1. High HIV Seropositivity among Heterosexuals
at Risk in Miami Confirmed
by Two Different Sampling Methods
David W. Forrest, Gabriel A. Cardenas, Marlene LaLota,
Dano W. Beck, Lisa R. Metsch, Xierong Wei,
Jeffrey A. Johnson, S. Michele Owen, Thomas M. Liberti
National HIV Prevention Conference 2011
Atlanta, GA
August 15, 2011

2. National HIV Behavioral Surveillance (NHBS)
 NHBS is a repeated, cross-
sectional study of high-risk
populations in US MSAs
 Target population rotates
each year
 MSM
 IDU
 Heterosexuals at increased risk of HIV
infection
 First round (2004-2007) conducted in Miami-
Dade and Broward counties
 Second round (2008-2010) in Miami only

3. NHBS Objectives
"Effective HIV prevention programs rely primarily on changing behavior;
therefore, behavioral data are needed to inform these programs.” [1]
 NHBS provides data on trends in:
Risk behaviors
HIV testing behaviors
Use and impact of prevention
services
HIV prevalence and incidence
[1] Lansky A, Abdul-Quader AS, Cribbin M, et al. Developing an HIV behavioral surveillance system for
injecting drug users: the National HIV Behavioral Surveillance System. Public Health Reports 2007;
122(suppl 1):48-55.

4. Target Population for
NHBS-HET
• The NHBS-HET1 and HET2 cycles
targeted heterosexually active adults in
areas with high poverty in Miami-Dade
County, Florida.

5. NHBS-HET Eligibility Criteria
 Eligible for study participation
 18-50 years of age for HET1, 18-60 years of
age for HET2
 Resident of Miami-Dade County
 Male or Female (not transgender)
 First-time participant during cycle
 Able to complete interview in English or Spanish

6. Assessing Characteristics of
Population X In ON-going surveillance

7. Interviewing Van

8. NHBS-HET Samples
HET-1
•Data collected through venue-based sampling
•March 2007 – October 2007
•Miami total sample N=668 HET
HET-2
•Data collected through respondent-driven sampling
•July 2010 – November 2010
•Miami total sample N=568 HET

9. HET Samples for Analysis
Any NHBS-HET participants reporting
injection drug use (IDU) and any male
participants reporting sex with another
male (MSM) in their lifetimes were
excluded from this analysis.
N=577 for HET1
N=456 for HET2

10. Demographics of HET1 & HET2
HET1 HET2
African American 80.59% 77.85%
Lower income 70.72% 87.06%
(<=$14,999)
High school education 79% 78.73%
or less
No health insurance 59.34% 58.41%
No visit to a health care 50.78% 46.49%
provider in past 12
months
Arrested in the previous 30.16% 22.37%
12 months

11. Drug use and sexual risk
behaviors of HET1 & HET2
HET1 HET2
Heavy alcohol use 26.9% 34.2%
Illicit drug use 47.7% 56.36%
Alcohol or drug treatment in 26.52% 33.77%
lifetime
Depression (CES-D 10 scale) 39.17% 52.19%
Unprotected vaginal 83.5% 87.5%
and/or anal sex
HIV testing during the previous 58.5% 55.2%
12 months

12. HIV among HET1 & HET2
HET1 HET2
HIV positive (HIV test result) 5.7% 7.7%
Previously undiagnosed HIV 42.4% 37%
(self reported HIV- or
unknown plus HIV+ test
result)
Previously undiagnosed who 85.71% 76.92%
reported unprotected vaginal
or anal sex in the past 12
months

13. HIV in NHBS-HET1
HIV positive test results were associated in
the HET1 sample with:
• Crack use in the past 12 months
14.93% vs 4.52% (p=.001)
• Self reported Hepatitis C infection
20% vs 5.5% (p=.051)

14. HIV in NHBS-HET2
HIV positive test results were
associated in the HET2 sample with:
• Female gender
11.6% vs 3.6% (p=.001)
• Crack use in the past 12 months
19.35% vs 5.84% (p<=.001)
• Self reported Hepatitis C infection
23.53% vs 6.96% (p=.011)

15. Recent HIV Infection
Results of tests for recent HIV infection
which exclude 12 month MSM and
IDU show that 4.5% of the positives in
HET1 and 7.1% in HET2 were
infected within the previous 12
months.

16. Conclusions
Our findings document the high rates of heterosexually
acquired HIV infection in lower-income communities in
Miami using two different sampling strategies and
underscore the need to increase and optimize HIV
testing and other prevention services.

17. Limitations
 Data are predominantly self-reported and
subject to recall bias
 Data are cross sectional and time order
cannot be established
 Findings can only be generalized to the
population meeting eligibility criteria

18. NHBS Website
 Visit www.PreventHIVFlorida.org
 Site has links to publications, presentations,
and fact sheets on findings
 Local and national
 Categorized by population (MSM, IDU, HET)
 Special Reports – e.g., “Out in the Open”

19. Credits
NHBS-HET Miami Other acknowledgements:
Interviewing Team: Miami-Dade County
Health Department
Emelina Martinez,
Miami Regional
Roxana Bell, Laboratory, Florida
Cristobal Plaza, Department of Health
Cheryl Riles,
Richard Walker NHBS-HET1 and HET2
participants

20. Contact
David W. Forrest, Ph.D.
University of Miami School of Medicine
dforrest@med.miami.edu