1. National HIV Behavioral Surveillance System for Heterosexuals at Risk for HIV Infection
Amy Lansky, Elizabeth DiNenno
Behavioral Surveillance Team
Behavioral and Clinical Surveillance Branch
Division of HIV/AIDS Prevention, NCHHSTP, CDC
Presented at APHA 135th Annual Meeting
November 5, 2007
Washington DC
The findings and conclusions in this presentation are those of the authors
and do not necessarily represent the views of the Centers for Disease Control and Prevention

2. National HIV Behavioral Surveillance System (NHBS): Objective
Among persons at high risk for HIV infections, assess:
Prevalence of and trends in
Risk behaviors
HIV testing behaviors
Assess exposure to and use of prevention services

5. Definition of Groups (inclusion criteria)
Men who have sex with men (MSM)
Man who had sex with 1 or more men in last 12 months
Injection Drug Users (IDU)
Injected drugs in last 12 months
Heterosexuals at risk (HET) ?

6. Conceptual Framework Sexual Behaviors 2) Sexual Networks
Risk behaviors that increase the likelihood of HIV infection
2) Sexual Networks
Whether sex partners are infected
3) Social Context
Demographic characteristics and social forces associated with population patterns of health and disease.

7. Conceptual Framework: Sexual Behaviors
Multiple sex partners
Concurrent partners
Type of partner
Condom use

8. Conceptual Framework: Sexual Networks
What do people know about the risk behaviors of their sex partners?

9. Conceptual Framework: Social Context
Demographic characteristics and social forces associated with population patterns of health and disease.
High rates of disease
Social forces

10. Social Context and Geography
Many social forces and disparities are geographically concentrated
Poverty
Incarceration
Racial segregation
Geographic analysis (GIS) can be used to identify communities “at risk”

11. What data can you get in 25 cities?
High Risk Areas
What geographic unit makes sense for understanding social/sexual behaviors?
Census tract: standardized population size
What data can you get in 25 cities?
High rates of heterosexually-acquired HIV/AIDS
High rates of poverty

12. Geography and social interaction
Physical connection to a high risk area
Living there
Socializing there
Social connection
Having sex partners/friends/family who live there

15. The NHBS-HET Pilot Cycle Definition: Heterosexual At Risk of HIV Infection
Adult male or female aged years
Physical or Social Connection to a High Risk Area
Had sex with an opposite-sex partner in the past 12 months

16. NHBS-HET Pilot Cycle Activities
Mapping to identify High Risk Areas
Formative research to learn about the local populations
Survey and HIV testing with heterosexuals at risk

17. National HIV Behavioral Surveillance System (NHBS), 2006-2007
Seattle
Boston
Detroit
New Haven
Nassau
New York City
Newark
San Francisco
Chicago
Philadelphia
Denver
Baltimore
Las Vegas
St. Louis
Washington, DC
Norfolk
Los Angeles
San Diego
Atlanta
Dallas
Houston
New Orleans
Ft. Lauderdale
Miami
San Juan

18. NHBS Overall Strategy Conducted in rotating, annual cycles
One group per cycle (MSM, IDU, HET)
Different sampling methods each cycle
Same populations and MSAs over time
Consistent eligibility criteria
18+ years of age
Resident of MSA
Questionnaire
Core + Local Questions
Interviewer uses handheld computer

19. NHBS-HET Pilot Cycle: Sampling Methods
Venue-based, Time-Space Sampling
Time space sampling to randomly select venues.
Participants in venues are systematically recruited and interviewed.
Respondent-Driven Sampling
Staff recruit “seeds” to start.
Seeds recruit other IDU, those IDU recruit other IDU, etc.
Sample size goal = 750 per MSA

20. NHBS-HET: Experiences from New Orleans, Baltimore, and Houston
Mapping/identifying high risk areas
Formative research methods & findings
Sampling methods and results
Venue based sampling
Respondent driven sampling