The Office of AIDS, in collaboration with the CDC, will be conducting the NHBS project in the Metropolitan Statistical Area (MSA) of San Diego County. NHBS will monitor the HIV epidemic through HIV behavioral surveillance by providing relevant, timely, and ? high-quality data on risk and prevention behaviors among men who have sex with men (MSM), injection drug users (IDUs), and heterosexuals at high risk for HIV infection (HET). The main objective of NHBS of MSM, IDUs, and HET is to help direct and evaluate local and national prevention efforts by identifying the prevalence and trends in sexual and drug-use behaviors, HIV testing behaviors, and exposure to and utilization of HIV testing and other prevention services funded by state and local health departments. Data collection will rotate each year among MSM, IDU, and HET. Each data collection ? year among a different group is called a cycle, thus, this cooperative agreement is for 3 cycles of data collection. Funded sites are expected to collaborate with community-based organizations (CBOs) and with ethnographers, and other academic or public health partners with expertise in qualitative and quantitative methods to conduct these behavioral surveillance activities. All eligible participants are given written informed consent. After giving informed consent, each participant is interviewed by trained staff using a standardized questionnaire. This survey instrument pertains to demographic information, sexual and drug using behaviors, sexual and drug using histories, HIV testing experiences, health conditions, access to medical care, and assessment of prevention activities. Additionally, each eligible participant is offered voluntary HIV testing and counseling. OA was awarded funding for PA 04017 and is currently completing the third cycle of NHBS among HET being conducted in the MSA of San Diego County. Funding for the current cycle will expire on December 31, 2007. Behavioral surveillance should be an ongoing, systematic collection, analyses, and interpretation of behavioral data for preventing or controlling disease or injury. In essence, HIV behavioral surveillance systems should collect data from various populations: the general population, people at risk for HIV infection, and people living with HIV infection. The need for development of a national behavioral surveillance system for people at risk for HIV infection was articulated in both CDC's HIV Prevention Strategic Plan, and the in the United States Joint Program on AIDS (UNAIDS)/World Health Organization's (WHO) second generation surveillance framework. The National HIV Behavioral Surveillance (NHBS) system aims to meet CDC's strategic goal of strengthening the capacity nationwide to monitor the HIV epidemic. The guidance from UNAIDS on second-generation surveillance for HIV infection strongly recommended the use of behavioral surveillance in the planning and evaluation of behavioral interventions, particularly in countries with low-level and concentrated epidemics. The primary objective of NHBS is to conduct behavioral surveillance among a representative group of people at high risk for HIV infection in the United States in order to assess prevalence of and trends in: 1) risk behaviors for HIV infection; 2) HIV testing behaviors; and 3) exposure to, use of, and impact of HIV prevention services. These behaviors can be assessed across geographic areas over time. In the U.S., HIV is primarily an epidemic that affects urban areas. Eighty-two percent of AIDS cases reported in 2002 resided in metropolitan statistical areas (MSAs) with populations of 500,000 or more. Additionally, 10% of reported AIDS cases resided in metropolitan areas with a population of 50,000 to 499,999; the remaining 8% lived in rural areas at the time of their diagnosis. For this reason, NHBS efforts are being focused in the MSAs with the largest burden of HIV disease. Over time, NHBS must be able to address the changing HIV epidemic in the U.S. Although changes can and should be made as ways to improve the system are identified or information needs change, these will need to be made with consideration for how they could impact interpretation of trends over time. The widespread geographic coverage of the surveillance system to include areas with the highest HIV morbidity means that data collected are likely to accurately reflect the behaviors of people at increased risk for HIV infection nationally. As a result, the information gathered by NHBS will be critical in the targeting of future HIV prevention programs in the U.S. ? ? ? ?
