JMIR Publications

ABSTRACT

Background:

Globally, men who have sex with men (MSM) continue to bear a disproportionately high burden of HIV infection. Rwanda experiences a mixed HIV epidemic; generalized in the adult population, with aspects of a concentrated epidemic among certain key populations at higher risk of HIV infection, including MSM. Limited data exist to estimate the population size at a national scale, hence missing an important piece in determining the denominators to use in estimates that policy makers, program managers and planners can use to monitor HIV epidemic control.

Objective:

This study aims at presenting the first ever national Population Size Estimate (PSE) and geographic distribution of MSM in Rwanda.

Methods:

Between October – December 2021, Three-source capture-recapture method was used to estimate the MSM population size in Rwanda. Unique objects were distributed to MSM through their networks (first capture); tagged with service provision (second capture) and a respondent- driven sampling (RDS) survey was used as the third capture. Capture histories were aggregated in a 2^k-1 contingency table where “1” and ’0” indicate captured and not captured, respectively. Statistical analysis was performed in R (version 4.0.5) and the Bayesian nonparametric latent-class capture-recapture package (LCMCR) was used to produce final PSE with 95% credible intervals (95% CI).

Results:

We sampled 2,465, 1,314, and 2,211 MSM in captures 1, 2, and 3, respectively. There were 721 recaptures between captures 1 and 2, 415 recaptures between capture 2 and 3, and 422 recaptures between captures 1 and 3. There were 210 MSM captured in all three captures. The total estimated population size of MSM above 18 years old in Rwanda is 18,100 (95% CI [11,300 – 29,700]) corresponding to 0.70% [0.4 - 1.1] of total adult males. Most MSM are located in the City of Kigali 7,842 (95% CI [4,587 - 13,153]); followed by Western province 2,469 (95% CI [1,994 - 3,518]); Northern province 2,375 (95% CI [842 - 4,239]); Eastern province 2,287 (95% CI [1,927 - 3,014]) and lastly Southern province 2,109 (95% CI [1,681 - 3,418]).

Conclusions:

Our study provides, for the first time, size estimate of MSM aged 18 or older in Rwanda. MSM are concentrated in the city of Kigali, and almost evenly distributed across the other 4 provinces. The national proportion estimate bounds of MSM out of the total adult males includes the WHO minimum recommended proportion (at least 1.0%) based on 2012 census population projections for 2021. These results will inform denominators that are used to estimate service coverage and gaps to enable policy makers and planners to monitor the HIV epidemic among MSM nationally. There is an opportunity for conducting small area MSM size estimation for sub-national level HIV treatment and prevention interventions.