Burundi PLACE Report Priorities for Local AIDS Control Efforts This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement GHA-A-00-08-00003-00, which is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this publication do not necessarily reflect the views of PEPFAR, USAID or the United States government. May 2014, revised October 2014 TR-14-99 Table of Contents Acknowledgements ........................................................................................................................ 1 Acronyms and Abbreviations ........................................................................................................ 3 Executive Summary ...................................................................................................................... 4 Summary of PLACE Indicators ................................................................................................... 7 1 Step 1: PLACE Strategy ........................................................................................... 13 1.1 Background: HIV Epidemic in Burundi .......................................................................... 13 1.2 The PLACE Protocol: Objectives .................................................................................... 13 1.3 Ethical Review and Approval ........................................................................................... 15 1.4 Identification of Areas for PLACE Implementation in Burundi ............................... 15 1.5 Training and Instrument Adaptation .............................................................................. 15 2 Step 2: Where Do People Go to Meet New Sexual Partners? Findings from Community Informant Interviews ............................................................................... 17 2.1 Methods to Identify Venues .............................................................................................. 17 2.2 Community Informant Fieldwork ..................................................................................... 17 2.3 Characteristics of Community Informants ................................................................... 18 3 Step 3: What Are the Characteristics of Venues Where People Meet New Sexual Partners? ...................................................................................................................... 19 3.1 Methods ................................................................................................................................. 19 3.2 Venue Verification Fieldwork ........................................................................................... 20 3.3 Types of Venues .................................................................................................................. 21 3.4 Activities that Occur at Venues and Other Characteristics of Venues ................. 23 3.5 When Do People Visit Venues? ....................................................................................... 24 3.6 HIV Prevention at Venues and Condom Availability at Venues .............................. 25 4 Step 4: What are the Characteristics of People Who Socialize at Venues where People Meet New Sexual Partners? Findings from Interviews with People Socializing at Venues ................................................................................................... 27 4.1 Methods ................................................................................................................................. 27 4.2 Socio-demographic Characteristics of People Socializing at Venues .................. 29 4.3 How Frequently Do People Visit Venues? .................................................................... 30 4.4 Where Do Venue Patrons Come from? Mobile Populations Are Important ......... 31 4.5 People Report Meeting New Sexual Partners at the Venues ................................... 32 4.6 Age at First Sex .................................................................................................................... 33 4.7 Number of Partners and Rate of New Sexual Partnerships ..................................... 34 4.8 Those with the Highest Rates of New Sexual Partnerships ..................................... 36 4.9 Other Risk Factors for HIV Infection .............................................................................. 37 4.10 Condom Use ......................................................................................................................... 38 4.11 HIV Testing and Circumcision ......................................................................................... 39 4.12 Youth....................................................................................................................................... 40 4.13 Key Populations: Commercial Sex Workers, Clients, Men Who Have Sex with Men, and Injection Drug Users ........................................................................................ 41 4.14 Treatment for Sexually Transmitted Infections ........................................................... 44 4.15 HIV Prevalence ..................................................................................................................... 44 4.16 Population Size Estimates ................................................................................................ 45 5 Step 5: Use Results to Improve Programs .................................................................. 46 5.1 Analysis and Summary of Main Results ....................................................................... 46 5.2 Modes of Transmission Modeling (MoT) ....................................................................... 48 ii 6 Appendices ............................................................................................................... 52 6.1 Appendix 1: Weighted frequency tables for most variables by type of area sampled: Bujumbura vs. other urban vs. rural areas ................................................ 52 6.2 Appendix 2: Questionnaires ................................................................................................ 84 List of Tables Table S.1. Summary of Key PLACE Indicators ..................................................................... 7 Table S.2. PLACE Indicators for Youth ................................................................................. 8 Table S.3. PLACE Indicators by Level of Partnerships among Men ...................................... 9 Table S.4. PLACE Indicators by Level of Partnerships among Women ............................... 10 Table S.5. PLACE Indicators for Female Sex Workers ....................................................... 11 Table S.6. PLACE Indicators for Men who Have Sex with Men ........................................... 12 Table 1.2.1. The Five Steps of the PLACE Protocol ........................................................... 14 Table 2.2.1. Community Informant Fieldwork ..................................................................... 17 Table 2.3.1 Characteristics of Community Informants ....................................................... 18 Table 3.2.1. Summary of Venue Verification Fieldwork ...................................................... 20 Table 3.3.1. Types of Venues ............................................................................................ 21 Table 3.4.1. Characteristics of Found and Verified Venues ................................................ 23 Table 3.5.1. Busy Times at Venues and Number of Patrons .............................................. 24 Table 3.6.1. HIV Prevention Activities at Venues ............................................................... 25 Table 4.2.1. Socio-demographic Characteristics of Individuals at Venues ......................... 29 Table 4.3.1. Self-Reported Venue Visiting Behavior .......................................................... 30 Table 4.4.1. Mobile Populations ......................................................................................... 31 Table 4.5.1. Meeting a New Partner at the Venue .............................................................. 32 Table 4.6.1. Ever Had Sex and Age at First Sex ................................................................ 33 Table 4.7.1. Rate of Partnership Acquisition ...................................................................... 34 Table 4.7.2. Percent Reporting 2+ Partners in the Past 12 Months: A Comparison of the PLACE Population with the General Population in Burundi .............................................. 35 Table 4.8.1. Gender and Rate of Sexual Partnership ......................................................... 36 Table 4.9.1. Other Risk Factors for HIV Infection ............................................................... 37 Table 4.10.1. Condom Use .................................................................................................. 38 Table 4.11.1. HIV Testing and Circumcision ........................................................................ 39 Table 4.12.1. Characteristics of Young Adults ..................................................................... 40 Table 4.13.1. Transactional Sex, Men Having Sex