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.3
To address the population of people at risk for HIV infection, from the mid-1990s through 2002, CDC sponsored two different surveys to measure HIV-related behaviors in at-risk people: the HIV Testing Survey (HITS) and the Young Men's Survey (YMS). HITS was a series of cross-sectional interview studies of people at high risk for acquiring HIV infection (men who have sex with men [MSM] recruited from gay bars, street-recruited injecting drug users (IDUs), and heterosexual people recruited from sexually transmitted disease [STD] clinics) conducted during five separate cycles between 1995 and 2002.4–7
During the course of the survey, data from 22 geographic areas were collected. For each geographic area, the intended sample size was 100 each for MSM, IDU, and heterosexuals during each cycle.
The YMS was a cross-sectional, multisite, venue-based survey of men aged 15–22 conducted in seven metropolitan areas from 1994–1998.8
Young men, most of whom were gay, were recruited from public venues within a defined geographic area frequented by gay men. These included bars, dance clubs, parks, street locations, business establishments, and social organizations. A sample size of 500 was targeted for each of the seven metropolitan health departments.
Although both of these studies were invaluable in providing behavioral information about these populations at risk, they were either time limited, not conducted in the same cities over time, or had relatively small sample sizes. These studies did not allow for the analysis of trends in consistent geographic areas over time.
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 in the United Nations Joint Programme on AIDS (UNAIDS)/World Health Organization's (WHO) second generation surveillance framework.9,10
A surveillance system to provide ongoing, systematic collection of data on behaviors related to HIV acquisition addresses CDC's strategic goal of strengthening the capacity nationwide to monitor the epidemic. Such a system is also consistent with the UNAIDS guidance on second-generation surveillance for HIV infection. The guidance strongly recommended the use of behavioral surveillance in the planning and evaluation of behavioral interventions, particularly in countries with low-level (i.e., HIV seroprevalence has not consistently exceeded 5% in any defined subpopulation) and concentrated (i.e., HIV seroprevalence below 1% in pregnant women in urban areas and
HIV seroprevalence consistently higher than 5% in at least one defined subpopulation) epidemics.10