Biological and Behavioral Surveillance Survey on Armenian, Male, Seasonal Labor Migrants in Rural Communities in Armenia, 2016 ACKNOWLEDGEMENTS The Biological and Behavioral Surveillance Surveys on Armenian, Male, Seasonal Labor Migrants in Rural Communities was implemented by the National Center for AIDS Prevention (NCAP), Yerevan, Armenia. Prof. Samvel Grigoryan, Director of NCAP, coordinated the survey. The survey implementing core team included Arshak Papoyan, Head of HIV Surveillance Department; Zhaneta Petrosyan, Head of Prevention Department; Marine Asryan, Head of Department of psychosocial counseling, Anahit Asatryan, Head of Laboratory Diagnostics Department; Trdat Grigoryan, Doctor-statistician; Vardan Arzakanyan, Doctor-epidemiologist; Eduard Hovhannisyan, Doctor- epidemiologist; Tigran Hovsepyan, Doctor-statistician; Lilit Hovhannisyan, Doctor-statistician; Seda Abgaryan, Monitoring and Evaluation specialist; Sofya Vardanyan, Assistant of Epidemiologist. The survey implementing team acknowledges the participation of all those involved in the surveys including those who gave their time to enroll and respond to the questionnaires. The team could not have efficiently carried out the surveys without the valuable support of the following people to whom we extend our gratitude: Stepan Khachatryan, Head of the Department of Health and Social Welfare of the Ararat Regional Administration Larisa Muradyan, Deputy Mayor of Armavir region Anush Poghosyan, Head of the Department of Health and Social Welfare of the Gegharkunik Regional Administration Samvel Lambaryan, Head of the Department of Health and Social Welfare Lusine Vardanyan, Head of the Health Unit of the Lori Regional Administration Vahagn Voskanyan Head of the Department of Health and Social Welfare of the Kotayk Regional Administration Hovhannes Hovhannisyan, Head of the Department of Health and Social Welfare of the Shirak Regional Administration Directors of the primary healthcare centers in each of the rural communities sampled. The team would like to give special thanks to Lisa G. Johnston, WHO Expert, for developing the survey protocol, providing consultancy support in the course of the survey implementation, analyzing the survey findings, and for preparing this report. The survey was implemented with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria. 1 CONTENTS ACKNOWLEDGEMENTS ..................................................................................................................................... 1 ABBREVIATIONS/ACRONYMS ......................................................................................................................... 4 1. EXECUTIVE SUMMARY ................................................................................................................................. 5 2. BACKGROUND ................................................................................................................................................. 7 3. OBJECTIVES ...................................................................................................................................................... 9 4. SAMPLING METHODS ..................................................................................................................................... 10 4.1 MULTISTAGE CLUSTER SAMPLING ....................................................................................................... 10 4.2 SELECTION OF THE RURAL SURVEY COMMUNITIES ........................................................................ 10 4.3 SAMPLE SIZE CALCULATION .................................................................................................................. 12 4.4 ELIGIBILITY ................................................................................................................................................ 13 4.5 SELECTING PARTICIPANTS ..................................................................................................................... 13 4.6 STAFFING ..................................................................................................................................................... 14 4.7 DATA COLLECTION STEPS ....................................................................................................................... 15 4.8 DATA MANAGEMENT AND ANALYSIS ................................................................................................. 16 DATA TRANSFER ............................................................................................................................................. 16 DATA PROCESSING ......................................................................................................................................... 16 DATA ANALYSIS .............................................................................................................................................. 17 DATA SECURITY .............................................................................................................................................. 17 5. LABORATORY PROCEDURES ....................................................................................................................... 18 5.1 BLOOD SAMPLES, TESTING AND HANDLING ...................................................................................... 18 6. RESULTS ............................................................................................................................................................ 19 6.1 SOCIO-DEMOGRAPHIC AND GENERAL WORKING CHARACTERISTICS ........................................ 21 6.2 GENERAL SEXUAL HISTORY ................................................................................................................... 22 6.3 SEXUAL BEHAVIORS WITH REGULAR PARTNERS ............................................................................. 23 6.4 SEXUAL BEHAVIORS WITH CASUAL PARTNERS ................................................................................ 25 6.5 SEXUAL BEHAVIORS WITH COMMERCIAL PARTNERS ..................................................................... 28 6.6 CONDOM USE WITH DIFFERENT PARTNER TYPES ............................................................................. 30 6.7 DRUG USE .................................................................................................................................................... 31 6.8 HIV AND STI TESTING AND RISK AND CONDOM ACCESS ................................................................ 32 6.9 HIV KNOWLEDGE AND PERCEPTIONS .................................................................................................. 34 2 6.10 HIV AND OTHER INFECTIONS PREVALENCE ..................................................................................... 36 7. DISCUSSION OF FINDINGS ............................................................................................................................ 37 8. LIMITATIONS AND INTERPRETING RESULTS ........................................................................................... 38 9. KEY RECOMMENDATIONS ............................................................................................................................ 40 10. CONCLUSION.................................................................................................................................................. 41 A. ANNEX .............................................................................................................................................................. 42 QUESTIONNAIRE.............................................................................................................................................. 42 B. ANNEX .............................................................................................................................................................. 52 ANALYSIS OF DATA BY EACH REGION....................................................................................................... 52 B.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS ........................................................................................ 52 B.2 GENERAL SEXUAL HISTORY .................................................................................................................. 55 B.3 SEXUAL BEHAVIORS WITH REGULAR PARTNERS ............................................................................ 56 B.4 SEXUAL BEHAVIORS WITH CASUAL PARTNERS ............................................................................... 60 B.5 SEXUAL BEHAVIORS WITH COMMERCIAL PARTNERS .................................................................... 64 B.6 DRUG USE.................................................................................................................................................... 68 B.7 HIV AND STI TESTING AND RISK ........................................................................................................... 70 B.8 HIV KNOWLEDGE AND PERCEPTIONS ................................................................................................. 73 B.9 HIV AND OTHER INFECTIONS PREVALENCE ...................................................................................... 75 3 ABBREVIATIONS/ACRONYMS ART Antiretroviral Therapy FSW Female sex workers GFATM Global Fund to fight AIDS, TB and Malaria HIV Human Immunodeficiency Virus HBV Hepatitis B virus HCV Hepatitis C virus BBS biological and behavioral surveillance MSM Men