Background and rationale: A few studies have examined the prevalence and incidence of human immunodeficiency virus (HIV) among female sex workers (FSWs) and their clients in Somalia. Studies among FSWs in Hargeisa found an HIV prevalence of 5.2 per cent in 2008 and 4.8 per cent in 2014. The lack of clear size estimates of population groups that are of high risk to HIV infection implies that national HIV prevention plans are not driven by evidence and may result in a mismatch between populations most in need and those who receive the available resources. To help formulate informed policies and intervention measures, a study on HIV mapping and size estimation of high-risk population groups was conducted in Somalia. This study aimed at establishing the location and size estimates of FSWs and their clients in Mogadishu, Bossaso and Hargeisa.
Conclusion and recommendations: FSWs and their male clients exist and operate in hidden ways in Mogadishu, Hargeisa and Bossaso. The data generated from this study can be used to enhance HIV prevention programme planning and implementation for FSWs and their clients, to form the basis for subsequent population size estimates and impact evaluations, and to improve programme coverage by directing efforts to locations with the greatest need as demonstrated by the findings of this study. In accordance with the findings of this study, indicating that the majority of FSWs and their clients are not seeking essential health services, prompt HIV interventions targeting FSWs and their clients should be implemented. These services ought to include at least HTC, STI/STD screening and treatment, cervical cancer screening (FSWs only) and condom provision. It will be essential to create separate databases for FSWs and their clients to guide the monitoring and evaluation of HIV interventions targeting these populations. This can be achieved by registering the key populations into the programme(s) and issuing them unique identifiers. Access to FSWs and their clients can be done with initial seeds of these key populations who then recruit more members into the programme(s). Essential health service provision can thereafter be tracked per unique individual in the programme. While this study contributes to the ongoing HIV programming in the studied locations, similar studies should be conducted in other locations to develop a more targeted national response for the key populations.