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Saatja: "Latsin Alijev" <[email protected]> Saaja: "Karmen Joller - SOM" <[email protected]>, "Gerli Baida - SOM" <[email protected]>, "Kerli Reintamm-Gutan - SOM" <[email protected]> Teema: Eesti HIV-positiivsete Võrgustik (EHPV) on rõõmus esitlema Teile uut analüütilist tööd Kuupäev: 2026-02-26 11:52 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. Lugupeetud proua minister, Eesti HIV-positiivsete Võrgustik (EHPV) on rõõmus esitlema Teile uut analüütilist tööd, mis on koostatud projekti „MSM Checkpoint“ raames ja rahvusvahelise konverentsi AIDS 2026 eel. Aruanne „LGBT isikute arvu hindamine Balti riikides: uurimisraport“ (autor: doktor Maksim Kasianczuk) sisaldab ajakohaseid ja põhjendatud hinnanguid, mis on rahvatervise strateegilise teabe peamised näitajad. Need andmed on kriitilise tähtsusega tõhusate HIV-i ennetusprogrammide planeerimiseks ja rakendamiseks, samuti haavatavate rühmade olukorra positiivsete muudatuste eest seismiseks. Aruande peamised tulemused hõlmavad: * Eestis on saadud konsensuslikud hinnangud LGBTIQ-kogukondade suuruse kohta: 6900 geid/biseksuaale ja teisi MSM-e; 8200 lesbisid ja biseksuaalseid cis-naisi; 2500 trans- ja mittebinaarset isikut. * MSM-ide ja trans-isikute ühendatud hinnangud on Lätis 12 300 inimest ja Leedus 17 500 inimest. Oleme veendunud, et käesolev uuring on oluline riikliku poliitika kujundamisel ja strateegiliste otsuste vastuvõtmisel tervishoiu valdkonnas. Oleme tänulikud Teiepoolse materjalidega tutvumise ja nende aktiivse kasutamise eest oma töös. Aruande täisversioonid inglise keeles on lisatud. Eestikeelne tõlge on ettevalmistamisel avaldamiseks. Lugupidamisega, Latsin Alijev -- Best regards, Latšin Alijev Director E-mail <mailto:[email protected]> [email protected] Mob <tel:+372%205870%206070> (+372) 5870 6070 Legal address Õismäe tee 36-8, 13511 Tallinn Head office Uus-Sadama 21,-303, 10120 Tallinn <http://www.ehpv.ee/> www.ehpv.ee www.facebook.com/ehpv.ee <http://www.facebook.com/ehpv.ee> Kasianczuk M. Population size estimation of LGBT persons in the Baltic states : Research report / EHPV. — Tallinn, 2026. — 20 p. ISBN 978-9916-9366-4-1 (pdf) Reviewer: Ivan Titar, PhD — Chief Research Specialist, Public Health Center of the Ministry of Health of Ukraine The study was conducted by the Estonian Network of People Living with HIV (EHPV) within the framework of the “MSM Checkpoint” project Translated in English by AI Cover design: Anastasiia Krugliakova Glossary............................................................................................................. 3 Summary ........................................................................................................... 4 Introduction ....................................................................................................... 5 1. MSM Population Size Estimates in the Baltic States .......................................... 5 1.1. Estonia ................................................................................................................ 5 1.2. Latvia and Lithuania ............................................................................................. 7 2. Methods ......................................................................................................... 8 3. Results ........................................................................................................... 9 3.1. Estonia ................................................................................................................ 9 3.2. GB and other MSM, as well as trans and non-binary people in Latvia and Lithuania.13 4. Discussion .....................................................................................................14 References ........................................................................................................17 2 Glossary CI — Confidence interval: with a given probability (usually 95%), the true value lies between the upper and lower bounds of the interval WHO — World Health Organization LGBTQ — Lesbian, gay, bisexual, transgender, and queer people MSM — Men who have sex with men SOGI — Sexual orientation and gender identity EHPV — Eesti HIV-positiivsete võrgustik — Estonian Network of People Living with HIV EMIS — European MSM Internet Survey FRA — European Union Agency for Fundamental Rights 3 Summary Data on the size of LGBT communities in the Baltic states are very limited. This study is based on an analysis of both the author’s own results and those of several other research teams (in particular, EMIS and FRA). In Estonia, in addition to estimating the number of gay, bisexual, and other cisgender men who have sex with men, the numbers of lesbian and bisexual cisgen- der women, as well as trans and non-binary people, were estimated. In Latvia and Lithuania, the available data allowed for a combined estimate of the number of MSM and trans people. Summary Table of LGBT Community Size Estimates Consensus Group 95% CI estimate Estonia Gay, bisexual, and other cis men who have sex with men 6,900 4,400 10,900 Lesbian and bisexual cis women 8,200 5,600 12,500 Trans and nonbinary people 2,500 2,300 4,000 Latvia Gay, bisexual, and other cis men who have sex with men, 12,300 9,800 15,500 plus trans and nonbinary people Lithuania Gay, bisexual, and other cis men who have sex with men, 17,500 15,500 19,600 plus trans and nonbinary people 4 Introduction Population size estimates (PSE) of vulnerable groups are among the few key indicators of strategic information in public health [1]. Understanding the scale of the human immunodefi- ciency virus (HIV) epidemic faces many challenges. However, without accurate measurements and estimates of the impact and magnitude of HIV, it is impossible to carry out programmatic activities such as advocating for positive changes in the status of vulnerable groups, planning and implementing HIV prevention, care, and treatment programs, and evaluating implemen- ted programs [2]. Establishing the size of groups at highest risk of HIV enables the develop- ment of models that forecast HIV prevalence [3]. From the perspective of politics as a system for organizing public life, size estimates matter because leaders of civil society organizations representing vulnerable communities (or more broadly, leaders of relevant social movements) use information on the size of their constitu- encies in dialogue with both the wider public and decision-makers [4]. Authorities are also interested in estimating the size of hidden populations—for example, estimates of informal employment [5, 6]. Another example of the political salience of size indicators is governments’ interest (e.g., in the conservative Muslim countries of Azerbaijan and Tajikistan) in reducing the published size of persecuted social groups [7, 8]. Although data are becoming more available, their quality varies, raising the question of stan- dardizing quality requirements. For PSEs, for example, the use of multiple alternative estima- tion methods and robust techniques for synthesizing estimates into a single figure, as well as documentation of extrapolation approaches, is recommended [9, 10]. 1. MSM Population Size Estimates in the Baltic States 1.1. Estonia The situation in Estonia with empirical PSEs was not encouraging up to 2023 (Fig. 1). The first estimate was published in 2013 [11], although the underlying data were collected back in 2009. For more than a decade, estimates were not updated—only in 2023 did a new estimate appear, based on 2021 data [12]. The data from two studies (2000 [13] and 2020 [14]) were 5 not known within the HIV-service sector and were not used in planning public health policy. Since 2023, data have begun to appear more regularly [15, 16], but they are still not in de- mand by state institutions. Figure 1 Estimates of the MSM population in Estonia Notes: The figure is based on data from [11, 12, 14, 17]; the dashed vertical line indicates the WHO-recom- mended minimum of 1% of adult men [8]; until 2024, PSEs for MSM also included trans and nonbinary people The population size of trans people in Estonia had not been established prior to 2024 [18], although there are limited data from a 2020 survey (0.96% of the population aged 18+) [14]. The number of identity documents changed due to a gender marker update can be obtained from Ministry of the Interior (Table 1); most records of gender marker changes were registe- red at the Tallinn Vital Statistics Department. 6 Table 1. Number of identity documents changed due to a gender marker change by year, according to data from the Estonian Ministry of the Interior / Population Register Year Identity documents changed 2019 22 2020 15 2021 9 2022 23 2023 25 2024 48 2025 39 Based on these data, as well as findings from a survey of LGBT people conducted during Tartu Pride 2024, publication [15] attempted to estimate the number of trans and non-binary peop- le separately from MSM. The same publication also made the first empirical attempt to esti- mate the number of cisgender lesbian and bisexual women. 1.2. Latvia and Lithuania Until 2020, the history of MSM PSEs in Latvia and Lithuania largely mirrored Estonia’s, as they relied on the same studies—EMIS-2009 [11] and FRA surveys from 2012 [19] and 2020 [14]. In 2023, an additional estimate was produced for MSM aged 15–24, yielding 3,200 and 4,900 persons for Latvia and Lithuania, respectively [18]. The numbers of trans and non-binary people, as well as cisgender lesbian and bisexual women, were not empirically estimated. In Latvia, between 2019 and 2024, only seven people changed their name in connection with a gender marker change (Table 2) [20]. Table 2. Number of name changes in connection with a gender marker change by year, according to the Latvian Ministry of Justice Year Name changes 2019 3 2020 1 2021 3 2022–2024 0 7 2. Methods A wide range of PSE methods exists [1]. More reliable results are obtained by combining several estimates into a consensus value [21]. Given available resources, we applied variants of the multiplier method, which is used when: (1) quantitative information is available from at least two independent sources; (2) the measured groups are known to overlap; and (3) the size of the overlap can be estimated. Example: Source 1: an organization’s roster interacting with members of the target group (statistical reports, routine information, and other databases). Source 2: information obtained directly from target group members about their contact with that organization. During Tartu Pride 2024, letters were sent to Estonian LGBTIQ organizations requesting the number of cisgender men and women, as well as trans/non-binary people, who participated in organizational events from August 2023 to August 2024. Responses were received from MTÜ Q-Space, MTÜ SevenBow, MTÜ Vikerlased, MTÜ Peemoti Raamatud, and MTÜ Eesti Transinimeste Ühing. An LGBTIQ survey conducted during Pride provided the second data component [15]. In the FRA 2024 survey, respondents were asked about participation in analogous surveys in 2012 and 2019 (capture–recapture method) [22]. Affirmative responses (for Estonia—disag- gregated by SOGI; for Latvia and Lithuania—among cis-MSM and trans people of all genders) were matched to the corresponding 2012 [19] and 2020 [14] samples. FRA survey datasets are publicly available at https://www.gesis.org/home. The estimates reported here comprise FRA-refined figures for Estonia and new estimates for Latvia and Lithuania. Point estimates were obtained using formulas (1–3). ! !=#⋅" (1) P — the estimated size of the group; I — the number of members of the estimated group according to an independent source; N — the survey sample size; n — the number of respondents who indicated their affiliation with the independent source 8  !⋅$⋅(!&")⋅($&") %&'(!) = "! (2) 95% CI: ! ± 1.96 ⋅ /%&'(!) (3) The synthesis of estimates was performed using a Bayesian approach in the Triangulator lib- rary (https://fellstat.github.io/triangulator/) [23]. Each point estimate’s contribution to the consensus value is based on “data strength”: estimates with narrower confidence intervals exert greater influence than those with wider intervals. Reliability was assessed by the re- search team’s expert judgment (e.g., counts of gender-marker changes do not capture trans and non-binary people who do not intend to change their marker; such point estimates are assigned lower reliability, which widens confidence intervals, thereby reducing their weight in the final estimate). All other computations were conducted in the R [24]. 3. Results Population size estimates are based on data from Estonian LGBTIQ organizations and LGBTIQ commercial initiatives reported in the previous publication [15], supplemented by FRA survey data from 2012, 2019, and 2023 [19, 22, 25, 26]. 3.1. Estonia GB men and other MSM (Table 3). The minimum point estimate (762) exceeds the number of male clients not only at MTÜ Peemoti Raamatud but also the counts of male visitors to the Festheart (648) and Q-Space (600) festivals. This allows inclusion of all point estimates in the consensus figure (Fig. 2): 6,900 [4,400–10,900], or 1.3% [0.8–2.0%] of men aged 15+ (538,798 according to https://www.stat.ee for 2024). LB community (Table 4). The minimum value (1,604) exceeds the number of unique female clients of MTÜ Peemoti Raamatud and visitors to Festheart (648) and Q-Space (600), allowing inclusion of all point estimates in the consensus figure (Fig. 3): 8,200 [5,600–12,500], or 1.3% [0.9–2.0%] of women aged 15+ (615,581 according to https://www.stat.ee for 2024). 9 Trans and non-binary people (Table 5). Point estimates span a sevenfold range; the minimum value (417) exceeds the number of gender-marker changes (94), permitting inclusion of all point estimates in the consensus calculation (Fig. 4): 2,500 [2,300–4,000], or 0.2% [0.1–0.3%] of Estonia’s residents aged 15+ (1,154,379 according to https://www.stat.ee for 2024). Table 3. Data and results of point estimates for the size of GB/MSM in Estonia and their 95% Cis Independent data source I N n PSE 95% CI EMIS-2024 participants a) 184 120 27 818 567 1069 Peemoti Raamatud 316 120 11 3447 1540 5355 Festheart b) 648 120 27 2878 1942 3813 Q-Space b) 600 120 24 3000 1948 4052 X-baar g) 2950 120 58 6103 4986 7221 Hello Bar g) 1000 120 49 2449 1935 2963 In a registered marriage or partnership with a person of the same gender d) (comparison with 127 120 20 762 482 1042 the Tartu Pride survey) In a registered marriage or partnership with a person of the same gender e) (comparison with 127 189 10 2400 1011 3790 FRA-2024) FRA-2019 participants z) 285 189 22 2448 1525 3372 z) 190 189 6 5985 1348 10622 FRA-2012 participants Notes: symbols I, N, n, PSE correspond to formulae (1–3); α) preliminary data as of 07 July 2024; β) 50% of the number of visitors to festivals organized by MTÜ SevenBow and MTÜ Q-Space from August 2023 to August 2024, according to those organizations; γ) data from the previous estimate [16], assuming the annual number of male visitors did not change; δ) data from [27]; ε) data from [25, 27]; ζ) data from [19, 22, 25, 26] 10 Figure 2. Deriving the consensus estimate of the size of GB/MSM in Estonia from the data in Table 3; the a priori value is taken from publication [16] Table 4. Data and results of point estimates for the size of LB women in Estonia and their 95% CIs Independent data source I N n PSE 95% CI Peemoti Raamatud 296 120 18 1973 1159 2788 Festheart a) 648 120 12 6475 3032 9918 Q-Space a) 600 120 15 4800 2556 7044 In a registered marriage or partnership with a person of the same gender b) 254 120 19 1604 968 2241 (comparison with the Tartu Pride survey) In a registered marriage or partnership with a person of the same gender g) 254 507 35 3679 2587 4771 (comparison with FRA-2024) FRA-2019 participants d) 652 507 18 18365 10148 26581 Notes: symbols I, N, n, PSE correspond to formulae (1–3); a) 50% of the number of visitors to festivals organized by MTÜ SevenBow and MTÜ Q-Space from August 2023 to August 2024, according to those organizations; b) data from [27]; g) data from [25, 27]; d) data from [19, 22, 25, 26] 11 Figure 3. Deriving the consensus estimate of the size of GB/MSM in Estonia from the data in Table 4; the a priori value is taken equal to GB/MSM from publication [16] Table 5. Data and results of point estimates for the size of trans and nonbinary people in Estonia and their 95% CIs Independent data source I N n PSE 95% CI EMIS-2024 participants a) 54 85 11 417 212 623 Individuals who have changed their gender marker according to government registers b) 94 85 11 726 350 1103 (comparison with the Tartu Pride survey) Individuals who have changed their gender marker according to government registers 94 414 4 2780 1459 4100 (comparison with FRA-2024) g) Eesti Transinimeste Ühing 150 85 13 981 512 1450 Peemoti Raamatud 1361 85 38 3044 2335 3754 FRA-2019 participants d) 187 414 27 2867 1900 3835 FRA-2012 participants d) 20 414 4 2070 264 3876 Notes: symbols I, N, n, PSE correspond to formulae (1–3); a) preliminary data as of 07 July 2024; b) data from [16]; g) data from [16, 25]; d) data from [19, 22, 25, 26] 12 Figure 4. Deriving the consensus estimate of the population size of trans and nonbinary people in Estonia based on the data in Table 5: the a priori value was set at a minimum of 0.2% of residents aged 15+ in Estonia, following WHO recommendations (0.1% as the minimum share of trans people [1] and an equal 0.1% for nonbinary persons) 3.2. GB and other MSM, as well as trans and non-binary people in Latvia and Lithuania There are very few source data for estimating the size of MSM and trans/non-binary people in Latvia (Table 6), and unfortunately no validation data are available. However, the resulting confidence intervals overlap, and the final estimate (taking into account the a priori value of 12,880 [11]) is 12,300 [9,800–15,500] persons, or 1.7% [1.4–2.2%] of men in Latvia aged 15 and older (714,328 men according to https://stat.gov.lv/en for 2022). Table 6. Data and results of point estimates for the size of GB/MSM in Latvia and their 95% Cis Independent data source I N n PSE 95% CI EMIS-2024 participants a) 198 27 7 764 285 1242 FRA-2019 participants b) 415 470 19 10266 5849 14683 FRA-2012 participants b) 278 470 4 32665 1020 64310 Notes: symbols I, N, n, PSE correspond to formulae (1–3); a) preliminary data as of 07 July 2024; b) data from [19, 22, 25, 26] 13 There are even fewer source data for estimating the number of MSM and trans/non-binary people in Lithuania (Table 7). The resulting confidence intervals overlap, and the final estimate (accounting for the a priori value of 17,760 [11]) is 17,500 [15,500–19,600] persons, or 1.3% [1.1–1.5%] of men in Lithuania aged 15 and older (1,373,683 men according to https://osp.stat.gov.lt/statistiniu-rodikliu-analize#/ as of 1 January 2025). Table 7. Data and results of point estimates for the size of GB/MSM in Lithuania and their 95% Cis Independent data source I N n PSE 95% CI FRA-2019 participants a) 672 642 37 11660 8115 15206 FRA-2012 participants a) 402 642 11 23462 9906 37019 Notes: symbols I, N, n, PSE correspond to formulae (1–3); a) data from [19, 22, 25, 26] 4. Discussion As shown in Section 1, data on the sizes of LGBT populations in the Baltic countries are quite limited and generally pertain to MSM (with the exception of Estonia, where since 2021 regular estimates have been produced and published by communities affected by HIV). In this study, taking into account new data [22], we revised the previously published [15] estimates of the sizes of LGBT communities in Estonia, which—unlike earlier estimates [12, 16]—for the first time separately included groups of lesbian and bisexual women and trans/non-binary people. We also separately estimated the number of MSM (including trans and non-binary people) in Latvia and Lithuania. The new data for MSM are summarized in Fig. 5, which shows that, despite some dispersion of point estimates due to differences in the data-source sets used, the size estimates lie along a single continuum (the confidence intervals overlap substantially). Although the Latvian and Lithuanian data, unlike the Estonian data, additionally include trans and non-binary people, the relatively small size of the latter does not materially affect the overall MSM totals. Whereas previously the number of GB men and other MSM, as well as trans / non-binary people, in Estonia was estimated at 9,892 [9,628–10,172] persons [16], the 14 combined total for these groups is now 9,400 [6,700–14,900]. Because the 95% CIs overlap, it can be asserted that the values have not changed in the year since the previous estimate. The newly presented MSM size estimates for Latvia and Lithuania also align well with the 2009 data [11]. The earlier estimates (12,880 and 17,760 for Latvia and Lithuania, respectively) fall within the confidence intervals of the new estimates. Figure 5. Estimates of the MSM population in the Baltic countries Notes: the dashed vertical line indicates the WHO-recommended minimum of 1% of adult men [8]; the MSM estimates for Latvia and Lithuania also include trans and nonbinary people It should be noted that estimates of MSM aged 15–24 published in 2019 [18] may differ from the data presented here. For example, in Lithuania that estimate reported 4,900 MSM aged 15–24; if extrapolated to all age groups 15+ (i.e., multiplied by 1,299,477/143,059—the ratio of all men aged 15+ to men aged 15–24), the result (44,509) would be more than twice the upper bound of our 95% confidence interval. However, such an extrapolation assumes that the same proportion of MSM in every age group, which may not reflect reality. Because PSEs (see Introduction) are a practical starting point for planning HIV prevention programs, Estonia’s available data on the number of MSM receiving PrEP prescriptions can be compared directly with the size estimate. In 2024, 2,291 MSM in Estonia were prescribed PrEP—about one-third of the estimated MSM population (6,900). 15 The results have several methodological limitations: • Convenience-based sampling implicitly assumes uniform representation of LGBT people across adult age groups. • It also assumes equal access to services used as independent data sources across all LGBT subgroups—assumptions that likely do not hold (e.g., gay bars are more acces- sible in large cities; women and trans people seek services from HIV NGOs implemen- ting MSM programs much less often than men). 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