Skip to main content

Critique and Lessons Learned from using Multiple Methods to Estimate Population Size of Men who have Sex with Men in Ghana

AIDS and Behavior volume 19, pages 16–23 (2015)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Beyrer C, Karim A. The changing epidemiology of HIV in 2013. Curr Opin HIV AIDS. 2013;8:306–10.

    PubMed  Google Scholar 

  2. UNAIDS. Global report: UNAIDS Report on the Global AIDS Epidemic. UNAIDS, Geneva. 2012.

  3. Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW. Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet. 2009;374:416–22.

    Article  PubMed  Google Scholar 

  4. Joint United Nations Programme on HIV/AIDS. Practical guidelines for intensifying HIV prevention: towards universal access. Geneva 2007.

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Herbst JH, Beeker C, Mathew A, et al. The effectiveness of individual, group, and community level HIV behavioral risk reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med. 2007 Apr;32(4 Suppl):S38–67.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

  9. Beyrer C, Baral SD, van Griensven F, et al. HIV in men who have sex with men: Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380:367–77.

    Article  PubMed Central  PubMed  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.

  11. Okal J, Geibel S, Muraguri N, et al. Estimates of the size of key populations at risk for HIV infection: men who have sex with men, female sex workers and injecting drug users in Nairobi. Kenya. Sex Transm Infect. 2013;89:366–71.

    Article  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.

  14. Faran E, Blanchard J, Zaheer HA, Reza T, Holte-McKenzie M. The HIV/AIDS Surveillance Project mapping approach: an innovative approach for mapping and size estimation for groups at a higher risk of HIV in Pakistan. AIDS. 2010;24(suppl 2):S77–84.

    Article  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.

  16. Lorenz J, Rauhut H, Schweitzer F, Helbing D. How social influence can undermine the wisdom of crowd effect. Proc Natl Acad Sci USA. 2011;108(22):9020–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Lee MD, Zhang S, Shi J. The wisdom of the crowd playing the price is right. Mem Cogn. 2011;39:914–23.

    Article  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.

  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.

Download references

Acknowledgments

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.

Author information

Affiliations

  1. Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, 24 Fourth Circular Rd., Cantonments, Accra, Ghana

    Silas Quaye

  2. Global Health Sciences, Prevention and Public Health Group, University of California, San Francisco, San Franciscos, CA, USA

    H. Fisher Raymond & Willi McFarland

  3. San Francisco Department of Public Health, San Francisco, CA, USA

    H. Fisher Raymond & Willi McFarland

  4. Ghana AIDS Commission, Accra, Ghana

    Kyeremeh Atuahene & Angela El-Adas

  5. UNAIDS-Technical Support Facility, West and Central Africa, West Africa

    Richard Amenyah

  6. Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia

    John Aberle-Grasse

Authors
  1. Silas Quaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Fisher Raymond
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyeremeh Atuahene
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Amenyah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Aberle-Grasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Willi McFarland
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela El-Adas
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Ghana Men Study Group

Corresponding author

Correspondence to Silas Quaye.

Additional information

Ghana Men’s Study team are listed in the Appendix.

Appendix: Ghana Men’s Study team

Appendix: Ghana Men’s Study team

The Ghana Men’s Study team includes the following members: Prof. Francis Dodoo, Prof. John K. Anarfi, Prof. Alexander Nyarko, Prof. William Ampofo, Prof. Richard Adanu, Prof. Stephen Kwankye, NaaDoduaAdjokatse, Adriana Biney, Eric Harrison, Prince Parbie, Samuel Dery (University of Ghana), Dr. Kelly Taylor, Ellen Stein, Shaan Chaturvedi (University of California San Francisco), Clive Ashby, and Jewel Lamptey (Ghana AIDS Commission).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Quaye, S., Fisher Raymond, H., Atuahene, K. et al. Critique and Lessons Learned from using Multiple Methods to Estimate Population Size of Men who have Sex with Men in Ghana. AIDS Behav 19, 16–23 (2015). https://doi.org/10.1007/s10461-014-0943-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0943-4

Keywords

  • Men who have sex with men
  • Africa
  • Population size estimates