“Are you counting me?” Addressing the challenge of estimating vulnerable populations in South Asia
02 Apr 2012
April 3, Colombo – How does a national HIV programme accurately estimate the size of high risk, vulnerable and hard-to-reach populations such as men who have sex with men and transgender persons? The question has long challenged government health authorities as well as community-based organisations and advocates that support surveillance and data collection in countries with populations huge and small alike.
The South Asia Regional Men who have Sex with Men (MSM) Size Estimation Workshop is bringing together over 40 participants responsible for size estimation activities from Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka; and additional resource persons from Viet Nam, Bangladesh, India, and Sudan. Participants collectively represent government, academia, civil society and the United Nations system. The workshop has been organized by the United Nations Development Programme Asia-Pacific Regional Centre (UNDP APRC) and the Joint United Nations Programme on HIV/AIDS Asia-Pacific Regional Support Team (UNAIDS RST).
HIV figures continue to rise rapidly among MSM and transgender communities in the region. In India, HIV prevalence for MSM is estimated at 7.3 percent, more than 20 times higher than that of the general population. In Nepal, it’s 3.8 percent and for Sri Lanka 0.5 percent -- also significantly higher than general population estimates. There are few countries with data on transgender persons; but where it exists, HIV infections are disproportionately high.
“At a time of rising HIV infection, it’s essential to get the estimation of vulnerable populations as accurate as possible to design and fund truly effective prevention, treatment and care programmes,” noted Edmund Settle, HIV Policy Specialist, UNDP APRC. “As the recent UNESCAP High Level Meeting on HIV noted just two months ago, the Asia-Pacific region including South Asia has seen impressive gains in addressing HIV, but the epidemic among these two key populations is still outpacing the response.”
A key aspect of successful mapping is the active involvement of the communities themselves in helping count their own numbers and feeding that information into an increasingly deeper pool of data, which in turn better equips policy strategists and planners. This is exactly the sort of capacity building and community strengthening Project DIVA – the South Asia Multi-country Global Fund grant – should encourage.
“The sharing and learning from real country experiences planned at this workshop is so important for fostering South-South technical cooperation and assistance,” said Amala Reddy, Regional Programme Advisor, Strategic Information, UNAIDS RST. “Workshop participants have, or will be, supporting national size estimation activities technically, with the close involvement of a number of community-based partners.”
Stigma and discrimination stemming from hostile socio-cultural environments have long pushed MSM and transgender persons, already all but invisible communities across much of this region, further to the margins of society. But there are innovative ways to attempt a more accurate count. As countries such as India increase the number of HIV surveillance sites for these communities, and outreach services for prevention and care are strengthened, a clearer picture is emerging, enhanced by increasingly sophisticated mathematical modeling and extrapolation.
After country experiences on national size estimation activities are reviewed and shared at the workshop, and national participants are updated on current models and methodologies with a focus on analyzing data, the aim is then to develop country-specific action plans to be integrated into the upcoming Phase II programming of the South Asia Multi-country Global Fund grant.
“The significance of this process cannot be underestimated “ said Shivananda Khan, Chief Executive of Naz Foundation International, a regional partner within the South Asia Multi-country Global Fund grant. “Improving national reporting will provide quality strategies to shape MSM and transgender-related HIV programming; ultimately containing and hopefully reversing the epidemic among our communities. To the question ‘Am I being counted?’ we will endeavor to answer, at long last, with a resounding “Yes.’”
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The South Asia Regional MSM and Transgender Size Estimation Workshop, “Strengthening National Reporting on HIV among MSM and Transgender Persons,” has been organised under Project DIVA (“Diversity in Action, Supporting Communities, Reducing Vulnerabilities”). This Global Fund Round 9 programme aims to support in-country MSM and transgender community systems strengthening, engage in policy advocacy initiatives, and strengthen strategic information on HIV-related issues of these highly marginalized populations. Population Services International (PSI) Nepal is the Principal Recipient and Naz Foundation International (NFI) is the regional partner. UNDP Asia-Pacific Regional Centre is the regional technical assistance provider.
For more on Project DIVA, please visit http://www.nfi.net/downloads/knowledge_centre/NFI%20publications/NFI%20brochures/NFI+DIVA_Brochure%2022-11-11%20.pdf