Journal of Urban Health

, Volume 92, Issue 4, pp 733–743 | Cite as

Population Size Estimates for Men who Have Sex with Men and Persons who Inject Drugs

  • Alexandra M. OsterEmail author
  • Maya Sternberg
  • Amy Lansky
  • Dita Broz
  • Cyprian Wejnert
  • Gabriela Paz-Bailey


Understanding geographic variation in the numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) is critical to targeting and scaling up HIV prevention programs, but population size estimates are not available at generalizable sub-national levels. We analyzed 1999–2010 National Health and Nutrition Examination Survey data on persons aged 18–59 years. We estimated weighted prevalence of recent (past 12 month) male-male sex and injection drug use by urbanicity (the degree to which a geographic area is urban) and US census region and calculated population sizes. Large metro areas (population ≥1,000,000) had higher prevalence of male-male sex (central areas, 4.4 % of men; fringe areas, 2.5 %) compared with medium/small metro areas (1.4 %) and nonmetro areas (1.1 %). Injection drug use did not vary by urbanicity and neither varied by census region. Three-quarters of MSM, but only half of PWID, resided in large metro areas. Two-thirds of MSM and two-thirds of PWID resided in the South and West. Efforts to reach MSM would benefit from being focused in large metro areas, while efforts to reach PWID should be delivered more broadly. These data allow for more effective allocation of funds for prevention programs.


HIV infection Men who have sex with men Persons who inject drugs Risk factors Gay and bisexual men 



We would like to thank Kim Elmore for creating the map used in this publication and Jianmin Li for assistance with census data. We would also like to thank Ajay Yesupriya at the Research Data Center and the NHANES staff for their work in study design and data collection and preparation.


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Source of Funding

The authors listed on this manuscript are federal employees working at the Centers for Disease Control and Prevention and have not obtained outside sources in the form of grants, equipment, drugs or any combination of these to complete this study.


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Copyright information

© The New York Academy of Medicine (outside the USA) 2015

Authors and Affiliations

  • Alexandra M. Oster
    • 1
    Email author
  • Maya Sternberg
    • 2
  • Amy Lansky
    • 1
  • Dita Broz
    • 1
  • Cyprian Wejnert
    • 1
  • Gabriela Paz-Bailey
    • 1
  1. 1.Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Laboratory Science, National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA

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