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A Comparison of Men Who Have Sex with Men, People Who Inject Drugs and High-Risk Heterosexuals’ Risk for HIV Infection, San Francisco

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HIV in the United States is concentrated in populations such as men who have sex with men (MSM), people who inject drugs (PWID), women of color and people living in poverty. These populations are labeled high-risk for HIV infection because of the higher levels of HIV or HIV risk taking behaviors seen in these groups compared to other sub-populations. It is also possible that a group may engage in behaviors that are “high-risk” for HIV infection but never become infected since HIV is not present or not present to a great extent in their social or sexual networks. We analyzed samples of MSM, PWID and high-risk heterosexuals (HRH) collected through the National HIV Behavioral Surveillance (NHBS) system in San Francisco to examine HIV risk taking and HIV burden to determine if the label “high-risk” is appropriately applied. NHBS samples MSM using time location sampling and PWID and HRH using Respondent Driven Sampling. We sampled 508 MSM in 2011, 570 PWID in 2012 and 267 HRH in 2013. There were, as expected, differences in demographic characteristics across the three groups. HRH had a greater number of high-risk behaviors compared to MSM and PWID but had the lowest HIV prevalence. Focusing on risk behavior alone to label populations without considering the background HIV prevalence in communities, the types of risks engaged in and actual HIV infections may obscure which populations truly merit the label “high-risk” for HIV infection.

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  1. CDC (2014) HIV in the United States: At a glance. Accessed 12 Mar 2015.

  2. Baggaley RF, White RG, Boily M-C. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2015;39:1048–63.

    Article  Google Scholar 

  3. Chenine AL, Siddappa NB, Kramer VG, et al. Relative transmissibility of an R5 Clade C Simian-Human immunodeficiency virus across different mucosae in Macaques parallels the relative risks of sexual HIV-1 transmission via different routes. J Infect Dis. 2010;201(8):1155–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Gallagher K, Sullivan P, Lansky A, Onorato I. Behavioral surveillance among people at risk for HIV infection in the U.S.: The National HIV Behavioral Surveillance System. Public Health Rep. 2007;122:32–8.

    PubMed Central  PubMed  Google Scholar 

  5. MacKellar D, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue based, time-space sampling. Public Health Rep. 2007;122 Sup. 1:39–47.

    Google Scholar 

  6. Raymond HF, Chen YH, Ick T, Scheer S, Bernstein K, Liska S, et al. A new trend in the HIV epidemic among men who have sex with men, San Francisco, 2004–2011. J Acquir Immune Defic Syndr. 2013;62(5):584–9. doi:10.1097/QAI.0b013e318285febf.

    Article  PubMed  Google Scholar 

  7. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.

    Article  Google Scholar 

  8. Lansky A, Abdul-Quader AS, Cribbin M, Hall T, Finlayson TJ, Garfein RS, et al. Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System. Pub Health Rep. 2007;122(Suppl 1):48–55.

    Google Scholar 

  9. Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(Suppl 2):S67–72.

    Article  PubMed  Google Scholar 

  10. Coffin PO, Jin H, Huriaux E, Mirzazadeh A, Raymond HF. Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: results from National HIV Behavioral Surveillance 2005–2012. Drug Alcohol Depend. 2015;146:45–51. doi:10.1016/j.drugalcdep.2014.10.025.

    Article  PubMed  Google Scholar 

  11. Raymond HF, Jin H, Scheer S, Ick TO, McFarland W. Efforts to find heterosexual HIV in San Francisco, 2007–2013. AIDS Behav. doi:10.1007/s10461-015-1047-5.

    Google Scholar 

  12. Aral SO. Patterns of sexual mixing: mechanisms for or limits to the spread of STIs? Sex Trans Inf. 2000;76:415–6. doi:10.1136/sti.76.6.415.

    Article  CAS  Google Scholar 

  13. Raymond HF, McFarland W. Racial mixing among men who have sex with men. AIDS Behav. 2009;13(4):671–6.

    Article  PubMed  Google Scholar 

  14. Gregson S, Nyamukapa CA, Garnett GP, Mason PR, Zhuwau T, Carael M, et al. Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet. 2002;359:1896–903.

    Article  PubMed  Google Scholar 

  15. Service SK, Blower SM. HIV transmission in sexual networks: an empirical analysis. Proc R Soc Lond B Biol Sci. 1995;260:237–44.

    Article  Google Scholar 

  16. Salganick M, Heckathorn DD. Sampling and estimation in hidden populations using respondent driven sampling. Sociol Methodol. 2004;34:193–239.

    Article  Google Scholar 

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The Centers for Disease Control and Prevention (CDC) funded the collection of data for NHBS; the funder had no role in the analysis or interpretation of data, the writing of the report, or the decision to submit the manuscript for publication.

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Correspondence to H. F. Raymond.

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Raymond, H.F., Ick, T.O. & Chen, YH. A Comparison of Men Who Have Sex with Men, People Who Inject Drugs and High-Risk Heterosexuals’ Risk for HIV Infection, San Francisco. AIDS Behav 20, 417–422 (2016).

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