale studies suggest prevalence rates up to 14%. 29,30 In addition, the percentage of younger MSM in the country have been increasing among new HIV diagnoses for the last decade, which is also supported by ECDC data where the highest rate (15%) of new diagnoses in 2021 among people aged 15–24 years is reported from Central Europe.…”

“…Although men who have sex with men (MSM) seem to comprise a minor percentage (13.3%) of new HIV diagnoses in 2021 according to official reports, cohort studies report significantly higher and steadily increasing rates (35.6%-51.8%) and MSM are estimated to be the main driver of the epidemic in Turkiye. 2,[8][9][10][11] Pre-exposure prophylaxis (PrEP), daily or on-demand oral administration of tenofovir disoprox fumarate/ emtricitabine (TDF/FTC) was proven highly effective to protect high-risk populations from HIV infection when used with a high level of adherence. [12][13][14] PrEP is available in many European countries either as a licensed strategy or through demonstration projects, but availability varies significantly between regions.…”

“…Although men who have sex with men (MSM) seem to comprise a minor percentage (13.3%) of new HIV diagnoses in 2021 according to official reports, cohort studies report significantly higher and steadily increasing rates (35.6%–51.8%) and MSM are estimated to be the main driver of the epidemic in Turkiye. 2,8–11…”

Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface

“…Instead, public health teams and stakeholders use a wide range of methods, many of which are not based on empirical data nor sound statistical concepts [ 2 , 3 ], potentially producing poor-quality estimates. Estimates of population sizes derived from programmatic mapping [ 4 , 5 ] enumerate members of the population attending venues during the exercise but often fail to account for the less socially visible, resulting in underestimates. Other nonempirical subjective methods such as Wisdom of the Crowd [ 6 , 7 ] and the Delphi methods [ 3 , 8 ] are susceptible to bias and the influence of individuals.…”