At a glance
National HIV Behavioral Surveillance (NHBS) is a comprehensive system for bio-behavioral surveillance conducted since 2003 in populations disproportionately affected by HIV. NHBS collects data on behavioral risk factors for HIV (e.g., sexual behaviors, drug use), HIV testing behaviors, receipt of prevention services, and use of prevention strategies (e.g., condoms, PrEP). All NHBS participants are offered an HIV test.
About national HIV behavioral surveillance
In 2003, CDC created NHBS to conduct bio-behavioral surveillance among populations disproportionately affected by HIV.
Surveillance is conducted in rotating, annual cycles in three different populations:
- Gay, bisexual and other men who have sex with men; known as the MSM cycle. The NHBS-MSM cycle collects information on persons who report sex with a male partner in the 12 months before interview.
- Persons who inject drugs; known as the PWID cycle. The NHBS-PWID cycle collects information on persons who report injecting a drug that was not prescribed for them in the 12 months before interview.
- Heterosexually active persons at increased risk for HIV infection; known as the HET cycle. The NHBS-HET cycle collects information on heterosexually active persons at increased risk for HIV* reporting sex with an opposite sex partner in the 12 months before interview.
These three annual cycles are considered a round.
In addition to the three core cycles, a limited number of project areas conducted surveys with women of trans experience and transfeminine people (NHBS-Trans). The NHBS-Trans focuses on women of trans experience and transfeminine people (WTE/TFP) especially WTE/TFP of color, who are disproportionately affected by HIV.
*NHBS uses low income as a proxy for increased risk for acquiring HIV through heterosexual sex.
Lab collaborations
In addition to the HIV test offered as part of NHBS, project areas may conduct other tests with local funds if local regulations permit anonymous testing. Further, CDC's Division of HIV Prevention (DHP) collaborates with other agencies and CDC divisions to fund additional biological testing as part of NHBS.
Analysis
NHBS Study Group publications can be found in Google Scholar.
Project areas
Currently (2023-2026), 19 project areas with high prevalence of HIV conduct NHBS. Many of the state health department recipients collaborate with local health departments, universities, or community-based organizations to implement NHBS activities. Several of the project areas also participate in conducting NHBS among additional populations and in collaborations to provide additional biological testing as part of NHBS.
- Los Angeles
Division of HIV and STD Programs
Los Angeles Department of Public Health - San Diego
Office of AIDS
California Department of Public Health - San Francisco
Center for Public Health Research
Population Health Division
San Francisco Department of Public Health
- Denver
STI/HIV/Viral Hepatitis Branch
Colorado Department of Public Health and Environment
- Washington, D.C.
HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA)
District of Columbia Department of Health
- Atlanta
Georgia HIV Behavioral Surveillance Team
HIV/AIDS Epidemiology Surveillance Section
Georgia Department of Public Health
- Chicago
HIV/STI Surveillance, Epidemiology, and Research
Chicago Department of Public Health
- Indianapolis
Division of HIV/STD/Viral Hepatitis
Indiana State Department of Health
- New Orleans
Louisiana OPH STD/HIV Program
Louisiana Department of Health and Hospitals
- Baltimore
Center for HIV Surveillance, Epidemiology and Evaluation
Maryland Department of Health
- Detroit
Communicable Disease Division
Michigan Department of Health and Human Services
- Newark
Epidemiologic Services
Division of HIV, STD and TB Services
New Jersey Department of Health
- New York City
HIV Epidemiology and Field Services Program
New York City Department of Health & Mental Hygiene
- Portland
HIV/STD/TB Section
Center for Public Health Practice
Oregon Health Authority
- Philadelphia
AIDS Activities Coordinating Office
Philadelphia Department of Public Health
- San Juan
HIV / AIDS / STD Surveillance
Puerto Rico Department of Health
- Houston
Bureau of Epidemiology
Office of Surveillance & Public Health Preparedness
Houston Health Department
- Virginia Beach/Norfolk
HIV Surveillance
Division of Disease Prevention
Virginia Department of Health
- Seattle
Office of Infectious Disease Assessment Unit
Division of Disease Control and Health Statistics
Washington State Department of Health
What's collected
NHBS-MSM/PWID/HET
NHBS collects data on behavioral risk factors for HIV (e.g., sexual behaviors, drug use), HIV testing behaviors, the receipt of prevention services, and use of prevention strategies (e.g., condoms, PrEP). In addition to these interview data, all NHBS participants are offered an HIV test regardless of their self-reported HIV status.
NHBS-Trans
A limited number of project areas have conducted surveys with transgender women. NHBS-Trans data are collected to assess HIV prevalence and associated behaviors and other experiences important to the health and well-being of transgender women, especially transgender women of color.
Technical Assistance
How information is collected
- Before each NHBS cycle, formative assessment is conducted to learn more about each local population and to inform operational procedures.
- Venue-based, time-space sampling (VBS) is used during the MSM cycles.
- Project area staff identify venues frequented by MSM (e.g., bars, clubs, organizations, and street locations) as well as days/times when men frequent those venues.
- Venues (and specific day/time periods) for recruitment are chosen randomly each month.
- Project area staff identify venues frequented by MSM (e.g., bars, clubs, organizations, and street locations) as well as days/times when men frequent those venues.
- Respondent-driven sampling (RDS) is used during the PWID and HET cycles.
- Project area staff select a small number of initial participants, or "seeds," who complete the survey and recruit their peers to participate.
- Project area staff select a small number of initial participants, or "seeds," who complete the survey and recruit their peers to participate.
- Recruitment and interviewing then continue until the target sample size is reached.
- Trained interviewers in all NHBS project areas use a standardized, anonymous questionnaire to collect information on HIV-related risk behaviors, HIV testing, and the use of HIV prevention services.
- HIV testing is offered to all participants regardless of their self-reported HIV status.
- During each cycle, a minimum of 500 eligible persons from each participating project area are interviewed and offered HIV testing.
How NHBS data are used
NHBS data are used to provide a behavioral context for trends seen in HIV surveillance data. They also describe populations disproportionately affected by HIV and thus provide an indication of the leading edge of the epidemic. Through systematic surveillance in these populations, NHBS is critical for monitoring the impact of the National HIV/AIDS Strategy, which focuses on decreasing HIV incidence, improving linkage to care, and reducing disparities.
Current data releases
- HIV Risk, Prevention, and Testing Behaviors Among Men Who Have Sex with Men
- HIV Risk, Prevention, and Testing Behaviors Among Persons Who Inject Drugs
- HIV Risk, Prevention, and Testing Behaviors Among Heterosexually Active People