HIV prevalence, sexual risk behaviours and HIV testing among female sex workers in three cities in Sri Lanka: Findings from respondent-driven sampling surveys.

Sri Lanka has a low-level HIV epidemic. This study aims to provide evidence on HIV, syphilis and hepatitis B (HBV) prevalence, sexual risk behaviours and utilisation of HIV prevention interventions among female sex workers (FSW) in the cities Colombo, Galle, and Kandy. Using respondent-driven sampling (RDS), we recruited a total of 458 FSW in Colombo, 360 in Galle and 362 in Kandy from November 2017 to March 2018. Participants provided biological specimens for testing for infections and completed a behavioural questionnaire. We found no HIV nor HBV infections in Galle and Kandy, and low HIV (0.4%) and HBV surface antigen (0.6%) prevalence in Colombo. FSW in Colombo had higher positivity on Treponema pallidum-particle agglutination test (8.4%) compared to Galle (2.0%) and Kandy (2.5%). About two thirds of FSW heard of HIV in each of the cities. Around 90% of FSW used condom at last sex with a client in both Colombo and Galle, but considerably less in Kandy (57.1%). However, lower proportion of FSW used condoms every time during sex with clients in the past 30 day: 22.9% of FSW in Colombo, 26.6% in Kandy and 68.4% in Galle. Across cities, 17.5%-39.5% of FSW reported being tested for HIV in the past 12 months or knowing HIV positive status. The commonest reasons for never testing for HIV was not knowing where to test (54.2% in Colombo, 41.8% in Galle, 48.1% in Kandy) followed by inconvenient testing location (23.7% in Colombo and 31.1% in Kandy). HIV has not yet been firmly established among FSW in three cities in Sri Lanka, but the vulnerability towards HIV and STIs is substantial. HIV interventions should be intensified by expanding community-based HIV testing approaches, increasingawareness of HIV risks and addressing socio-structural vulnerabilities of FSW to HIV

Estimating the population size of female sex workers and transgender women in Sri Lanka.

We implemented population size estimation of female sex workers (FSW) and transgender women (TGW) in Sri Lanka in 2018 using several approaches (geographical mapping, service and unique object multiplier and a modified Delphi method during the stakeholder consensus meeting). Mapping was done in 49 randomly selected Divisional Secretariats, which provided a basis for extrapolation of size estimates to the national level. Two types of adjustments were applied on the mean (minimum-maximum) population estimate obtained during mapping: (1) an adjustment for mobility to reduce double counting of FSW and TGW frequenting multiple spots, obtained during mapping; (2) an adjustment for "a hidden population", obtained from surveys among FSW and TGW. For the multiplier method, we used data from services of non-governmental organisations that FSW and TGW were in contact with, and surveys based on respondent-driven sampling. Surveys were carried out in the cities of Colombo (FSW, TGW), Kandy (FSW), Galle (FSW) and Jaffna (TGW). We estimated that there are 30,000 FSWs in Sri Lanka, with a plausible range of 20,000-35,000, which implies a prevalence of FSW of 0.56% (0.37-0.65%) among adult females. This study provided baseline estimates of 2,200 TGW in the country, with a plausible range of 2,000-3,500, which is 0.04% (0.04-0.07%) of adult male population. Our estimates of the proportional contribution of the FSW and TGW populations among the adult population in Sri Lanka are consistent with the The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended estimates for Asia and the Pacific. The results provide an important point for macro- and micro-level planning of HIV services, allocating programme resources and assessing programme coverage and quality