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Original research
Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in İstanbul and Ankara, Turkey
  1. Deniz Gokengin1,2,
  2. Georgetta Aybek2,
  3. Sevgi O Aral3,
  4. James Blanchard4,
  5. Demir Serter2,
  6. Faran Emmanuel4
  1. 1 Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
  2. 2 AIDS and Sexually Transmitted Diseases Society, Izmir, Turkey
  3. 3 Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  4. 4 Institute of Global Public Health University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Deniz Gokengin, Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir 35100, Turkey; deniz.gokengin{at}


Objectives Despite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies.

Methods Female and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in İstanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots.

Results FSWs were the largest KP identified in İstanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both İstanbul and Ankara.

Conclusions This study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in İstanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest.

  • sex work
  • sexual and gender minorities
  • sexual behavior

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Handling editor Jason J Ong

  • Contributors All authors contributed to the design of the study. DG, GA and FE conducted all the field work and extracted the data. FE performed the statistical analyses. GA conducted the literature review. DG and FE drafted the manuscript. All authors contributed to discussions, review of and final amendments to the final manuscript. DS, JB and SOA are guarantors.

  • Funding This project was funded by a non-conditional grant from Gilead Sciences.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.