Characteristics and Population Size Estimation of Female Sex Workers in Bhutan.


Journal

Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941

Informations de publication

Date de publication:
01 10 2021
Historique:
pubmed: 11 6 2021
medline: 3 11 2021
entrez: 10 6 2021
Statut: ppublish

Résumé

Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan. We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture. Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345-362). Extrapolation to the whole country projected 597 (417-777) FSWs nationally. Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.

Sections du résumé

BACKGROUND
Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan.
METHODS
We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture.
RESULTS
Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345-362). Extrapolation to the whole country projected 597 (417-777) FSWs nationally.
CONCLUSIONS
Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.

Identifiants

pubmed: 34110741
pii: 00007435-202110000-00008
doi: 10.1097/OLQ.0000000000001417
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

754-760

Informations de copyright

Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest and Sources of Funding: This study was funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria; Save the Children Bhutan; and the Australian Federation of AIDS Organization. The authors declare they have no conflict of interests.

Références

Khandu L. Bhutan and the Phallus: 26 Years of HIV in Bhutan. Thimphu, Bhutan: Ministry of Health, Royal Government of Bhutan, 2019.
UNAIDS. Country Factsheet, Bhutan, 2019. Available at: https://www.unaids.org/en/regionscountries/countries/bhutan . Accessed December 26, 2020.
National AIDS/STI Control Programme. Sexual Behaviours and Networks in Bhutan: A Rapid Assessment. Thimphu, Bhutan: Ministry of Health, Royal Government of Bhutan, 2016.
National AIDS/STI Control Programme. Integrated Biological and Behavioral Surveillance (IBBS) Surveys Among Vulnerable and Key Populations at Higher Risk in Bhutan, 2016. Thimphu, Bhutan: Ministry of Health, Royal Government of Bhutan, 2016.
UNAIDS. Global AIDS Update 2020. Available at: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf . Accessed December 26, 2020.
Harcourt C, Donovan B. The many faces of sex work. Sex Transm Infect 2005; 81:201–206.
Li L, Wu Z, Rotheram-Borus MJ, et al; NIMH Collaborative HIV/STD Prevention Trial Group. Visiting entertainment venues and sexual health in China. Arch Sex Behav 2009; 38:814–820.
Yan L, Yan Z, Wilson E, et al. Awareness and willingness to use HIV pre-exposure prophylaxis (PrEP) among trans women in China: A community-based survey. AIDS Behav 2021; 25:866–874.
Khandu L, Zwanikken P, Wangdi S. HIV vulnerability and sexual risk behaviour of the drayang girls in Bhutan. SAARC J TB Lung Dis HIV/AIDS 2019; 17:24–33. doi: https://doi.org/10.3126/saarctb.v17i1.25025 .
doi: 10.3126/saarctb.v17i1.25025
Lorway R, Dorji G, Bradley J, et al. The Drayang Girls of Thimphu: sexual network formation, transactional sex and emerging modernities in Bhutan. Cult Health Sex 2011; 13(Suppl 2):S293–S308.
Pem D, Nidup T, Wangdi U, et al. Emergency contraceptive pills (ECP) knowledge, attitudes, and practices among women working in the entertainment industry and men in the trucking industry, Bhutan. AIDS Behav 2018; 22(Suppl 1):121–124.
UNAIDS/WHO. Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on estimating the size of populations most at risk to HIV. Geneva: World Health Organization, and UNAIDS; 2010. Available at: http://www.who.int/hiv/pub/surveillance/final_estimating_populations_en.pdf . Accessed December 26, 2020.
Bozicevic I, Manathunge A, Dominkovic Z, et al. Estimating the population size of female sex workers and transgender women in Sri Lanka. PLoS One 2020; 15:e0227689.
Khalid FJ, Hamad FM, Othman AA, et al. Estimating the number of people who inject drugs, female sex workers, and men who have sex with men, Unguja Island, Zanzibar: Results and synthesis of multiple methods. AIDS Behav 2014; 18(Suppl 1):S25–S31.
Wesson P, Reingold A, McFarland W. Theoretical and empirical comparisons of methods to estimate the size of hard-to-reach populations: A systematic review. AIDS Behav 2017; 21:2188–2206.
Emmanuel F, Blanchard J, Zaheer HA, et al. 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–S84.
Ndayongeje J, Msami A, Laurent YI, et al. Illicit drug users in the Tanzanian hinterland: population size estimation through key informant-driven hot spot mapping. AIDS Behav 2018; 22(Suppl 1):4–9.
Wesson P, Lechtenberg R, Reingold A, et al. Evaluating the completeness of HIV surveillance using capture-recapture models, Alameda County, California. AIDS Behav 2018; 22:2248–2257.
Wesson PD, Mirzazadeh A, McFarland W. A Bayesian approach to synthesize estimates of the size of hidden populations: The anchored multiplier. Int J Epidemiol 2018; 47:1636–1644.
Wesson PD, McFarland W, Mirzazadeh A. Software application profile: The anchored multiplier calculator—A Bayesian tool to synthesize population size estimates. Int J Epidemiol 2019; 48:1744–1749.
National Statistics Bureau. 2017 Population and Housing Census of Bhutan. Thimphu, Bhutan: Royal Government of Bhutan, 2018.
Raymond HF, Chen Y-H, McFarland W. “Starfish sampling”: A novel, hybrid approach to recruiting hidden populations. J Urban Health 2019; 96:55–62.
Aguilar G, Samudio T, Lopez G, et al. High HIV prevalence among transgender women in Paraguay. Int J STD AIDS 2020; 31:1308–1314.
Cai WD, Zhao J, Zhao J, et al. HIV prevalence and related risk factors among male sex workers in Shenzhen, China: Results from a time-location sampling survey. Sex Transm Infect 2010; 86:15–20.
Yan H, Yang H, Zhao J, et al. Long-chain peer referral of men who have sex with men: A novel approach to establish and maintain a cohort to measure HIV incidence, Nanjing, China. J Acquir Immune Defic Syndr 2012; 59:177–184.
Rivest S, Baillargeo L-P. Rcapture: Loglinear Models for Capture-Recapture in R. Available at: https://pdfs.semanticscholar.org/94cc/498c0a32b1336859f70fcec440a573474a01.pdf . Accessed December 26, 2020.
Yu D, Calleja JMG, Zhao J, et al., Technical Consultation on Lessons Learnt from Size Estimation among Key Populations in Asian Countries. Estimating the size of key populations at higher risk of HIV infection: A summary of experiences and lessons presented during a technical meeting on size estimation among key populations in Asian countries. Western Pac Surveill Response J 2014; 5:43–49.
Vandepitte J, Lyerla R, Dallabetta G, et al. Estimates of the number of female sex workers in different regions of the world. Sex Transm Infect 2006; 82(Suppl 3):iii18–iii25.
Thein ST, Aung T, McFarland W. Estimation of the number of female sex workers in Yangon and Mandalay, Myanmar. AIDS Behav 2015; 19:1941–1947.

Auteurs

Lekey Khandu (L)

From the National HIV, AIDS and STIs Control Program, Ministry of Health.

Tashi Tobgay (T)

Institute of Health Partners (IHP).

Kinley Kinley (K)

From the National HIV, AIDS and STIs Control Program, Ministry of Health.

Ngawang Choida (N)

Health Information and Service Center, Ministry of Health.

Tshering Tashi (T)

Rainbow Bhutan, Thimphu, Bhutan.

Tashi Wangdi (T)

Health Information and Service Center, Ministry of Health.

Ugyen Tashi (U)

Health Information and Service Center, Ministry of Health.

Dechenmo Dechenmo (D)

Health Information and Service Center, Ministry of Health.

Karma Choden Choden (KC)

Health Information and Service Center, Ministry of Health.

Tashi Tsheten (T)

Rainbow Bhutan, Thimphu, Bhutan.

Tenzin Gyeltshen (T)

Rainbow Bhutan, Thimphu, Bhutan.

Kencho Zangmo (K)

Rainbow Bhutan, Thimphu, Bhutan.

Sonam Choden (S)

Rainbow Bhutan, Thimphu, Bhutan.

Willi McFarland (W)

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.

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