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In 2019, heterosexual sex accounted for 23% of new HIV diagnoses in the United States and six dependent areas (1). Although preexposure prophylaxis (PrEP) can safely reduce the risk for HIV infection among heterosexual persons, this group is underrepresented in PrEP research (2). CDC analyzed National HIV Behavioral Surveillance (NHBS) data to describe PrEP awareness among heterosexually active adults in cities with high HIV prevalence. Overall, although 32.3% of heterosexually active adults who were eligible were aware of PrEP

Men who have sex with men (MSM) in the United States are stigmatized for their same-sex practices, which can lead to risky sexual behavior, potentiating risk for human immunodeficiency virus (HIV) infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to local surveys administered in 2017 at 9 sites in the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system, which uses venue-based, time-sampling procedures to survey cisgender MSM in US Census Metropolitan Statistical Areas. We performed exploratory factor analytical procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; and Virginia Beach-Norfolk, Virginia) and pooled responses to the survey items. A 3-factor solution—“stigma from family” (α = 0.70), “anticipated health-care stigma” (α = 0.75), and “general social stigma” (α = 0.66)—best fitted the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the United States experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking trends in stigma over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the United States.

Antiretroviral therapy (ART) to treat and pre-exposure prophylaxis (PrEP) to prevent HIV infection are effective tools to help end the HIV epidemic. However, their use could affect HIV transfusion-transmission risk. Three different ART/PrEP prevalence analyses in blood donors were conducted. First, blood samples from HIV-positive and a comparison group of infection-nonreactive donors were tested under blind using liquid chromatography-tandem mass spectrometry for ART. Second, blood donor samples from infection-nonreactive, 18- to 45-year-old, male, first-time blood donors in 6 US locations were tested for emtricitabine and tenofovir. Third, in men who have sex with men (MSM) participating in the 2017 Centers for Disease Control and Prevention National HIV Behavioral Surveillance (NHBS) from 5 US cities, self-reported PrEP use proximate to donation was assessed. In blind testing, no ART was detected in 300 infection-nonreactive donor samples, but in 299 HIV confirmed-infected donor samples, 46 (15.4%; 95% confidence interval [CI], 11.5% to 20.0%) had evidence of ART. Of the 1494 samples tested from first-time male donors, 9 (0.6%; 95% CI, 0.03% to 1.1%) had tenofovir and emtricitabine. In the NHBS MSM survey, 27 of 591 respondents (4.8%; 95% CI, 3.2% to 6.9%) reported donating blood in 2016 or 2017 and PrEP use within the same time frame as blood donation. Persons who are HIV positive and taking ART and persons taking PrEP to prevent HIV infection are donating blood. Both situations could lead to increased risk of HIV transfusion transmission if blood screening assays are unable to detect HIV in donations from infected donors.

BACKGROUND Phylogenetic studies show links between heterosexual women and men who have sex with men (MSM) that are more numerous than from heterosexual men to women suggesting that HIV infections among heterosexual women may stem from MSM. Poor communities have been associated with high rates of HIV among heterosexual women. Our analysis investigates potential transmission of HIV between MSM and female heterosexuals. METHODS National HIV Behavioral Surveillance data describe transmission risk behaviors of MSM, and HIV case reporting data describe the percentages of cases that are attributed to transmission risk categories. We examined correlations between the percentages of men who were MSM who also have sex with women and female heterosexual cases. We also examined census data to characterize each city in terms of poverty level and race/ethnicity makeup. RESULTS There was a high correlation (0.93) between the percentage of reported living HIV cases attributed to male heterosexual contact and female heterosexual contact and a moderate nonsignificant correlation (0.49) between the percentage of MSM who were men who have sex with men and women (MSMW) in National HIV Behavioral Surveillance and the percentage of reported cases that were attributed to female heterosexual contact suggesting some potential overlap. Cities with high levels of poverty and African American/Black residents had higher levels of MSMW and higher levels of heterosexual female cases. CONCLUSIONS Addressing HIV in cities with high levels of MSMW may have the dual effect of improving the health of MSM populations that have a high burden of HIV and to improve the health of their larger communities.

The prevalence of transmitted HIV drug resistance (TDR) in Los Angeles County remains unknown, due in part to the absence of reliable genotypic data. The specific objectives of this study are to estimate the prevalence of TDR, to describe the demographic characteristics associated with TDR and to investigate the distribution of HIV-1 subtypes among persons newly diagnosed with HIV in Los Angeles County. From 2007 through 2009, 1,414 sequences were obtained from 7,100 persons newly diagnosed with HIV through HIV resistance surveillance. Overall, 257 (18%) sequences had some genetic evidence of drug resistance. Of these, 122 (9%) exhibited evidence of resistance to non-nucleoside reverse transcriptase inhibitors, 121 (9%) to nucleoside reverse transcriptase inhibitors and 76 (5%) to protease inhibitors. Subtype B was dominant (97%), followed by subtypes C (1.2%), CRF01_AE (0.8%), CRF02_AG (0.4%), A (0.3%), and F (0.1%). With a TDR prevalence of 18%, Los Angeles County ranks high compared with other jurisdictions across the nation. The prevalence of TDR in recent (19%) and long-standing (17%) HIV cases were similar, thus providing additional support for the notion that TDR-associated mutations may persist well beyond the period of recent infection. HIV-1 CRF01_AE, observed historically in central Africa and Asia, was observed to be circulating among men who have sex with men and heterosexuals in Los Angeles County. These findings underscore the need for continued and expanded HIV resistance surveillance to inform healthcare providers, policy makers and at-risk populations of emerging trends in HIV drug resistance.

Men who have sex with men (MSM) bear a disproportionate burden of hepatitis B virus (HBV) infections. We used serologic data from the National HIV Behavioral Surveillance (NHBS) system to determine the prevalence and correlates of HBV infection, immunization, and susceptibility in a sample of Los Angeles County MSM. Approximately 19 % (95 % CI 15-24 %) had serologic evidence of current or past infection, while 35 % (95 % CI 30-40 %) were susceptible. Compared with the youngest age group, MSM ages 40-49 years had a lower prevalence of immunization (aPR 0.28, 95 % CI 0.17-0.45) and a higher prevalence of infection (aPR 8.53, 95 % CI 3.95-18.4) and susceptibility (aPR 2.02, 95 % CI 1.13-3.63). We also observed poor concordance between self-reported and serologic measures of vaccination. Our results indicate the possibility of missed opportunities to vaccinate MSM. Gaps in implementing existing vaccination strategies must be addressed to increase hepatitis B vaccination coverage for MSM, especially in older age groups.

ARTICLES Exposure to HIV Partner Counseling and Referral Services and Notification of Sexual Partners among Persons Recently Diagnosed with HIV Duncan A. MacKellar, MA, MPH,* Sn-I Hon, DRPH,7‘ Stephanie Behel, MPH,* Brian Boyett, MS,* David Miller, BA,* Ekow Sey, PHD,.3Iq Nina Harawa, PHD,§ Nik Prachand, MPH,|| Trista Bingham, PHD,i and Carol Ciesielski, MD||fl Objective: Among HIV-infected persons. we evaluated use of client partner notification (CPN) and health-department partner notification strategies to infonn sex partners of possible HIV exposure. and prior exposure to partner counseling and referral services. Methods: We conducted a cross-sectional. observational study of 590 persons diagnosed with HIV in the prior 6 months at 5| HIV test. medical. and research providers in Chicago and Los Angeles in 2003 and 2004. Logistic regression was used to identify independent corre- lates of using CPN to notify all locatahle partners. Results: Participants reported a total of 5091 sex partners in the 6 months preceding HIV diagnosis: I253 (24.6%) partners were locatable and not known to be HIV-positive. Of 439 panicipants with 2| locatable partners. 332 (75.6%) reported notifying 696 (55.5%) part- ners by CPN (585. 8-Ll‘/r). health-department partner notification (94. l3.5%). or other means ( I7. 2.4%): 208 (47.4%) used CPN to notify all locatahle partners. Independent correlates of CPN included having fewer locatable partners and discussing the need to notify partners with an HIV medical-care provider (black and Hispanic participants only). Many participants reported that their HIV test or medical-care provider did not discuss the need to notify partners (48.8%. 33.7%. respectively) and did not offer health-department partner-notification services (60.8%. 52.8%). Conclusion: Many locatahle sex partners who might beneiit from being notified of potential HIV exposure are not notified. In accordance with national policies. HIV test and medical-care providers should routinely provide partner counseling and referral services to HIV- infected clients so that all locatable partners are notified and provided *Division of HIV/AIDS Prevention—Surveillance and Epidemiology. National Center for HIV. STD. and TB Prevention. Centers for Disease Control and Prevention. Atlanta. CA: the I'College of Public Health. University of Georgia. Athens. GA: the :£Los An- geles County Department of Public Health; the §Charles R Drew University of Medicine and Science. Los Angeles. CA; the ||Chi- cago Department of Public Health. Chicago. IL: and the ‘IDivision of STD Prevention. National Center for HIV. STD. and TB Pre- vention. Centers for Disease Control and Prevention. Atlanta. GA Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services. Correspondence: Duncan A. MacKellar. MA. MPH. Centers for Dis- ease Control and Prevention. 1600 Clifton Road NE. MS E-46. Atlanta. GA 30333. E—mail: dym4@cdc.gov. Received for publication March 17. 2008. and accepted October 2. 2008. D01: I0. I097/0LQ.0b0 I 3e3 l 8 I 8d6500 Copyright © 2009 American Sexually Transmitted Diseases Association All rights reserved. an opportunity to learn their HIV status. H iv partner counseling and referral services (PCRS) include the broad array of prevention counseling. testing, and referral services provided to HIV-infected persons and their sexual and needle-sharing partners.‘ In accordance with na- tional PCRS policies. HIV test and medical-care providers should discuss with their HIV-infected clients the need to notify partners of their possible exposure to HIV and help plan how partners might be notified.'-3 Two frequently used partner-notification strategies in- clude client partner notification (CPN). where HIV-infected clients personally notify their partners. and health-department partner notification (HDPN). where clients give sufficient in- formation to health department staff who are then responsible for notifying identified partners.'-4 Provision of PCRS and use of CPN and HDPN are important prevention strategies in the United States because many partners of HIV-infected persons are unaware of their HIV infection. and because most persons who become aware of their infection take steps to prevent transmission to others.-q5 Most research on PCRS. conducted before the dissemi- nation of national policies and the availability of highly active antiretroviral therapy. has focused on the effectiveness of HDPN in identifying and testing I-IIV-infected. unaware part- nets.‘-4 Provision of PCRS by HIV test and medical-care pro- viders since the dissemination of national polices and the relative use of CPN and HDPN to notify partners have not been reported and are unknown. Use of CPN to notify all locatahle partners by client socio-demographic characteristics. time since diagnosis. number and types of partners. and exposure to PCRS is also unknown. Infomiation on these and other potential correlates of CPN might be useful for improving PCRS by identifying potential partner-notification barriers and helping clients choose successful strategies to notify partners. To evaluate implementation of national PCRS policies and to help meet these infomtation needs. we analyzed data from the client‘s perspective on exposure to PCRS from HIV test and medical-care providers. use of CPN and HDPN, and correlates of CPN among persons recently diagnosed with HIV in Chicago and Los Angeles. METHODS Survey Design, Recruitment, and Interview We conducted a cross-sectional. observational study of persons recently diagnosed with HIV referred from a nonprob- ability sample of 51 HIV test. medical. and research providers in Chicago and Los Angeles in 2003 and 2004. Providers 170 Sexually Transmitted Diseases 0 Volume 36, Number 3, March 2009

According to National HIV Behavioral Surveillance system data, human immunodeficiency virus (HIV) testing increased among gay, bisexual, and other men who have sex with men from 2008 to 2011 in cities funded by the Centers for Disease Control and Prevention's Expanded Testing Initiative, suggesting that focused HIV testing initiatives might have positive effects.

The prevalence of transmitted HIV drug resistance (TDR) in Los Angeles County remains unknown, due in part to the absence of reliable genotypic data. The specific objectives of this study are to estimate the prevalence of TDR, to describe the demographic characteristics associated with TDR and to investigate the distribution of HIV-1 subtypes among persons newly diagnosed with HIV in Los Angeles County. From 2007 through 2009, 1,414 sequences were obtained from 7,100 persons newly diagnosed with HIV through HIV resistance surveillance. Overall, 257 (18%) sequences had some genetic evidence of drug resistance. Of these, 122 (9%) exhibited evidence of resistance to non-nucleoside reverse transcriptase inhibitors, 121 (9%) to nucleoside reverse transcriptase inhibitors and 76 (5%) to protease inhibitors. Subtype B was dominant (97%), followed by subtypes C (1.2%), CRF01_AE (0.8%), CRF02_AG (0.4%), A (0.3%), and F (0.1%). With a TDR prevalence of 18%, Los Angeles County ranks high compared with other jurisdictions across the nation. The prevalence of TDR in recent (19%) and long-standing (17%) HIV cases were similar, thus providing additional support for the notion that TDR-associated mutations may persist well beyond the period of recent infection. HIV-1 CRF01_AE, observed historically in central Africa and Asia, was observed to be circulating among men who have sex with men and heterosexuals in Los Angeles County. These findings underscore the need for continued and expanded HIV resistance surveillance to inform healthcare providers, policy makers and at-risk populations of emerging trends in HIV drug resistance.

Purpose Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States. Methods PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment). Results Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.21–4.17; P = .011), and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex (AOR = 1.02, 95% CI = 1.00–1.04; P = .046). Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex (AOR = 0.93, 95% CI = 0.88–1.00; P = .038). Conclusions Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.