Size of Key Populations in the Dominican Republic - 2016 Estimates
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Author(s): MEASURE Evaluation
In the field of HIV prevention and treatment of AIDS, there is increased emphasis on monitoring progress toward stopping the spread of the virus. Not only have evidence-based approaches been in demand, but there are new goals intended to slow the epidemic so that it can be stopped in 2030. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) put forth the targets that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will be receiving sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression (UNAIDS, 2014). The Dominican Republic is on its way to tracking the numbers of people tested, on treatment, and virally suppressed, but without knowing the number of people estimated to be HIV-positive, it is impossible to calculate progress toward these goals. Key populations such as female sex workers (FSWs), men who have sex with men (MSM), and transgender (TG) people are disproportionately infected by HIV in the Dominican Republic, making it imperative to know the size of each key population to estimate the number of people expected to be HIV-positive. (The focus of HIV prevention efforts for TG in the Dominican Republic is on TG women: people who were assigned male at birth but who present as women.) This report describes an activity undertaken to provide these population estimates for each province and nationally for use in monitoring progress toward these global goals.
Recent surveys have documented higher prevalence of HIV and syphilis among key populations than among all adult men and women in the Dominican Republic. The 2013 Demographic and Health Survey (DHS) measured a prevalence of HIV among women ages 15 to 49 as 0.7 percent and among men as 0.9 percent, resulting in a national prevalence of 0.8 percent. However, the 2012 Integrated Biological and Behavioral Surveillance Survey (IBBSS) carried out in five cities found HIV prevalence among FSWs to be between 1.7 percent and 6.3 percent, and among MSM and TG women to be between 3.9 percent and 6.9 percent. Syphilis prevalence was higher than HIV among these populations, with between 6.0 percent and 12.1 percent of FSWs, 9.8 percent and 13.9 percent of MSM and TG women testing positive. Similar results were found in the Priorities for Local AIDS Control Efforts (PLACE) study in 2014, with 2.5 percent of FSWs having a positive HIV test and 5.4 percent a positive syphilis test; 3.9 percent of MSM with HIV and 4.9 percent with syphilis; and 18.2 percent of TG women with HIV and 21.2 percent with syphilis (MEASURE Evaluation, 2014).
Estimating the number of sex workers, gay or bisexual men, and TG women is not a new undertaking in the Dominican Republic. A 2014 report reviewed existing estimates and put forth one national estimate for each population, in addition to addressing the complexity of these calculations. The resulting estimates of MSM and TG women relied on different methods and mostly on data from the capital city. No estimate of FSWs was provided in that report. The National Strategic Plan for STI and HIV/AIDS 2015–2018 refers to an estimate of FSWs from 2004. No estimates for provinces or regions of the country were available.
The aim of the present study was to provide information useful for monitoring progress toward the UNAIDS 90-90-90 goal, as well as for programs. The main objective was to estimate the number of FSWs, MSM, and TG women in each province and nationally with input from local stakeholders. The study team selected a method to fill the need for a systematic approach to calculating size estimates of each population that incorporates data collected from each health region in the country and that uses other available data to extrapolate estimates to areas where primary data were not collected. This method is consistent with current recommendations of international technical working groups.
MEASURE Evaluation implemented this study in 2016 in collaboration with three local organizations: the Center for Advocacy and Human Solidarity (CEPROSH), the Center for Comprehensive Investigation and Orientation (COIN), and the Institute for Dermatology and Skin Surgery Dr. Huberto Bogaert Díaz (IDCP).
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