Gexha Bunjaku Dafina, Deva Edona, Gashi Luljeta, Kaçaniku-Gunga Pranvera, Comins Carly A, Emmanuel Faran
National Institute of Public Health, Department of Epidemiolo, Pristina, Kosovo, Albania.
Community Development Fund, Kosovo, Albania.
JMIR Public Health Surveill. 2019 Mar 5;5(1):e11194. doi: 10.2196/11194.
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.
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.
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.
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.
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.
科索沃的艾滋病疫情负担主要集中在女性性工作者、男男性行为者和注射吸毒者这些关键人群中。针对这些关键人群的现有干预措施零散，缺乏制定大规模外展项目所需的充分且合适的详细信息。
本研究旨在估计这些人群的规模和分布，为制定艾滋病预防行动计划提供依据。
采用规划性绘图方法，从关键信息提供者处收集系统信息，包括2016年2月至4月间科索沃26个市的地理和虚拟地点信息。在第一阶段，通过在每个市内对1537名关键信息提供者进行访谈，收集有关关键人群数量和地点的信息。第二阶段则通过对聚集在这些地点的关键人群再进行976次访谈来验证这些地点。计算每个地点的人口规模估计值，最后得出全国范围的估计值，并对重复和重叠情况进行校正。
在估计的6814名男男性行为者中（范围：6445至7117），近4940人通过互联网开展活动，因为同性关系面临着巨大的耻辱感和歧视。基于地理位置开展活动的男男性行为者（通过实体场所开展活动）聚集在少数几个规模较大的场所（每个场所13.3名男男性行为者）。四分之三的男男性行为者分布在5个主要城市。周五和周六是活动高峰期，但人数仅增加5%。相当一部分人从事性工作，即向其他男性提供性服务以获取金钱。注射吸毒者大多基于地理位置开展活动；在总数为5819人（范围：4777至6860）的注射吸毒者中，4973人（范围：3932至6015）会前往特定地理场所，平均每个场所7.1人。在较小的城市，他们大多在居住场所注射毒品。整周人数保持稳定，没有高峰期。在5037名女性性工作者中（范围：4213至5860），20%使用手机，10%使用网站与客户联系。周末人数增加25%，尤其是在性工作最为集中的较大城市。除了少数街边场所外，大多数场所是由皮条客经营的机构，这反映出女性性工作者网络高度制度化、结构化且有组织。
本研究提供了关于关键人群规模估计以及各关键人群动态的宝贵信息，这是制定有效的艾滋病预防策略的关键。这些信息应被用于制定微观计划，并有效地为各类关键人群提供艾滋病预防服务。
