Estimation of the Population Size of Men Who Have Sex with Men (MSM) in Kazakhstan: Implications for HIV Testing and Surveillance

BACKGROUND & PUPOSE: Kazakhstan is one of only seven countries that experienced increasing HIV transmission rates from 2001-2009. UNAIDS reports that 60% of men who have sex with men (MSM) in Kazakhstan received an HIV test in the past year. However, official HIV test surveillance data from Kazakhstan indicates that only 331/815,680 (0.04%) of the tested 18-59 year old men were identified as MSM. These MSM identification rates varied by city: 165/43,355 (0.38%) in Almaty; 19/39,710 (0.05%) in Astana; 0/37,790 (<0.01%) in Pavlodar; and 17/75,328 (0.02%) in Shymkent. While the reported numbers of MSM identified during testing are very low, the UNAIDS data and HIV test surveillance data could be consistent if indeed there are very few MSM in Kazakhstan. To validate or refute this possibility, this study aimed to estimating the number and proportion of 18-59 year old men who are MSM in four geographically dispersed cities in Kazakhstan.

METHODS: From each of four cities marked by elevated rates of HIV in Kazakhstan—Almaty, Astana, Pavlodar, and Shymkent—a target sample of 100 men/city from MSM-serving sites (e.g., NGOs, bars/clubs, strolls) and a sample of 200 individuals/city from “general population” sites (e.g., shopping centers, train/bus stations, universities) was planned. Interviewers administered a structured interview (15-30 minutes in duration) that elicited self-reported data on sociodemographics, sexual orientation and behaviors, and additional data needed to employ several different population size estimation methods. These estimation methods included: Capture-Recapture, Network Scale-Up Method using both Summation and Known Populations variants, and Wisdom of the Crowds.

RESULTS: In each city, the target sample size of 100 men/city recruited from MSM-serving sites and 200 individuals/city recruited from general population sites willing to complete an interview regarding MSM and associated behaviors were achieved (total N = 1,200). Estimates of the number of MSM using the four population size estimation methods ranged from 9,320-26,400 in Almaty; 4,000-14,500 in Astana; 1,970-8,330 in Pavlodar; and 2,000-17,700 in Shymkent. Averaged across methods and inversely weighted by uncertainty in the estimate for each method, the estimated proportion of 18-59 year old men in each city is as follows: 4.5% in Almaty, 2.4% in Astana, 0.9% in Pavlodar, and 2.1% in Shymkent. Weighting each of these summary estimates by the proportion of the Kazakhstan population in each city, we estimate that 3.2% of 18-59 year old men in Kazakhstan are MSM. Among the MSM identified in our total sample, 49.9% reported taking an HIV test in the prior year.

CONCLUSIONS: To our knowledge, this is the first nationwide population size estimation of MSM in Kazakhstan. Testing data from the study sample were quite consistent with prior UNAIDS studies regarding HIV testing rates among MSM, yet the study findings also indicate that MSM are , at best, under-identified by HIV testing personnel and, at worst, unable or unwilling to access HIV testing in Kazakhstan. Since MSM are one of the Most-At-Risk Populations for HIV, findings support national policy and training efforts to better reach and/or more accurately identify MSM during HIV testing in Kazakhstan.