A Key Comprehensive System for Biobehavioral Surveillance of Populations Disproportionately Affected by HIV (National HIV Behavioral Surveillance): Cross-sectional Survey Study

BackgroundThe National HIV Behavioral Surveillance (NHBS) is a comprehensive system for biobehavioral surveillance conducted since 2003 in 3 populations disproportionately affected by HIV: gay, bisexual, and other men who have sex with men (MSM); people who inject drugs; and heterosexually active persons at increased risk for HIV infection (HET). This ongoing and systematic collection and analysis of data is needed to identify baseline prevalence of behavioral risk factors and prevention service use, as well as to measure progress toward meeting HIV prevention goals among key populations disproportionately affected by HIV. ObjectiveThis manuscript provides an overview of NHBS from 2003 to 2019. MethodsNHBS is conducted in rotating, annual cycles; these 3 annual cycles are considered a round. Venue-based, time-space sampling is used for the MSM population. Respondent-driven sampling is used for people who inject drugs and HET populations. A standardized, anonymous questionnaire collects information on HIV-related behavioral risk factors, HIV testing, and use of prevention services. In each cycle, approximately 500 eligible persons from each participating area are interviewed and offered anonymous HIV testing. ResultsFrom 2003 to 2019, 168,600 persons were interviewed and 143,570 agreed to HIV testing across 17 to 25 cities in the United States. In the fifth round (2017 to 2019), over 10,000 (10,760-12,284) persons were interviewed each of the 3 population cycles in 23 cities. Of those, most (92%-99%) agreed to HIV testing. Several cities also conducted sexually transmitted infection or hepatitis C testing. ConclusionsNHBS is critical for monitoring the impact of the Ending the HIV Epidemic in the United States initiative. Data collected from NHBS are key to describe trends in key populations and tailor new prevention activities to ensure high prevention impact. NHBS data provide valuable information for monitoring and evaluating national HIV prevention goals and guiding national and local HIV prevention efforts. Furthermore, NHBS data can be used by public health officials and researchers to identify HIV prevention needs, allocate prevention resources, and develop and improve prevention programs directed to the populations of interest and their communities

A Prospective Study of Psychological Distress and Sexual Risk Behavior Among Black Adolescent Females

ABSTRACT. Objective. The purpose of the study was to examine the association between adolescents’ psychological distress and their sexually transmitted disease/ human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. Method. Sexually active black adolescent females (N 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, .84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. Results. In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: 2.0), have had unprotected vaginal sex (AOR 2.1), have nonmonogamous sex partners (AOR 1.7), and not use any form of contraception (AOR 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR 2.2), be fearful of the adverse consequences of negotiating condom use (AOR 2.0), perceive less control in their relationship (AOR 2.0), have experienced dating violence (AOR 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR 1.7). Discussion. The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment,those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/ HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy

Estimated proportion of heterosexual persons in the United States, by survey and combined by meta-analysis.

<p>* I² = 81.1; Q = 10.6, p = 0.005</p><p>^† I² = 88.1; Q = 16.8, p <0.001</p><p>^§ I² = 91.6; Q = 23.7, p < 0.001. CI = confidence interval. GSS = General Social Survey (2010); NHANES = National Health and Nutrition Examination Survey (2009–2010); NSFG = National Survey of Family Growth (2006–2010). See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133543#pone.0133543.t001" target="_blank">Table 1</a> for description of each survey.</p><p>Estimated proportion of heterosexual persons in the United States, by survey and combined by meta-analysis.</p

Description of 3 national household surveys of the non-institutionalized population of the United States used in meta-analysis.

<p>* Interview method is for the sexual and drug use behavior questions.</p><p>^† Question wording includes all questions used to determine heterosexual (ever had sex with opposite sex partner, did not ever inject drugs, did not ever have sex with same-sex partner [males]). Note that for NSFG the questions on injection drug use were not used.</p><p>^§ Analyses were limited to those aged 18–69 years to match the upper age limit of NHANES.</p><p>^¶ Data were available for respondents aged 14–69 years. Analyses were limited to those aged 15–69 years to match the lower age limit of NSFG.</p><p>CAPI = Computer-Assisted Personal Interview; ACASI = Audio, Computer-Assisted Self Interview</p

Estimating the Number of Heterosexual Persons in the United States to Calculate National Rates of HIV Infection

<div><p>Background</p><p>This study estimated the proportions and numbers of heterosexuals in the United States (U.S.) to calculate rates of heterosexually acquired human immunodeficiency virus (HIV) infection. Quantifying the burden of disease can inform effective prevention planning and resource allocation.</p><p>Methods</p><p>Heterosexuals were defined as males and females who ever had sex with an opposite-sex partner and excluded those with other HIV risks: persons who ever injected drugs and males who ever had sex with another man. We conducted meta-analysis using data from 3 national probability surveys that measured lifetime (ever) sexual activity and injection drug use among persons aged 15 years and older to estimate the proportion of heterosexuals in the United States population. We then applied the proportion of heterosexual persons to census data to produce population size estimates. National HIV infection rates among heterosexuals were calculated using surveillance data (cases attributable to heterosexual contact) in the numerators and the heterosexual population size estimates in the denominators.</p><p>Results</p><p>Adult and adolescent heterosexuals comprised an estimated 86.7% (95% confidence interval: 84.1%-89.3%) of the U.S. population. The estimate for males was 84.1% (CI: 81.2%-86.9%) and for females was 89.4% (95% CI: 86.9%-91.8%). The HIV diagnosis rate for 2013 was 5.2 per 100,000 heterosexuals and the rate of persons living with diagnosed HIV infection in 2012was 104 per 100,000 heterosexuals aged 13 years or older. Rates of HIV infection were >20 times as high among black heterosexuals compared to white heterosexuals, indicating considerable disparity. Rates among heterosexual men demonstrated higher disparities than overall population rates for men.</p><p>Conclusions</p><p>The best available data must be used to guide decision-making for HIV prevention. HIV rates among heterosexuals in the U.S. are important additions to cost effectiveness and other data used to make critical decisions about resources for prevention of HIV infection.</p></div

Adult and adolescent heterosexuals living with diagnosed HIV infection- United States, 2012.

<p>*Number of cases attributable to heterosexual contact, statistically adjusted to account for reporting delays and missing risk factor information, but not for incomplete reporting.</p><p>^†Per 100,000 heterosexuals.</p><p>^§ Hispanics/Latinos may be of any race.</p><p>^¶ Other race includes American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, unknown race/ethnicity, and multiple races.</p><p>** Relative standard error >30% for meta-analysis estimate of the population proportion heterosexual for this group.</p><p>Note. Data include persons age 13 years and older with a diagnosis of HIV infection regardless of stage of disease at diagnosis. CI = confidence interval</p

Estimated proportion of heterosexual persons in the United States, by sex, race/ethnicity, and age group--meta-analysis of 3 national surveys^*.

<p>*Surveys used in the meta-analysis: General Social Survey (2010); NHANES = National Health and Nutrition Examination Survey (2009–2010); NSFG = National Survey of Family Growth (2006–2010). See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133543#pone.0133543.t001" target="_blank">Table 1</a> for description of each survey.</p><p>^† Relative Standard Error (RSE) = 30–49%.</p><p>CI = confidence interval.</p

Diagnoses of HIV infection among adult and adolescent heterosexuals, by selected characteristics—United States, 2013.

<p>*Number of cases attributable to heterosexual contact, statistically adjusted to account for reporting delays and missing risk factor information, but not for incomplete reporting.</p><p>^†Per 100,000 heterosexuals.</p><p>^§ Hispanics/Latinos may be of any race.</p><p>^¶ Other race includes American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, unknown race/ethnicity, and multiple races.</p><p>** Relative standard error >30% for meta-analysis estimate of the population proportion heterosexual for this group.</p><p>Note. Data include persons age 13 years and older with a diagnosis of HIV infection regardless of stage of disease at diagnosis. CI = confidence interval</p

Incident Infection and Resistance Mutation Analysis of Dried Blood Spots Collected in a Field Study of HIV Risk Groups, 2007-2010

To assess the utility of cost-effective dried blood spot (DBS) field sampling for incidence and drug resistance surveillance of persons at high risk for HIV infection. We evaluated DBS collected in 2007-2010 in non-clinical settings by finger-stick from HIV-positive heterosexuals at increased risk of HIV infection (n = 124), men who have sex with men (MSM, n = 110), and persons who inject drugs (PWID, n = 58). Relative proportions of recent-infection findings among risk groups were assessed at avidity index (AI) cutoffs of ≤25%, ≤30%, and ≤35%, corresponding to an infection mean duration of recency (MDR) of 220.6, 250.4, and 278.3 days, respectively. Drug resistance mutation prevalence was compared among the risk groups and avidity indices. HIV antibody avidity testing of all self-reported ARV-naïve persons (n = 186) resulted in 9.7%, 11.3% and 14.0% with findings within the 221, 250, and 278-day MDRs, respectively. The proportion of ARV-naïve MSM, heterosexuals, and PWID reporting only one risk category who had findings below the suggested 30% AI was 23.1%, 6.9% and 3.6% (p<0.001), respectively. MSM had the highest prevalence of drug resistance and the only cases of transmitted multi-class resistance. Among the ARV-experienced, MSM had disproportionately more recent-infection results than did heterosexuals and PWID. The disproportionately higher recent-infection findings for MSM as compared to PWID and heterosexuals increased as the MDR window increased. Unreported ARV use might explain greater recent-infection findings and drug resistance in this MSM population. DBS demonstrated utility in expanded HIV testing; however, optimal field handling is key to accurate recent-infection estimates