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Prevalence of HIV, Sexually Transmitted Infections, and Viral Hepatitis by Urbanicity, Among Men Who Have Sex With Men, Injection Drug Users, and Heterosexuals in the United States

Oster, Alexandra M. MD*; Sternberg, Maya PhD; Nebenzahl, Samara MD*; Broz, Dita PhD*; Xu, Fujie MD, PhD; Hariri, Susan PhD§; Miles, Isa ScD*; Paz-Bailey, Gabriela MD, PhD, MSc*

Sexually Transmitted Diseases: April 2014 - Volume 41 - Issue 4 - p 272–279
doi: 10.1097/OLQ.0000000000000110
Original Study

Background Men who have sex with men (MSM), injection drug users (IDUs), and certain subgroups of heterosexuals are disproportionately affected by the syndemics of HIV, other sexually transmitted infections, and viral hepatitis. Although understanding the burden of these infections in these populations by urbanicity (the degree to which a geographic area is urban) is critical to targeting prevention programs, few studies have done so.

Methods We analyzed nationally representative 1999 to 2010 data from the National Health and Nutrition Examination Survey on persons aged 18 to 59 years. We estimated the weighted prevalence of HIV, herpes simplex virus type 2 (HSV-2), human papillomavirus, chlamydia, hepatitis B, and hepatitis C, stratified by urbanicity level, for the overall sample, MSM, IDUs, and heterosexuals. Geographic areas with population at least million are classified into large central and large fringe metropolitan counties.

Results Overall, large central metropolitan areas had a higher prevalence of HIV, HSV-2, and hepatitis B. HIV prevalence among MSM was elevated in large central and large fringe metro areas (14.5% and 16.9%, respectively). Among heterosexuals, large central metropolitan areas had elevated prevalence of HSV-2, chlamydia, and hepatitis B. Human papillomavirus and hepatitis C prevalence did not vary significantly by urbanicity for any population, including IDUs.

Conclusions Infections with higher prevalence in urban areas merit a geographically focused approach to screening and prevention programs, whereas those with uniform prevalence across levels of urbanicity would benefit from a generalized prevention approach. These nationally representative, population-based data allow for more effective planning for prevention programs.

Supplemental Digital Content is available in the text. A study of HIV, other sexually transmitted infections, and viral hepatitis by urbanicity found an important geographic variation in the prevalence of HIV, hepatitis B, and herpes simplex virus type 2.

From the *Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, GA; †Division of Laboratory Science, National Center for Environmental Health, CDC, Atlanta, GA; and Divisions of ‡Viral Hepatitis and §STD Prevention, NCHHSTP, CDC, Atlanta, GA

Acknowledgments: The authors thank Kim Elmore for creating the map used in this publication. They also thank Ajay Yesupriya at the Research Data Center and the National Health and Nutrition Examination Survey staff for their work in study design and data collection and preparation.

Conflicts of interest and source of funding: The authors declare no conflicts of interest.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence: Alexandra M. Oster, MD, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, 1600 Clifton Rd NE, MS E-47, Atlanta, GA 30333. E-mail:

Received for publication October 3, 2013, and accepted February 3, 2014.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© Copyright 2014 American Sexually Transmitted Diseases Association