HIV This Week

Geibel S, van der Elst EM, King'ola N, Luchters S, Davies A, Getambu EM, Peshu N,Graham SM, McClelland RS, Sanders EJ.'Are you on the market?': a capture-recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. Population Council, Nairobi, Kenya. AIDS. 2007 Jun 19;21(10):1349-54.

Men who have sex with men (MSM) are highly vulnerable to HIV infection, but this population can be particularly difficult to reach in sub-Saharan Africa. We aimed to estimate the number of MSM who sell sex in and around Mombasa, Kenya, in order to plan HIV prevention research. The authors identified 77 potential MSM contact locations, including public streets and parks, brothels, bars and nightclubs, in and around Mombasa and trained 37 MSM peer leader enumerators to extend a recruitment leaflet to MSM who were identified as 'on the market', that is, a man who admitted to selling sex to men. They captured men on two consecutive Saturdays, 1 week apart. A record was kept of when, where and by whom the invitation was extended and received, and of refusals. The total estimate of MSM who sell sex was derived from capture-recapture calculation. As a result, capture 1 included 284 men (following removal of 15 duplicates); 89 men refused to participate. Capture 2 included 484 men (following removal of 35 duplicates); 75 men refused to participate. Of the 484 men in capture 2, 186 were recaptures from capture 1, resulting in a total estimate of 739 (95% confidence interval, 690-798) MSM who sell sex in and around Mombasa. Of these, 484 were contacted through trained peer enumerators in a single day. MSM who sell sex in and around Mombasa represent a sizeable population who urgently need to be targeted by HIV prevention strategies.

Editors’ note: Capture-recapture techniques were initially developed to ascertain the size of fish populations but they work well for people too! They can be used to establish the size of the population to be reached by programmes permitting assessment of service coverage against this denominator.

HIV risk and infection are markedly increased among sexual minority women injectors compared to other injecting drug users. Our ethnographic exploration of this well-documented but poorly understood phenomenon included 270 interviews and over 350 field observations with 65 sexual minority women injectors in New York City and Boston. We discuss findings in relation to four preliminary hypotheses. Neither the presence of gay or bisexual men in risk networks, nor a sense of invulnerability due to lesbian(or other sexual minority) identity seem to be plausible explanations of increased HIV among sexual minority women injectors. However, multiple marginalization was found to be pervasive and to have severe consequences that can be traced to increased HIV risk for many women in the study.

Editors’ note: Prevention programmes for women who have sex with women are virtually non-existent, in part because sexual risk is low, but, as this ethnographic study shows, risk from injecting practices can be compounded by marginalization. Engaging and empowering sexual minority women injectors for HIV prevention is not possible without bridging strategies that address multiple underlying concerns.