Houston's Behavorial Surveillance Program

The Houston’s Behavioral Surveillance program is a Behavioral Surveillance System funded by the Centers for Disease Control and Prevention (CDC). The National HIV Behavioral Surveillance System (NHBS) was established to monitor behaviors that put people at risk for HIV infection. Houston is one of more than twenty U.S. metropolitan areas with high HIV/AIDS prevalence rates selected as NHBS sites. NHBS consists of a repeated, cross-sectional survey of men who have sex with men (MSM), injecting drug users (IDU), and heterosexuals at risk for HIV infection (HET).

In 2006, MSM accounted for 50 percent of the reported male HIV cases (regardless of AIDS status) in Houston. In addition, 3 percent of all reported HIV infections among men were classified into the MSM/IDU risk category. IDUs are at high risk of becoming infected with HIV and other blood borne pathogens through sharing injection-drug equipment with HIV-infected persons. HIV cases attributed to injection drug use accounted for 5 percent of Houston's total male cases in 2006; an additional 3 percent of the total male cases were among men who have sex with men and inject drugs. HIV cases attributed to injection drug use accounted for 7 percent of Houston’s total female cases in 2006. HIV cases attributed to heterosexual contact accounted for 17 percent of Houston's total male cases and 50 percent of the Houston's total female cases in 2006.

NHBS aims to gain a deeper understanding of the high risk behavior related to HIV infection. The goals of the project are: 1) Develop an ongoing behavioral surveillance program to ascertain the prevalence of, and trends in HIV risk behaviors among selected populations of high-risk MSMs, IDUs and HETs. 2) Develop an ongoing program to evaluate changes over time in behaviors among the selected populations of MSMs, IDUs and HETs. 3) Develop a mechanism to incorporate and utilize the behavioral data gathered during this project and other sources of HIV-related behavioral risk data, to effectively summarize what is currently known about HIV risk taking behaviors in Houston.

NHBS activities are implemented in cycles so that data are collected from each risk group every three years; these study cycles are referred to as NHBS-MSM, NHBS-IDU, and NHBS-HET. The project seeks to identify the prevalence and trends of sexual and drug-use risk behaviors among each risk group, as well as their exposure to and utilization of HIV testing and other prevention services funded by the CDC and state and local health departments. The overarching goal of NHBS is to help evaluate and direct local and national prevention efforts. The Bureau of Epidemiology is collaborating with the CDC and the University of Texas School of Public Health to conduct NHBS activities in Houston and Harris County. Individuals who agree to participate undergo an anonymous interview and anonymous HIV Testing. In addition to the standard NHBS questionnaire, participants are asked questions tailored to Houston/Harris County.

NHBS-MSM 1 (2004)
During the first cycle of data collection (January 2004 - August 2004), surveillance activities focused on MSM NHBS-MSM is a survey of men who attend MSM-identified venues within locally defined geographic areas. Survey methods are based on an application of time-space sampling that was successful in obtaining large and diverse samples of MSM. In Houston/Harris County, 685 MSM (defined as men who had one or more male sex partners in the past twelve months) participated in NHBS. The findings from the first cycle were presented at local, state, and national forums.

NHBS-IDU 1 (2005)
The second cycle of data collection (May 2005 - November 2005) focused on injection drug users. The IDU population represents a large proportion of individuals affected by HIV/AIDS throughout the state. The sampling method used for NHBS-IDU was Respondent Driven Sampling (RDS), which has become a standard sampling method to recruit IDUs. RDS is based on the recognition that peers are better able than outreach workers or researchers to locate and recruit other members of a hidden population. In Houston/Harris County, 662 IDUs (defined as persons who injected drugs in the past twelve months) participated in NHBS.

NHBS-HET 1 (2006-2007)
The third cycle of data collection (October 2006 - June 2007) has focused on heterosexuals at risk for HIV infection. HIV cases attributed to heterosexual contact accounted for 17 percent of Houston's total male cases and 50 percent of the Houston's total female cases in 2006.

For the purpose of this study the heterosexual at risk of HIV infection is defined as one who is a resident of or has a social connection to a geographic area characterized by high rate of poverty and HIV/AIDS disease. The geographic areas with high poverty and HIV/AIDS rate are defined as high risk areas.

The sampling method used for NHBS-HET was Respondent Driven Sampling (RDS), which helps to locate and recruit other members of the population. All NHBS-HET participants are offered anonymous HIV counseling and testing upon completion of the survey. In Houston/Harris County, 921 high risk heterosexuals participated in NHBS.

The Partner Study (2007)
The Partner study was also a part of HET cycle where high risk females along with their male partners were recruited and interviewed. The aim of this study was to recruit and interview at least 100 couples. A total of 255 females and 112 of their male partners were recruited. All the participants were also tested for HIV infection.

NHBS-MSM 2 (2008)
During the second phase of Behavioral Surveillance data collection (July 2008 - December 2008), surveillance activities focused on MSM. NHBS-MSM 2 was again a survey of men who attend MSM-identified venues within locally defined geographic areas. Survey methods were based on an application of time-space sampling that was successful in obtaining large and diverse samples of MSM during the MSM 1 cycle in 2004. The surveillance was different this year from the 2004 cycle with the introduction of voluntary HIV testing to the participants. In Houston/Harris County, 456 MSM (defined as men who had one or more male sex partners in the past twelve months) participated in NHBS. Data from this cycle are currently being analyzed by the Houston Department of Health and Human Services.

NHBS-IDU2 (2009)
The formative research activities are being completed for the IDU2 Cycle of the second phase of Behavioral Surveillance in Houston. The data collection is expected to begin in June 2009.

HOUSTON'S BEHAVIORAL SURVEILLANCE PROGRAM