Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Apr 11, 2026
Open Peer Review Period: Apr 13, 2026 - Jun 8, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Population Size Estimates of MSM, TGW, FSW, and PWID at District, Provincial, and National Levels in Nepal
ABSTRACT
Background:
Key populations, including men who have sex with men (MSM), transgender women (TGW), female sex workers (FSW), and people who inject drugs (PWID) bear a disproportionate burden of the HIV epidemic in Nepal. Accurate size estimates are essential for effective HIV prevention, planning, and advocacy.
Objective:
This study estimated the size of these populations at district, provincial, and national levels in Nepal.
Methods:
Between May and June 2024, we conducted mapping, three-source capture-recapture (CRC), multiplier methods, and network scale-up (NSU) in 14 districts of Nepal. Mapping identified and enumerated Level 1 and Level 2 hotspots. CRC involved three time-separated captures from randomly selected hotspots, while multiplier methods used unique objects and service-utilization data from community-based organizations. NSU was embedded in a household survey of 1,872 male labor migrants with bias adjustments. Bayesian modeling synthesized and extrapolated district estimates to provincial and national levels.
Results:
Based on the Bayesian synthesis of multiple methods and data extrapolation, the estimated national population sizes were: 100,637 MSM (1.21% of adult males, Provincial range: 2.35% in Bagmati to 0.33% in Karnali), 38,520 TGW (0.46% of adult males, Provincial range: 0.67% in Madhesh to 0.14% in Karnali), 70,610 FSW (0.76% of adult females, Provincial range: 1.32% in Bagmati to 0.27% in Karnali), and 43,636 PWID (0.25% of adults, Provincial range: 0.42% in Gandaki to 0.15% in Karnali).
Conclusions:
This study provides the first comprehensive, methodologically triangulated population size estimates of four key populations at risk of HIV in Nepal. These estimates can inform HIV program design, service delivery, target setting, and policy advocacy, particularly in reaching those populations at the provincial and local level. These updated and more granular size estimates will enhance strategic planning for equitable and impactful HIV interventions nationwide.
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