JMIR Publications

ABSTRACT

Background:

The burden of HIV epidemic in Kosovo lies among the key populations (KPs) of FSWs, MSM and PWIDs. The available interventions for KPs are fragmented, lack sufficient and appropriate granularity of information needed to develop large scale outreach programs.

Objective:

We conducted this study to estimate the size and distribution of these populations to create evidence for developing action plans for HIV prevention.

Methods:

Programmatic mapping approach was used to collect systematic information from key informants including geographic and virtual locations in 26 municipalities of Kosovo. In Level 1, information was gathered about KPs numbers and locations through 1,537 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 estimate was developed which was corrected for duplication and overlaps.

Results:

Of the estimated 6,814 MSM (6,445 to 7,117), nearly 4,940 operate through the internet owing to the large stigma and discrimination against same sex relationships. Geo-based MSM congregate at a few spots having large spot sizes (13.3 MSM/spot). Three-fourth of the MSM are distributed in five major municipalities. Fridays and Saturdays are the peak days of operation, however the number only increase by 5%. A significant number are involved in sex work i.e., provide sex to other men for money. PWID are largely geo-based; 4,973 (range; 3,932 to 6,015) PWID of the total number of 5,819 (range; 4,777 to 6,860) 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 5,037 (range; 4,213 to 5,860) FSW, 20% use cell phones while 10% use websites to connect with clients. The number increase 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.

Conclusions:

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 needs to be used to micro-plan and design plans to contact and provide effective outreach using information on how each KP operates within each typology.