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National HIV Behavioral Surveillance (NHBS)
The National HIV Behavioral Surveillance (NHBS) is a multisite project funded by the Centers for Disease Control and Prevention (CDC). NHBS was established to monitor selected behaviors and use of prevention services among populations overburdened with HIV infection. NHBS operates through activities designed to monitor HIV risk behaviors to assist in prevention education, service initiatives, and allocation of prevention resources. Nationally, data is collected in 22 metropolitan areas that have the highest prevalence of HIV cases.
Why is NHBS Important?
Case surveillance provides basic information about people who have tested positive for HIV. Behavioral surveillance provides information for those who are at high risk but not yet infected. This helps to better anticipate the populations in which HIV rates are likely to increase in the future. NHBS informs decisions about where researchers and practitioners should focus resources for prevention efforts. At the individual level, participants can benefit from HIV prevention counseling, knowledge of HIV status, and referrals for additional HIV risk information and care.
Learn More About NHBS
Michigan has participated in numerous HIV surveillance activities and interview studies since 1986. Prior to National HIV Behavioral Surveillance (NHBS), Michigan participated in the HIV Testing Survey (HITS) where we interviewed STI clients, persons who inject drugs (PWID) via street intercepts, and men who have sex with men (MSM) in gay bars.
After HITS, Detroit was one of three sites selected to do a pilot for the PWID cycle (formerly IDU cycle) of NHBS. We successfully tested 2 recruitment methodologies: respondent-driven sampling (RDS) and targeted-driven sampling (TDS). Our shared experience was instrumental in choosing the sampling method that would be used for all sites during data collection for the IDU1 cycle.
In 2004, we received funding to participate in NHBS. Under the name of Project ASK, we successfully interviewed and collected data from PWID's for the first cycle of NHBS. In 2005, we also participated in the High-Risk Area (HRA) pre-pilot for the heterosexually active persons at increased risk for HIV infection (HET) cycle to explore strategies for identifying HRAs.
In 2016, Detroit was one of five cities that participated in a pilot study exploring a subset of women who exchange sex for drugs or money (WES). All participants were recruited using RDS. Ways in which women find exchange sex partners were identified and helpful to prevention programs in tailoring their focus on women at increased risk for HIV.
The NHBS occurs in multiple cycles with each year targeting populations overburdened with HIV infection:
- gay, bisexual, and other men who have sex with men (MSM) cycle
- persons who inject drugs (PWID) cycle (formerly IDU cycle)
- heterosexually active persons at increased risk for HIV infection (HET) cycle
NHBS recruitment methodologies vary according to cycles.
- Respondent-Driven Sampling (RDS)
Respondent-driven sampling (RDS) methodology is implemented for persons who inject drugs (PWID) and heterosexually active persons at increased risk for HIV infection (HET) cycles. RDS is based on a chain-referral sampling strategy or snowball sampling. Data collection starts with a small number of recruits (seeds), the recruits complete NHBS data collection activities and if NHBS criteria are met, then are asked to recruit up to a specified number of people they know to participant in data collection activities. Participants receive incentives for recruiting others that complete NHBS activities.
- Venue-Based Sampling (VBS)
Venue-based sampling (VBS) methodology is used for the gay, bisexual, and other men who have sex with men (MSM) cycle. VBS is based on NHBS staff creating a venue universe that includes a list of all possible places/locations where MSM congregate. Recruitment barriers and logistical information are collected to assess viable venues for data collection. Eligible venues have 50% or greater of MSM attendance. Day-time periods of MSM attendance are recorded and input into a sampling frame; a monthly sampling frame is created from randomly selected day-time periods where recruitment events are scheduled. At the recruitment events, venue attendees are counted by NHBS staff, men are approached and are invited to participate in the survey. Selected men are interviewed and offered a HIV test.
NHBS activities are anonymous and include:
- Consent of data collection activities.
- A core questionnaire that addresses the following topics: demographics, sexual history, alcohol and drug use history, HIV testing history, incarceration history, and prevention activities, PrEP use.
- A local questionnaire that is developed based on input from service providers, community leaders, and individuals living in the metro Detroit areas.
- Rapid HIV testing.
- Respondent-Driven Sampling (RDS)
NHBS Activities MaterialsConfidentiality
NHBS is an anonymous project. Participants' responses and test results are labeled with a project number. Only the NHBS project staff and CDC will have access to the interview and testing data with no participant identifiers.Additional Resources
More information on NHBS: CDC National HIV Behavioral Surveillance
Men Who Have Sex with Men (MSM) Cycles
People Who Inject Drugs (PWID) Cycles (formerly known as the Injection Drug Use [IDU] Cycles)
- NHBS Comparative Fact Sheet, Men Who Have Sex with Men, Michigan, 2011 and 2014
- MSM3 Fact Sheet from Interviews among Men Who Have Sex with Men in Wayne County, 2011
- Behavioral Surveillance among Men Who Have Sex with Men (MSM) in the Detroit Metro Area: 2011
- HIV Behavioral Surveillance Interview (Young MSM sub-study ages 13-24), 2009
- MSM2 Report: Men who Have Sex with Men in the Detroit area, 2008
- MSM2 Fact Sheet from Interviews among Men who Have Sex with Men in Wayne County, 2008
Heterosexually Active Persons at Increased Risk for HIV Infection (HET) Cycles
- HIV Testing and Needle Usage Among Persons Who Inject Drugs Experiencing and Not Experiencing Homelessness Fact Sheet, 2012-2018
- Fact Sheet from interviews with People Who Inject Drugs, 2015
- NHBS-IDU3 Fact Sheet from Interviews Among Persons Who Inject Drugs, 2012
- NHBS-IDU2 Fact Sheet from Interviews among Injecting Drug Users in Metro Detroit, 2009
- IDU1 Report: Injection Drug Use in the Wayne County Area, 2005
- Fact Sheet from interviews with Heterosexual Women, 2016
- Exchange Sex Among Heterosexual Women Fact Sheet, 2013
- HET1 Report: Heterosexuals living in "High Risk" Areas in SE Michigan, 2007
- NHBS HET1 Partner Study Report, 2007
- NHBS HET1 Partner Study Presentation, 2007
- NHBS HET1 Partner Study Presentation 2007 (presented at Michigan HIV/AIDS Council, Nov. 17, 2011)
If you would like to request data regarding NHBS or additional aggregate outcome data on people living with HIV (PLWH) or affected by STIs in Michigan that is not available on our Data & Statistics page, please use SHOARS to submit a data request.
For detailed instructions on how to register for SHOARS and submit a data request, visit: Michigan.gov/SHOARS. If there are any questions or concerns regarding this process, reach out to MDHHS-SHOARS-SUPPORT@michigan.gov.