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Abstract
Introduction The Timor-Leste HIV/STI response is largely focused on the key populations of sex workers, men who have sex with men and transgender (MSM&TG) and people who use and/or inject drugs (PWUD/PWID). With no prior national size estimation (NSE), a NSE was undertaken to inform HIV/STI programming for these population groups. Behavioural surveying of FSW and MSM&TG in Dili was also completed.
Methods To improve reliability, several size estimation methods were used: Network Scale-Up; Service Multiplier; Successive Sampling – Size; and ‘Wisdom of the Crowd’. Estimates were cross-referenced with service records, estimates from comparable settings and key informant estimates. Plausible estimates were combined and extrapolated to non-assessed districts. A consensus process with key stakeholders was undertaken for validation. For behavioural data, a respondent-driven sampling (RDS)-based survey of FSW and MSM&TG was conducted in the capital of Dili.
Results
National size estimates
FSW: 1688 (95% CI: 1333, 2044); 0.71% females aged 15–49
MSM&TG: 8703 (95% CI: 7821, 9,585); 2.76% males aged 15+
PWUD: 388 (95% CI: 208, 787); 0.07% adults aged 15–64
PWID: 53 (95% CI: 10, 127); <0.01% adults aged 15–64
Behaviour
A total of 125 FSW and 229 MSM&TG participated in the Dili behavioural survey. Service interaction was mixed, with 67.8% (95% CI: 55.7%, 79.0%, n = 91) of FSW and 51.0% (95% CI: 40.6%, 61.1%, n = 124) of MSM&TG reporting ever having had an HIV test. About one-quarter of both FSW (25.7%, 95% CI: 16.1%, 34.3%, n = 39) and MSM&TG (26.1%, 95% CI: 18.8%, 33.5%, n = 51) reported always using condoms with their client/male sexual partner respectively. Reported illicit drug use among both populations was extremely low.
Conclusion Estimates produced were deemed plausible. The comparably low national PWUD/PWID estimates reflected an extremely low current prevalence of illicit drug use in the country. Behavioural data indicated ongoing HIV/STI risk factors for FSW and MSM&TG.
Disclosure of interest statement This project received funding from the Ministry of Health Timor-Leste under a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria. No pharmaceutical grants were received in the development of this study.