Transgender Women Experiencing Homelessness - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020.

Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection.

Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states.

Background And Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line.

Socioeconomic and racial/ethnic spatial polarization and incarceration among people who inject drugs in 19 US metropolitan areas, 2015.

The purpose of this study is to test, for the first time, the association between spatial social polarization and incarceration among people who inject drugs (PWID) in 19 large U.S. metropolitan statistical areas (MSAs) in 2015.

HIV Pre-exposure Prophylaxis Persistence and Adherence Among Men Who Have Sex With Men in Four US Cities.

Background: HIV pre-exposure prophylaxis (PrEP) persistence and adherence are critical to ending the HIV epidemic in the United States.

Setting: In 2017 National HIV Behavioral Surveillance, HIV-negative men who have sex with men (MSM) in 4 US cities completed a survey, HIV testing, and dried blood spots at recruitment.

Methods: We assessed 3 PrEP outcomes: persistence (self-reported PrEP use at any time in the past 12 months and had tenofovir, emtricitabine, or tenofovir diphosphate detected in dried blood spots), adherence at ≥4 doses/week (self-reported past-month PrEP use and tenofovir diphosphate concentration ≥700 fmol/punch), and adherence at 7 doses/week (self-reported past-month PrEP use and tenofovir diphosphate concentration ≥1250 fmol/punch).

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

Background: The 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.

Objective: This manuscript provides an overview of NHBS from 2003 to 2019.

Racial, Ethnic, and Gender Disparities in Awareness of Preexposure Prophylaxis Among HIV-Negative Heterosexually Active Adults at Increased Risk for HIV Infection - 23 Urban Areas, United States, 2019.

In 2019, heterosexual sex accounted for 23% of new HIV diagnoses in the United States and six dependent areas (1). Although preexposure prophylaxis (PrEP) can safely reduce the risk for HIV infection among heterosexual persons, this group is underrepresented in PrEP research (2). CDC analyzed National HIV Behavioral Surveillance (NHBS) data to describe PrEP awareness among heterosexually active adults in cities with high HIV prevalence.

Material Hardship and Association With Sexual Risk Behavior Among Adolescent Sexual Minority Males in 3 US Cities-National HIV Behavioral Surveillance-Young Men Who Have Sex With Men, 2015.

Introduction: Adolescent sexual minority males (ASMMs) are disproportionately affected by HIV relative to other youth within the United States. Social determinants of health have been explored among this population; however, economic determinants, such as material hardship, remain understudied. We examined the relationship between material hardship and sexual behavior among ASMMs aged 13-18 years residing in 3 US cities using 2015 data from CDC's National HIV Behavioral Surveillance among Young Men Who Have Sex with Men.

Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017.

To compare health care coverage and utilization between men who have sex with men (MSM) in Medicaid expansion versus nonexpansion states. We used cross-sectional weighted data from the National HIV Behavioral Surveillance system, which used venue-based methods to interview and test MSM in 22 US cities from June through December, 2017 (n = 8857). We compared MSM in Medicaid expansion versus nonexpansion states by using the Rao-Scott χ test stratified by HIV status.

Assessing self-reported discrimination among men who have sex with men (MSM).

Objectives: To determine the prevalence of four forms of sexual identity discrimination among MSM in 23 US metropolitan statistical areas, examine racial/ethnic and socioeconomic disparities in each form of discrimination.

Methods: We examined interview data collected during 2017 for National HIV Behavioral Surveillance (n = 10 029 respondents) and used generalized linear models to assess the association between the prevalence of reported discrimination during the previous 12 months and selected sociodemographic groups.

Results: Overall, 34% of participants reported experiencing verbal discrimination; 16%, discrimination in a workplace, school, or a healthcare setting; and 8%, physical assault.

Serious Mental Illness Among Young People Who Inject Drugs: An Assessment of Injection Risks and Healthcare Use.

Background: Data on behavioral correlates of mental illness among young people who inject drugs (PWID) are limited. We examine injection risks and healthcare use among young PWID with probable serious mental illness (PSMI).

Methods: People who inject drugs were recruited and interviewed in 20 US cities for 2015 National HIV Behavioral Surveillance.

Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018.

Background: Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status.

Methods: In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance.

HIV Injection Risk Behaviors among HIV-Negative People Who Inject Drugs Experiencing Homelessness, 23 U.S. Cities.

Despite recent declines in numbers of people who inject drugs (PWID) diagnosed with HIV, clusters of HIV among PWID are ongoing, especially among PWID experiencing homelessness. Using data from the National HIV Behavioral Surveillance in 2018, we evaluated the association between homelessness and injection risk and prevention behaviors among HIV-negative PWID who were recruited by respondent-driven sampling in 23 U.S.

High prevalence of disability and HIV risk among low socioeconomic status urban adults, 17 U.S. cities.

Background: In the United States, approximately 10% of adults 18-64 years are disabled. However, there is scarce literature on the associations between disability and HIV risk.

Objective: To assess disability prevalence and its associations to health and HIV risk factors among low socioeconomic status (SES) (≤high school education or ≤ poverty guidelines) urban adults.

Incarceration, HIV Risk-Related Behaviors, and Partner Characteristics Among Heterosexual Men at Increased Risk of HIV Infection, 20 US Cities.

Objectives: The effect of incarceration on HIV risk-related behaviors among at-risk heterosexual men is understudied. The objective of our study was to examine the association between incarceration and HIV risk-related behaviors among a sample of predominantly non-Hispanic black and Hispanic heterosexual men residing in urban areas in the United States with a high prevalence of AIDS.

Methods: We analyzed data from the 2013 National HIV Behavioral Surveillance system on 5321 at-risk heterosexual men using log-linked Poisson regression models, adjusted for demographic characteristics and clustered on city.

Recent US Centers for Disease Control and Prevention Activities to Reduce HIV Stigma.

HIV stigma affects many persons living with HIV in the United States, and reducing stigma is central to the US Centers for Disease Control and Prevention's (CDC) mission to promote health and prevent HIV transmission. To this end, CDC funds and implements programmatic activities, research, communication campaigns, and monitoring through data collection and public health surveillance. Centers for Disease Control and Prevention-funded programs have developed promising interventions and educational materials for reducing HIV stigma.

Undisclosed HIV infection among MSM in a behavioral surveillance study.

Objective: As a proxy for undiagnosed HIV, the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS) monitors participants who report being unaware of their infection, defined as self-reporting an HIV-negative or unknown status during the interview but testing positive for HIV infection. We validated the NHBS measure of awareness among MSM in 2014.

Design: We tested dried blood spots from MSM who reported being unaware of their infection for seven antiretrovirals (ARVs).

An Innovative Approach to Assess Similarity Between Sex Partners.

We present a simple, comprehensive method for assessing similarity between sex partners of a participant and demonstrate its application using data collected in 2015 as part of CDC's National HIV behavioral surveillance (NHBS) among persons who inject drugs (PWID). We found that the pairwise similarity between sex partners of a survey participant was high. The similarity between second-to-last and third-to-last partners in the past 3 months was significantly higher than that between last and second-to-last partner in partner type, frequency of sex acts, and the contextual characteristics of sex behavior at last sexual encounter.

Assessing the Theory of Gender and Power: HIV Risk Among Heterosexual Minority Dyads.

This study drew on the Theory of Gender and Power (TGP) as a framework to assess power inequalities within heterosexual dyads and their effects on women. Structural equation modeling was used to better understand the relationship between structural and interpersonal power and HIV sexual risk within African American and Latina women's heterosexual dyads. The main outcome variable was women's sexual HIV risk in the dyad and was created using women's reports of condomless sex with their main male partners and partners' reports of their HIV risk behaviors.

Exchange Sex and HIV Infection Among Women Who Inject Drugs-20 US Cities, 2009.

Background: Women who inject drugs and who also exchange sex are at increased risk for HIV infection, but data on this population in the United States remain sparse.

Methods: This study assessed the prevalence of exchanging sex for money or drugs among women who inject drugs using data from the 2009 US National HIV Behavioral Surveillance (NHBS) system. Prevalence of being HIV-positive (testing positive in NHBS), HIV-positive-unaware (reporting being HIV-negative or unknown status but testing positive in NHBS), and risk behaviors and use of services were compared between women who did and did not exchange sex.

Incarceration, Sexual Risk-Related Behaviors, and HIV Infection Among Women at Increased Risk of HIV Infection, 20 United States Cities.

Background: Women involved in the criminal justice system experience multiple risk factors that increase the likelihood of acquiring HIV infection. We evaluated the prevalence of incarceration and compared behaviors among women with and without an incarceration history.

Methods: We use the 2013 National HIV Behavioral Surveillance data, which uses respondent-driven sampling.

Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States.

Purpose: Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States.

Methods: PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived.

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

Objective: 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.

Methods: 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.