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Geographic Mapping of Most at Risk Populations for HIV in Kenya

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Geographic Mapping of Most at Risk Populations for HIV in Kenya Foreword Dr. William Maina Head NASCOP The high burden of HIV infections among Key Populations (KPs) (female sex workers [FSW], male sex workers [MSW] and injecting drug users [IDU]) in Kenya has been long recognised, but effective preventive interventions have largely not been taken to scale. This is partly due to a lack of accurate information on where KPs are based, their numbers, and the alignment of programme implementation with the locations where KPs operate. This report presents findings of a national geographical mapping exercise conducted in 2011/2012 to assess the locations and population size of KPs in Kenya, to facilitate targeted HIV prevention services for this population. The approach used for the geographical mapping, consisted of interviews with secondary key informants to identify “hot” spots frequented by FSW, their operational dynamics and the estimated numbers of KPs in those spots. This was followed by validation of the estimates through interviews with KPs at each spot identified. The mapping covered Nairobi, the capital city of Kenya, and 50 other major urban centres in all of the traditional eight administrative provinces in Kenya, except North Eastern Province, situated near the border of Kenya and Somalia, which was excluded for security concerns. This study represents the first single largest KPs size estimation exercise in Kenya. The data contained in this report can be used to enhance HIV prevention programme planning and implementation for KPs, to form the basis for impact evaluations, and to improve programme coverage by directing efforts to locations with the greatest need. Population estimates are however, not static. As programmes are scaled-up to serve KPs, these estimates will equally be updated. Dr. William Maina Head: NASCOP Table of Contents List of Tables and Figures ...............................................................................................................................................i Acknowledgements ........................................................................................................................................................ iii The Study Team ................................................................................................................................................................ iv Acronyms ......................................................................................................................................................................... viii Executive Summary ........................................................................................................................................................ ix 1. Background .............................................................................................................................................................. 1 1.2. Introduction .................................................................................................................................................... 1 1.2. The history of HIV/AIDS in Kenya.......................................................................................................... 3 1.3. Understanding the magnitude of MARPs in Kenya ......................................................................... 3 2. Geographic Mapping Methodology ................................................................................................................. 5 2.1. Key Objectives: ............................................................................................................................................... 5 2.2. Included most at risk populations.......................................................................................................... 5 2.2.1. Female sex workers ............................................................................................................................ 5 2.2.2. High-risk men who have sex with men ...................................................................................... 6 2.2.3. Injecting drug users ............................................................................................................................ 7 2.3. Study sites ........................................................................................................................................................ 7 2.4. Methodology for geographic mapping of MARPs ......................................................................... 10 2.5. The mapping process ................................................................................................................................ 11 2.5.1. The pre-mapping activities ........................................................................................................... 11 2.5.2. Data management............................................................................................................................. 12 2.6. Study implementation process ............................................................................................................. 12 2.6.1. Study protocol development ........................................................................................................ 13 2.6.2. Identification of implementing partners ................................................................................ 13 2.6.3. Acquisition of maps ......................................................................................................................... 13 2.6.4. Training of field teams .................................................................................................................... 14 2.6.5. Data collection ................................................................................................................................... 14 2.6.6. Data processing and analysis ....................................................................................................... 15 3. Estimates of female sex worker spots and population size ............................................................... 16 3.1. Number of secondary key informant interviews .......................................................................... 16 3.2. Estimates of female sex worker spots ............................................................................................... 17 3.2.1. Estimated number of active spots in Nairobi city, by administrative units ............. 20 3.2.2. Estimated number of active spots in Mombasa city, by administrative units ......... 21 3.3. FSW population estimates ...................................................................................................................... 22 3.3.1. Estimated number of FSWs in Nairobi city by administrative units ........................... 27 3.3.2. Estimated number of FSWs in Mombasa city by administrative units....................... 27 3.4. Estimates of FSWs by typology............................................................................................................. 28 3.5. Number of FSWs per spot ....................................................................................................................... 29 3.6. Per capita number of FSWs .................................................................................................................... 31 3.7. Characteristics of FSWs ........................................................................................................................... 36 3.7.1. Age .......................................................................................................................................................... 37 3.7.2. Education ............................................................................................................................................. 37 3.7.3. Marital status ...................................................................................................................................... 38 3.7.4. Number of sexual partners per day .......................................................................................... 38 3.7.5. FSWs’ participation in other economic activities ................................................................ 39 4. Estimates of male sex worker/men who have sex with men spots and population size ...... 40 4.1. Estimates of MSWS/MSM spots ........................................................................................................... 40 4.2. Estimated number of active MSW/MSM spots in individual towns mapped .................... 41 4.3. MSW/MSM population estimates ........................................................................................................ 43 4.3.1. MSW/MSM population estimates in the towns mapped .................................................. 44 4.3.2. Estimated number of MSWs/MSM in Nairobi city by administrative units ............. 46 4.3.3. Estimated number of MSWs/MSM in Mombasa city, by administrative units........ 47 4.4. MSWs/MSM population by typology ................................................................................................. 48 4.5. Number of MSWs/MSM per spot ......................................................................................................... 49 4.6. Characteristics of MSWs/MSM ............................................................................................................. 51 4.6.1. Age .........................................................................................................................................................
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