National HIV Behavioral Surveillance System for Heterosexuals at Risk for HIV Infection

The National HIV Behavioral Surveillance System (NHBS) is CDC's system for monitoring behaviors among persons at highest risk for HIV infection. The NHBS strategy involves rotating cycles of surveillance in three populations at risk for HIV: men who have sex with men, injection drug users, and heterosexuals in high risk areas (HET). In 2005, 32% of HIV/AIDS cases were attributed to heterosexual contact, underscoring the need for behavioral surveillance among heterosexuals at risk for infection. The lack of consensus on a definition of heterosexuals at risk hinders identifying effective sampling methods to reach them. For the NHBS-HET cycle (September 2006 – October 2007), we are conducting a pilot study to test a definition of heterosexual at risk and sampling methods (respondent-driven sampling and venue-based, time-space sampling) for use in future HET cycles. The pilot definition includes persons who 1) live or socialize in areas with high rates of HIV/AIDS and poverty and 2) had sex with an opposite-sex partner in the past year. The pilot study involves mapping high risk areas, conducting formative research to learn more about the population in their community, and conducting interviews. A minimum of 750 persons from each MSA will be interviewed for the pilot study; interviewers administer a standardized questionnaire about risk behaviors, HIV testing patterns and use of prevention services. NHBS-HET will provide important data from men and women in communities that are most at risk of HIV infection.