Critique and Lessons Learned from using Multiple Methods to Estimate Population Size of Men who have Sex with Men in Ghana
Population size estimation of key populations at risk of HIV is essential to every national response. We implemented population size estimation of men who have sex with men (MSM) in Ghana using a three-stage approach within the 2011 Ghana Men’s Study: during the study’s formative assessment, the larger integrated bio-behavioral surveillance (IBBS) survey; and during the stakeholder meeting. We used six methods in combination within the three-stage approach (literature review, mapping with census, unique object multiplier, service multiplier, wisdom of the crowd, and modified Delphi) to generate size estimates from 16 locations (4 IBBS survey sites and 12 other locations) and used the estimates from the 16 sites to extrapolate the total MSM population size of Ghana. We estimated the number of MSM in Ghana to be 30,579 with a plausible range of 21,645–34,470. The overall estimate suggests that the prevalence of MSM in Ghana is 0.48 % of the adult male population. Lessons learned are shared to inform and improve applications of the methods in future studies.
KeywordsMen who have sex with men Africa Population size estimates
This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) Ghana Country Office under the terms of Cooperative Agreement Number 5U2GPS001469-03. The authors would like to thank Dr. Fazle Khan, Dr. Celia Woodfill and all reviewers for helpful comments on the manuscript. The views expressed in this manuscript do not necessarily reflect the official views of the U.S. Centers for Disease Control and Prevention.
- 2.UNAIDS. Global report: UNAIDS Report on the Global AIDS Epidemic. UNAIDS, Geneva. 2012.Google Scholar
- 4.Joint United Nations Programme on HIV/AIDS. Practical guidelines for intensifying HIV prevention: towards universal access. Geneva 2007.Google Scholar
- 5.Gutierrez J, McPherson S, Fakoya A, Matheou A, Bertozzi SM. Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): the Frontiers Prevention Project (FPP) evaluation results. BMC Public Health. 2010;10:497–508.CrossRefPubMedCentralPubMedGoogle Scholar
- 7.Johnston LG, Prybylski D, Raymond H. Fisher, Mirzazadeh A, Manopaiboon C, McFarland W. Incorporating the service multiplier method in respondent-driven sampling surveys to estimate the size of hidden and hard-to-reach populations: case studies from around the world. Sex Transm Dis. 2013;40(4):304–10.CrossRefPubMedGoogle Scholar
- 8.FHI Impact, USAID, UNAIDS, WHO, UNDP. Estimating the size of populations at risk for HIV: issues and methods. Genova: UNAIDS; 2003. p. 03–36E.Google Scholar
- 10.Aberle-Grasse J, McFarland W, El-Adas A, Quaye S, et al. HIV prevalence and correlates of infection among MSM: 4 areas in Ghana, the Ghana Men’s Health Study 2010–2011, in 20th Conference on Retroviral and Opportunistic Infections, March 3–6, 2013. Atlanta, GA: Ghana Men’s Health Study; 2013.Google Scholar
- 12.Pietersma S, de Vries M, van den Akker-van ME. Domains of quality of life: results of a three-stage Delphi consensus procedure among patients, family of patients, clinicians, scientists and the general public. Qual Life Res 2013. doi: 10.1007/s11136-013-0578-3.
- 13.Cáceres C, Konda K, Pecheny M, Chatterjee A, Lyerla R. Estimating the number of men who have sex with men in low and middle income countries. Sex Transm Infect. 2006; 82(Suppl 3):iii3–iii9.Google Scholar
- 15.UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Estimating the Size of Populations Most at Risk to HIV Infection: Participant Manual. Genova: UNAIDS; 2010.Google Scholar
- 18.Hsu C, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007; 12(10). http://preoline.net/getvn. Accessed 18 Aug 2013.
- 19.Raymond HF, Bereknyei S, Berglas N, et al. Estimating population size, HIV prevalence and HIV incidence among men who have sex with men in San Francisco: A case example of triangulation methods. STI. 2013;89(5):383–7.Google Scholar
- 20.Muraguri N, Temmerman M, Geibel S. A decade of research involving men who have sex with men in sub-Saharan Africa: current knowledge and future directions. SAHARA-J 2012; 9(3):137–147.Google Scholar
- 21.UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on Estimating the Size of Populations Most at Risk to HIV. Genova: WHO; 2010.Google Scholar