Mapping and Size Estimation of FSW and MSM in the District of Anuradhapura, Sri LankaKarawita DA1, Shajy I2, Emmanuel F2, Ranatunga D3, Chawla R4, Navaratne K51National STD/AIDS Control Programme, Sri Lanka, 2University of Manitoba, Canada, 3UNAIDS, Sri Lanka, 4UNFPA, Sri Lanka, 5 World Bank, Sri Lanka
Background• Population size estimation is one of the precursor activities in planning interventions for most-at-risk populations• It will help your programme in number of ways – Planning of activities/projects/ programmes, Monitoring and evaluation, Resource mobilization etc.
Objective• Mapping and size estimation of Female Sex Workers (FSW) and Men who have Sex with Men (MSM) in the district of Anuradhapura
Overview of size estimation methodologies for KPs “Census” Geographic mapping +/- Network mapping Mapping-based methods Enumeration (sample from the full list then extrapolation)Size estimation of Programmatic high risk groups multiplier Multiplier method Unique object multiplier Survey-based Capture-Recapture method method Network Scale up
Methodology• Basic methodology is the geographic mapping of MSM and FSWs in the district• MSM and FSW locations are identified and mapped in relation to the geography of the district• In the first level - Key informant interviews are used to identify locations and in the second level – Identified locations are evaluated for the existence, number of HRG members and the typology.
Study setting Anuradhapura District Category Values Mid year population 830,000 Area km2 7,179 Percent land area 10.9% No of MOH areas 19
Timeline Stage of the mapping Duration Pre-mapping stage 1 wk Level 1 interviews 2 wks Level 2 spot validation 2-3 wks Total duration 1 ½ monthsDistrict Activity FSW MSMAnuradhapura L1 21-30 Sep’09 22-29 Sep’09 L2 03-12 Oct’09 02-08 Oct’09
Geographical Mapping methodology in detail1. The pre-mapping: Preparatory activities – Studying maps, Permission and authorization, Zone demarcations, Organization of research teams, logistics etc.
Organization of research teams Data management team Project coordinator Consultant/ Data Data entry Statistician manager operator Field staff FS FS Field Supervisor (FS) Field Worker (FW) (Community-non-community combination)FW FW FW
Geographical Mapping methodology in detail2. Level 1 Systematic information gathering from key informants (KI) regarding the locations (“hot spots”) where key population members congregate and/or meet casual or paying sexual partners (20-100 interviews depending on the geographic area and the size of the population)
No of KI interviews for FSWs by No of KI interviews for MSM by MOH area MOH area Anuradhapura Thirappane 32Thambuththegama 25 Thalawa 25 Rambewa 40 Rajanganaya 21 Palagale 20 Padaviya 12 NPE 80 NPC 75 Nochchiyagama 34 Mihinthale 34 Medawachchiya 65 Kekirawa 46 Kebithigollewe 44 Kahatagasdiliya 34 Ipalogama 28 Horowpothana 42 Galnewa 31Galenbidunuwawe 37
No of KI interviews and active spotsCategory FSWs MSMNo of L1 interviews 725 834No of different spots identified 626 75(after removing the duplications)No of active sites 311 77(identified in spot validation at L2)
Distribution of 311 FSW Hot spots - Anuradhapura district
Distribution of FSW Hot spots – Anuradhapura city limits
Distribution of 77 MSM Hot spots – Anuradhapura
Distribution of MSM Hot spots – Anuradhapura city limits
Final estimates for the district Category Average Range FSWs 1,138 991-1,285 MSM 729 615-844
Number of FSW per 1000 adult females District Population FSW/1000 Anuradhapura 800,000 4.9 Number of MSM per 1000 adult men District Population MSM/1000 Anuradhapura 800,000 3.1
Conclusion• Number of FSWs and MSM is not easy to estimate with precision since these numbers are live and moving.• However, these estimates are more practical and useful denominators for programme planning, monitoring and evaluation of HIV prevention interventions for MARPs.
Acknowledgement to partners of this mapping study Ministry of Health Sri Lanka Community Strength Development Foundation Sri Lanka Police