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Chime In: National HIV Behavioral Surveillance
Chime In: National HIV Behavioral Surveillance

In 2015, 39,513 people were diagnosed with HIV infection in the United States. The number of new HIV diagnoses fell 19% from 2005 to 2014. Because HIV testing has remained stable or increased in recent years, this decrease in diagnoses suggests a true decline in new infections. The decrease may be due to targeted HIV prevention efforts. However, progress has been uneven, and diagnoses have increased among vulnerable groups including men who have sex with men, heterosexual injection drug users, African Americans, and Latinos.

CDC’S National HIV Surveillance System is the primary source for monitoring HIV trends in the United States. CDC funds and assists state and local health departments to collect the information. Health departments report de-identified data to CDC so that information from around the country can be analyzed to determine who is being affected and why. Surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event. HIV surveillance collects, analyzes, and disseminates information about new and existing cases of HIV infection (including AIDS). The ultimate surveillance goal is a nationwide system that combines information on HIV infection, disease progression, and behaviors and characteristics of people at high risk. By meeting this goal, CDC can direct HIV prevention funding to where it is needed the most.

In 2015, I partnered with the Oregon Public Health Division to apply for funding to conduct, for the first time, the National HIV behavioral Surveillance in the larger metropolitan Portland region. We received the award and began the work in 2016. I serve as Co-Principal Investigator, along with Dr. Sean Schafer, the Medical Director of the HIV/AIDS Division in the Public Health Department.

Our surveillance work is conducted in rotating, annual cycles in three different populations at increased risk for HIV:

  1. Gay, bisexual and other men who have sex with men; known as the MSM cycle.
  2. Persons who inject drugs (PWID); known as the injection drug use or IDU cycle, and
  3. Heterosexuals at increased risk for HIV infection; known as the HET cycle.

Before each NHBS cycle, we conduct formative assessments to learn more about each local population and to inform operational procedures. Venue-based, time-space sampling is used during the MSM cycles. We identify venues frequented by MSM (e.g., bars, clubs, organizations, and street locations) as well as days/times when men frequent those venues. We use respondent-driven sampling (RDS) during the IDU and HET cycles. We select a small number of initial participants, or “seeds,” who complete the survey and recruit their peers to participate. Recruitment and interviewing then continue until the target sample size is reached.

Trained interviewers in all NHBS project areas use a standardized, anonymous questionnaire to collect information on HIV-related risk behaviors, HIV testing, and the use of HIV prevention services. HIV testing is offered to all participants. During each cycle, a minimum of 500 eligible persons from each participating project area are interviewed and offered HIV testing. 

The Portland team joined NHBS in 2016 and successfully completed the heterosexual cycle. Currently, we are conducting the MSM cycle. Data from the HET cycle is still being cleaned and merged at the CDC. We anticipate the publication of multiple papers for each cycle.