Size of Key Populations in the Dominican Republic 2016 Estimates January 2017 TR-16-146 Size of Key Populations in the Dominican Republic 2016 Estimates January 2017 MEASURE Evaluation This publication was produced with the support of the United States Agency for International Development (USAID) under the terms of the University of North Carolina at Chapel Hill MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. 400 Meadowmont Village Circle, 3rd Floor MEASURE Evaluation is implemented by the Carolina Population Chapel Hill, North Carolina 27517 Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Phone: +1 919-445-9350 Palladium; and Tulane University. Views expressed are not necessarily [email protected] those of USAID or the United States government. TR-16-146 www.measureevaluation.org ISBN: 978-1-943364-89-3 ACKNOWLEDGMENTS This study would not have been possible without the leadership of the local principal investigator, Yeycy Donastorg of IDCP, and co-investigators Bayardo Gomez of CEPROSH, and Santo Rosario of COIN, representing important organizations in the effort to fight HIV in the Dominican Republic. Their contributions during all phases of the study are much appreciated: protocol development, ethics approval, managing field work teams, reviewing results, and coordinating with other stakeholders. Special thanks are owed to Leinadine Lucien and Julie Sarita for their work as field supervisors. Their dedication to high-quality data collection and to leading cohesive teams stood out in this process. Interviewers and other members of the field work teams worked tirelessly to interview more than three thousand people in a short amount of time: Juana Clase, Rosalba Karina Crisóstomo, Juan Carlos Encarnación, Mary Jane Fiallo, Alfredo Gutiérrez, Julio Gutiérrez, Miriam Guzmán, Harol Jiménez, José Antonio López, Francis Noel Mejía Beard, María Martínez Muñoz, Melchor Moya, Ketty Peña, Aridia Pérez, Miguel Ángel Cruz, Estefanía Hernández, and Augustina Peña. Their abilities to engage in conversation with a variety of people were essential to this study. An expression of gratitude is also due to Hoisex Gómez for her dedication and skill in leading focus group discussions. The study team is grateful to all study participants for sharing their knowledge of their communities and providing information necessary to achieve the study aim. We extend our gratitude to local stakeholders at both the policy and program levels for their participation in the preparatory phase and in the review of results. Especially important was the involvement of Rosa Sánchez of CONAVIHSIDA and the other members of the HIV Monitoring and Evaluation Technical Working Group who reviewed the methodology in detail and provided input that led to the final results: Josefina Rosa Acosta, Orlando Alberto Asencio, Jonathan Patricio Baldera, Generoso Castillo, Erika Suarez Feliz, Begoña Gómez, Ilka González, Gloriflor Luna, Ana Martin, Yadira Medina, Nilo Mercedes, Robert Paulino, Clotilde Peña, Matilde Peguero, Aurora Rodríguez, Mayra Rodríguez, M. Tapia, and Nurys Vargas. The study team would like to thank USAID for support throughout the process, specifically Elizabeth Conklin, Carolina Piña, and Yvette Regino. This report was prepared by Sarah Hileman, edited by Debbie McGill and Natasha Mack, and designed by Denise Todloski and Gwendolyn Stinger of MEASURE Evaluation, University of North Carolina at Chapel Hill (UNC-CH). The report was translated into Spanish by Marina McCune. We also appreciate the contributions of the following MEASURE Evaluation staff: Jess Edwards for her technical expertise in designing the models, Sabrina Zadrozny for her contributions to the models, Becky Wilkes for the creation of maps, and Sharon Weir for her leadership. Key population size estimates for the Dominican Republic 2016 3 CONTENTS Abbreviations ................................................................................................................................................................ 6 Executive Summary ..................................................................................................................................................... 7 Introduction .................................................................................................................................................................. 9 Methods ....................................................................................................................................................................... 10 General Approach ................................................................................................................................................. 10 Step 1: Calculation of Size Estimates of Key Populations Using Place Data ............................................. 11 Why the Place Method? .................................................................................................................................. 11 Implementing the Place Lite Study in 2016 ................................................................................................. 11 Community Informant Interviews ................................................................................................................ 12 Venue Visits and Mapping .............................................................................................................................. 13 Focus Groups with TG Women ................................................................................................................... 14 Revisiting Sites from Place 2014 .................................................................................................................... 15 Data Analysis to Directly Calculate Size Estimates .................................................................................... 15 Step 2: Gathering Data from Other Sources .................................................................................................... 18 Step 3: Using a Statistical Model to Provide Provincial Size Estimates ....................................................... 19 Results .......................................................................................................................................................................... 19 Discussion ................................................................................................................................................................... 23 Recommendations ..................................................................................................................................................... 25 Conclusion................................................................................................................................................................... 26 References ................................................................................................................................................................... 27 Appendix A ................................................................................................................................................................. 29 Appendix B ................................................................................................................................................................. 35 Appendix C ................................................................................................................................................................. 60 Appendix D ................................................................................................................................................................. 67 Appendix E ................................................................................................................................................................. 68 4 Key population size estimates for the Dominican Republic 2016 FIGURES Figure 1. Map of percentage of the female population ages 15 to 49 in each province who are estimated to engage in sex work and can be found in public places ........................................................................................ 22 Figure 2. Map of percentage of the male population ages 15 to 49 in each province who are estimated to have sex with men and who can be found in public places ................................................................................ 22 Figure 3. Map of percentage of the male population ages 15 to 49 in each province who are estimated to be TG women and can be found in public places ................................................................................................ 23 TABLES Table 1. Number of community informants in municipalities of different population sizes ........................ 13 Table 2. Municipalities with direct estimates of the size of key populations using PLACE data ................................................................................................................................................................ 15 Table 3. Independent variables at the municipality level used in the model for each key population and their sources ................................................................................................................................................................ 19 Table 4. Estimates of the number and population percentage of FSWs, MSM, and TG women in each province