title: 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.
abstract: 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.
authors.affiliation: 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.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Oster
authors.forename: Maya
authors.initials: M
authors.lastname: Sternberg
authors.forename: Samara
authors.initials: S
authors.lastname: Nebenzahl
authors.forename: Dita
authors.initials: D
authors.lastname: Broz
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.forename: Isa
authors.initials: I
authors.lastname: Miles
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D002690:Chlamydia Infections / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology*; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014507:Urbanization