Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 27:9:e43114.
doi: 10.2196/43114.

Population Size Estimation of Men Who Have Sex With Men in Rwanda: Three-Source Capture-Recapture Method

Elysee Tuyishime  1   2 , Catherine Kayitesi  3 , Gentille Musengimana  2 , Samuel Malamba  2 , Hailegiorgis Moges  2 , Ida Kankindi  2 , Horacio Ruisenor Escudero  4 , Ignace Habimana Kabano  1 , Tom Oluoch  2 , Eric Remera  3 , Angela Chukwu  1
Affiliations

Population Size Estimation of Men Who Have Sex With Men in Rwanda: Three-Source Capture-Recapture Method

Elysee Tuyishime et al. JMIR Public Health Surveill. .

Abstract

Background: Globally, men who have sex with men (MSM) continue to bear a disproportionately high burden of HIV infection. Rwanda experiences a mixed HIV epidemic, which is generalized in the adult population, with aspects of a concentrated epidemic among certain key populations at higher risk of HIV infection, including MSM. Limited data exist to estimate the population size of MSM at a national scale; hence, an important piece is missing in determining the denominators to use in estimates for policy makers, program managers, and planners to effectively monitor HIV epidemic control.

Objective: The aims of this study were to provide the first national population size estimate (PSE) and geographic distribution of MSM in Rwanda.

Methods: Between October and December 2021, a three-source capture-recapture method was used to estimate the MSM population size in Rwanda. Unique objects were distributed to MSM through their networks (first capture), who were then tagged according to MSM-friendly service provision (second capture), and a respondent-driven sampling survey was used as the third capture. Capture histories were aggregated in a 2k-1 contingency table, where k indicates the number of capture occasions and "1" and "0" indicate captured and not captured, respectively. Statistical analysis was performed in R (version 4.0.5) and the Bayesian nonparametric latent-class capture-recapture package was used to produce the final PSE with 95% credibility sets (CS).

Results: We sampled 2465, 1314, and 2211 MSM in capture one, two, and three, respectively. There were 721 recaptures between captures one and two, 415 recaptures between captures two and three, and 422 recaptures between captures one and three. There were 210 MSM captured in all three captures. The total estimated population size of MSM above 18 years old in Rwanda was 18,100 (95% CS 11,300-29,700), corresponding to 0.70% (95% CI 0.4%-1.1%) of total adult males. Most MSM reside in the city of Kigali (7842, 95% CS 4587-13,153), followed by the Western province (2469, 95% CS 1994-3518), Northern province (2375, 95% CS 842-4239), Eastern province (2287, 95% CS 1927-3014), and Southern province (2109, 95% CS 1681-3418).

Conclusions: Our study provides, for the first time, a PSE of MSM aged 18 years or older in Rwanda. MSM are concentrated in the city of Kigali and are almost evenly distributed across the other 4 provinces. The national proportion estimate bounds of MSM out of the total adult males includes the World Health Organization's minimum recommended proportion (at least 1.0%) based on 2012 census population projections for 2021. These results will inform denominators to be used for estimating service coverage and fill existing information gaps to enable policy makers and planners to monitor the HIV epidemic among MSM nationally. There is an opportunity for conducting small-area MSM PSEs for subnational-level HIV treatment and prevention interventions.

Keywords: HIV; RDS; Rwanda; capture-recapture; men who have sex with men; nationwide; population size; three-source.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Example of a unique object (keychain) distributed in capture one.
Figure 2
Figure 2
Venn diagram representing individual capture results and overlaps between capture occasions. Numbers represent the numbers of men who have sex with men captured at each round.
Figure 3
Figure 3
Trace plot for the population size estimate.
Figure 4
Figure 4
Histogram of the posterior probability distribution for population size.
See this image and copyright information in PMC

References

    1. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, Brookmeyer R. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012 Jul 28;380(9839):367–377. doi: 10.1016/S0140-6736(12)60821-6. https://europepmc.org/abstract/MED/22819660 S0140-6736(12)60821-6 - DOI - PMC - PubMed
    1. Sandfort TGM, Dominguez K, Kayange N, Ogendo A, Panchia R, Chen YQ, Chege W, Cummings V, Guo X, Hamilton EL, Stirratt M, Eshleman SH. HIV testing and the HIV care continuum among sub-Saharan African men who have sex with men and transgender women screened for participation in HPTN 075. PLoS One. 2019 May 31;14(5):e0217501. doi: 10.1371/journal.pone.0217501. https://dx.plos.org/10.1371/journal.pone.0217501 PONE-D-19-00150 - DOI - DOI - PMC - PubMed
    1. Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000-2006: a systematic review. PLoS Med. 2007 Dec;4(12):e339. doi: 10.1371/journal.pmed.0040339. https://dx.plos.org/10.1371/journal.pmed.0040339 07-PLME-RA-1077 - DOI - DOI - PMC - PubMed
    1. Frescura L, Godfrey-Faussett P, Feizzadeh AA, El-Sadr W, Syarif O, Ghys PD, on behalf of the 2025 testing treatment target Working Group Achieving the 95 95 95 targets for all: a pathway to ending AIDS. PLoS One. 2022;17(8):e0272405. doi: 10.1371/journal.pone.0272405. https://dx.plos.org/10.1371/journal.pone.0272405 PONE-D-22-08252 - DOI - DOI - PMC - PubMed
    1. Beyrer C, Baral SD, Collins C, Richardson ET, Sullivan PS, Sanchez J, Trapence G, Katabira E, Kazatchkine M, Ryan O, Wirtz AL, Mayer KH. The global response to HIV in men who have sex with men. Lancet. 2016 Jul 09;388(10040):198–206. doi: 10.1016/S0140-6736(16)30781-4.S0140-6736(16)30781-4 - DOI - PubMed

Publication types