Amy Lansky

• PhD, MPH
• Managing Director at Centers for Disease Control and Prevention

We assessed mpox vaccine communication and sexual behavior among U.S. MSM during the 2022 mpox outbreak. Less than 40% of respondents asked a new male sex partner about their mpox vaccination status. Mpox vaccine communication was positively associated with condomless anal sex and group sex. Mpox vaccine communication is low but may inform and sexu...

Introduction This research aims to characterize disparities in mpox- and vaccine-related knowledge in gay, bisexual, and other men who have sex with men in the U.S. Methods The authors conducted a study using the American Men's Internet Survey, which includes 823 cisgender (defined as their gender identity matching their sex assigned at birth) mal...

Mpox vaccination is recommended for persons exposed to or at risk for mpox. Approximately 25% of an online sample of men who have sex with men (MSM) with presumed mpox exposure were vaccinated (≥1 dose). Vaccination was higher among younger MSM, MSM concerned about mpox, or MSM reporting sexual risk behaviors. Incorporating mpox vaccination into ro...

The Centers for Disease Control and Prevention (CDC) recommended in 2006 that sexually active gay, bisexual, and other men who have sex with men (MSM) be screened for human immunodeficiency virus (HIV) at least annually. A workgroup comprising CDC and external experts conducted a systematic review of the literature, including benefits, harms, accep...

CDC's 2006 recommendations for human immunodeficiency virus (HIV) testing state that all persons aged 13-64 years should be screened for HIV at least once, and that persons at higher risk for HIV infection, including sexually active gay, bisexual, and other men who have sex with men (MSM), should be rescreened at least annually (1). Authors of repo...

Purpose: To estimate lifetime risk of receiving an HIV diagnosis in the United States if existing infection rates continue. Methods: We used mortality, census, and HIV surveillance data for 2010 to 2014 to calculate age-specific probabilities of an HIV diagnosis. The probabilities were applied to a hypothetical cohort of 10 million live births t...

Background: This study estimated the proportions and numbers of heterosexuals in the United States (U.S.) to calculate rates of heterosexually acquired human immunodeficiency virus (HIV) infection. Quantifying the burden of disease can inform effective prevention planning and resource allocation. Methods: Heterosexuals were defined as males and...

Understanding geographic variation in the numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) is critical to targeting and scaling up HIV prevention programs, but population size estimates are not available at generalizable sub-national levels. We analyzed 1999-2010 National Health and Nutrition Examination Survey data on...

Human immunodeficiency virus (HIV) transmission risk is primarily dependent on behavior (sexual and injection drug use) and HIV viral load. National goals emphasize maximizing coverage along the HIV care continuum, but the effect on HIV prevention is unknown. To estimate the rate and number of HIV transmissions attributable to persons at each of th...

Men who have sex with men (MSM) represent over half of new HIV infections in the United States. It is important to understand the factors associated with engaging in risky sexual behavior to develop effective prevention interventions. Binge drinking (≥5 drinks on ≥1 occasion) is the most common form of excessive alcohol consumption. This study exam...

1A combined measure of risk was used, that included behaviors such as having had 5 or more sex partners, exchanged sex for money or drugs, had a male sex partner who had sex with men or injected drugs, had a sex partner who was HIV-positive, injected drugs or used crack cocaine or methamphetamines, or was treated for an STD.

The goals of the National HIV/AIDS Strategy are to reduce new human immunodeficiency virus (HIV) infections, increase access to care and improve health outcomes for persons living with HIV, and reduce HIV-related health disparities. In July 2013, by presidential executive order, the HIV Care Continuum Initiative was established, focusing on acceler...

Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the risk group most affected by human immunodeficiency virus (HIV). In 2010, among persons newly infected with HIV, 63% were MSM; among persons living with HIV, 52% were MSM. The three goals of the National HIV/AIDS Strategy...

Corresponding Author: Anna Satcher Johnson, MPH, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, 1600 Clifton Rd NE, Atlanta, GA 30329 (ats5@cdc.gov). Author Contributions: Ms Johnson and Dr Hall had full access to all of the data in the study and take responsibility for the integrity of...

Background Injection drug use provides an efficient mechanism for transmitting bloodborne viruses, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Effective targeting of resources for prevention of HIV and HCV infection among persons who inject drugs (PWID) is based on knowledge of the population size and disparity in dise...

Objective: To describe the prevalence and association of sexual risk behaviours and viral suppression among HIV-infected adults in the United States. Design: Cross-sectional analysis of weighted data from a probability sample of HIV-infected adults receiving outpatient medical care. The facility and patient response rates were 76 and 51%, respec...

Effective HIV prevention programs rely on accurate estimates of the per-act risk of HIV acquisition from sexual and parenteral exposures. We updated the previous risk estimates of HIV acquisition from parenteral, vertical, and sexual exposures, and assessed the modifying effects of factors including condom use, male circumcision, and antiretroviral...

We assessed factors associated with HIV care among HIV-infected men who have sex with men (MSM). We used 2008 data on MSM from the National HIV Behavioral Surveillance System (NHBS). Venue-based, time-space sampling was used to recruit and interview men in 21 U.S. cities with high AIDS prevalence. Among self-reported HIV-positive MSM, we used gener...

The National HIV Behavioral Surveillance system (NHBS) was designed to monitor HIV prevalence and risk factors for infection among higher-risk individuals, i.e., sexually active men who have sex with men who attend venues, injection drug users who injected in the past 12 months, and heterosexuals living in low socioeconomic urban areas. These group...

BACKGROUND: Injection and sexual behavior among persons who inject drugs (PWIDs) contribute importantly to the HIV burden in the United States (U.S). In 1983, the U.S. Centers for Disease Control issued HIV prevention guidelines for PWID and others at high risk of becoming infected and transmitting infection to others. We aimed to inform how to fo...

The goals of the National HIV/AIDS Strategy are to reduce new human immunodeficiency virus (HIV) infections, increase access to care and improve health outcomes for persons living with HIV, and reduce HIV-related health disparities. Recently, by executive order, the HIV Care Continuum Initiative was established, focusing on accelerating federal eff...

Male-to-male sex and illicit injection drug use are important transmission routes for human immunodeficiency virus (HIV) infection. Of all new HIV infections in 2010, 80% were among men, of which 78% were among men who have sex with men (MSM), 6% among male injection drug users (IDU), and 4% among men who have sex with men and inject drugs (MSM/IDU...

We examined trends in cross-sectional HIV prevalence (a surrogate for incidence) and past 12 month testing behavior among young men who have sex with men (MSM). The Young Men's Survey and the National HIV Behavioral Surveillance System conducted interviews and HIV testing among MSM recruited by venue-based sampling during 1994-2011. Using data from...

On June 12, 2013, the Thailand Ministry of Health and CDC published results from a randomized controlled trial of a daily oral dose of 300 mg of tenofovir disoproxil fumarate (TDF) that showed efficacy in reducing the acquisition of human immunodeficiency virus (HIV) infection among injecting drug users (IDUs) (1). Based on these findings, CDC reco...

People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term...

The Estimates of the Number of PWID per 10,000 population aged 15–64 years for each of the 96 largest MSAs in the US for each year from 1992 to 2007. (PDF)

A1. AIDS cases as adjusted for HIV prevalence Figure A1: Estimation of Annual U.S. HIV Prevalence Rates among People Who Inject Drugs, Observed and Predicted Values A2. Adjustment of AIDS diagnoses for the proportion of PWID testing positive for HIV. (DOC)

This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicit...

A web-based HIV behavioral surveillance system (WHBS) has potential to collect behavioral data from men who have sex with men (MSM) not reached through traditional sampling methods. Six U.S. cities conducted a WHBS pilot in 2005-2007 to determine the feasibility to conduct a behavioral surveillance project entirely on the internet. THREE SAMPLING M...

Several assumptions determine whether respondent-driven sampling (RDS) is an appropriate sampling method to use with a particular group, including the population being recruited must know one another as members of the group (i.e., injection drug users [IDUs] must know each other as IDUs) and be networked and that the sample size is small relative t...

Internet-based sampling methods may reach men who have sex with men (MSM) who don't attend physical venues frequented by MSM and may be at higher risk of HIV infection. Multivariate logistic regression was used to examine characteristics of adult MSM participants in 2 studies conducted in the same 5 U.S. cities: the 2003-2005 National HIV Behaviora...

Background: CDC has not previously calculated disease rates for men who have sex with men (MSM) because there is no single comprehensive source of data on population size. To inform prevention planning, CDC developed a national population size estimate for MSM to calculate disease metrics for HIV and syphilis. Methods: We conducted a systematic li...

During the past decade, the number and proportion of reported HIV cases in the United States acquired through heterosexual contact has increased markedly. CDC employs the National HIV Behavioral Surveillance System (NHBS) to monitor risk behaviors and HIV prevalence in high-risk populations. To identify a target population for conducting NHBS among...

This report describes the prevalence of HIV among intravenous drug users in the United States based on demographics and other behavioral risk factors, providing additional insight to identification of the increased risk donor profile.

During 2003-2005, the National HIV Behavioral Surveillance System (NHBS) enrolled men who have sex with men (MSM) from 12 different venue types in 15 metropolitan areas in the United States. Our goal was to examine whether limiting NHBS enrollment venues to gay bars and dance clubs could increase efficiency without changing the overall results and...

Unprotected anal intercourse (UAI) is a key risk factor for HIV transmission among heterosexuals. • There is growing concern about the impact of UAI on the measured effectiveness of vaginal microbicides as UAI among trial participants potentially reduces study power to detect protection from vaginal transmission. • Prevalence of UAI can inform the...

An estimated 1.2 million persons in the USA are infected with HIV, of whom approximately 20% are unaware they are infected. HIV testing and knowledge of HIV serostatus have important individual and public health benefits, including reduction of morbidity, mortality and HIV transmission. Although testing is the necessary first step to prevention, mo...

Group-level probability of testing for HIV within the BED recency period (P) based on the proportion of individuals diagnosed with AIDS at the time of HIV diagnosis (q). (XLSX)

Probability of testing for HIV within the BED recency period (P) by number of months since most recent negative HIV test (T). (XLSX)

Estimated diagnoses of HIV Infection, number BED tested, and estimated incidence of HIV infection in 16 states and 2 cities contributing data for analysis, 2006–2009. (XLSX)

Background: The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200-64,500). We updated the 2006 estimate and calculated incidence for 2007-2009 using improved methodology. Methodology: We estimated in...

Background Approximately 1.1 million persons in the United States are living with HIV and for 18.5% their infections are attributable to injection drug use. In 2009 there were an estimated 5063 new HIV diagnoses attributed to injection drug use. In 2002, CDC developed the National HIV Behavioural Surveillance System (NHBS) to help state and local h...

Correlates of main reasons for not HIV testing, HIV testing intentions, and potential use of an over-the-counter rapid HIV test (OTCRT) among men who have sex with men who have never tested for HIV (NTMSM) are unknown. We evaluated these correlates among 946 NTMSM from 6 US cities who participated in an internet-based survey in 2007. Main reasons f...

The United States has a comprehensive system of HIV surveillance, including case reporting and disease staging, estimates of incidence, behavioral, and clinical indicators and monitoring of HIV-related mortality. These data are used to monitor the epidemic and to better design, implement, and evaluate public health programs. We describe HIV-related...

In February 2007, Public Health-Seattle and King County issued a press release describing a cluster of multiclass drug-resistant HIV cases among men who had sex with men (MSM). We evaluated the effect of the press release among MSM in the Seattle area. We administered a rapid assessment survey at venues where MSM congregate. Eligible participants w...

The National Human Immunodeficiency Virus (HIV) Behavioral Surveillance System (NHBS) is the Centers for Disease Control and Prevention's (CDC's) newest system for measuring HIV risk behaviors among three adult populations at highest risk for HIV infection in the U.S.: men who have sex with men, injecting drug users, and heterosexuals at risk of HI...

The Centers for Disease Control and Prevention provides guidance on sexually transmitted disease (STD) testing specifically for men who have sex with men (MSM) in STD treatment guidelines to address increasing rates of gonorrhoea and syphilis among MSM in the USA. The guidelines recommend at least annual syphilis, gonorrhoea and chlamydia testing f...

Background: The Centers for Disease Control and Prevention first provided guidance on STD testing specifically for MSM in the 2002 STD Treatment Guidelines as part of a strategy to address increasing rates of gonorrhea and syphilis among MSM in the United States. These guidelines recommended at least annual syphilis, gonorrhea, and chlamydia testin...

To identify challenges that women face 2-9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We anal...

To assess trends in prenatal discussions about HIV testing and prenatal HIV testing during the period 1996-2001. Using data from the Pregnancy Risk Assessment Monitoring System, a population-based postpartum survey of women, we calculated the self-reported prevalences of discussion of prenatal HIV testing and testing. Data were analyzed using SUDAA...

Issue: We conducted a study of Black and Hispanic women and their male sex partners to assess risk behaviors and knowledge of partner risks. Implementing this anonymous survey in multiple cities posed many challenges. Methods: Black and Hispanic women in 21 cities were asked to recruit up to 2 men they had sex with in the past 3 months. Both partne...

The National HIV Behavioral Surveillance System (NHBS) is CDC's system for monitoring behaviors among persons at highest risk for HIV infection. The NHBS strategy involves rotating cycles of surveillance in three populations at risk for HIV: men who have sex with men, injection drug users, and heterosexuals in high risk areas (HET). In 2005, 32% of...

Convenience samples are used to determine HIV-related behaviors among men who have sex with men (MSM) without measuring the extent to which the results are representative of the broader MSM population. We compared results from a cross-sectional survey of MSM recruited from gay bars between June and October 2001 to a random digit dial telephone surv...

This article describes a conceptual framework for HIV behavioral surveillance in the United States. The framework includes types of behaviors to monitor, such as risk behaviors, HIV testing behaviors, adherence to HIV treatment, and care-seeking for HIV/AIDS. The framework also describes the population groups in which specific behaviors should be m...

HIV behavioral surveillance in the United States is conducted among three groups: infected populations, high-risk populations, and the general population. We describe the general population component of the overall U.S. HIV behavioral surveillance program and identify priority analyses. This component comprises several data systems (ongoing, system...

The Centers for Disease Control and Prevention, in collaboration with 25 state and local health departments, began the National HIV Behavioral Surveillance System (NHBS) in 2003. The system focuses on people at risk for HIV infection and surveys the three populations at highest risk for HIV in the United States: men who have sex with men, injecting...

In collaboration with the Centers for Disease Control and Prevention, participating state and local health departments, universities, and community-based organizations applied venue-based, time-space sampling methods for the first wave of National HIV Behavioral Surveillance of men who have sex with men (NHBS-MSM). Conducted in 17 metropolitan area...

While disease surveillance for HIV/AIDS is now widely conducted in the United States, effective HIV prevention programs rely primarily on changing behavior; therefore, behavioral data are needed to inform these programs. To achieve the goal of reducing HIV infections in the U.S., the Centers for Disease Control and Prevention, in cooperation with s...

Although the history of CDC spans 60 years, only during the last 2 decades of the 20th century did the agency come to recognize and better understand the importance of the behavioral and social sciences to its overall mission. This recognition was a consequence of several events, notably the growing public awareness of the many conditions and disea...

For CDC's goal of reducing the number of new human immunodeficiency virus (HIV) infections to be achieved, data are needed to assess the prevalence of HIV-related risk behaviors at a given time, monitor trends in these behaviors, and assess the correlates of risk. These data also can be used to evaluate the extent to which current HIV-prevention pr...

We reviewed data from multiple sources to examine distinguishing features of the HIV epidemic among women in the South. The goal of this study was to identify HIV and sexually transmitted disease (STD) prevention research priorities in the South. Cases of HIV/AIDS and STDs were analyzed to compare rates by region and rates in urban versus rural are...

Although HIV information is widely available in this country, little is known about how commonly used HIV prevention activities reach persons at highest risk for HIV. In this paper, we describe the extent to which HIV prevention strategies reach a sample of high-risk persons and whether such exposure correlates with having been tested for HIV. Data...

To examine early postnatal care among healthy newborns during 2000 in 19 states. Using data from the Pregnancy Risk Assessment Monitoring System, a multistate population-based postpartum survey of women, we calculated prevalences of early discharge (ED; stays of < or =2 days after vaginal delivery and < or =4 days after Cesarean delivery) and early...

Our objectives were to describe the methodology of the Pregnancy Risk Assessment Monitoring System (PRAMS), examine recent response rates, determine characteristics associated with response, and track response patterns over time. PRAMS is a mixed-mode surveillance system, using mail and telephone surveys. Rates for response, contact, cooperation, a...

Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blac...

Disparities in maternal and infant health have been observed among members of different racial and ethnic populations and persons of differing socioeconomic status. For the Healthy People 2010 objectives for maternal and child health to be achieved (US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and impr...

Voluntary counseling and testing is an important strategy for HIV prevention. For optimal impact, however, clients must return for HIV test results and counseling. The goal of this study was to document the frequency of self-reported failure to return for HIV test results (FTR) and associated reasons among persons at high risk for HIV infection. Re...

Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., ina...

The purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection. Data were collected as part of an anonymous, cross-sectional interview study--the HIV Testing Survey (HITS)--conducted in seve...

Name-based HIV case surveillance was implemented in New Mexico on January 15, 1998. The objective of the present study was to assess changes in HIV testing patterns after implementation of HIV case surveillance. The timing of the HIV Testing Survey (HITS), developed to gather data on HIV testing patterns among persons at risk for infection through...

In the United States, monitoring the HIV/AIDS epidemic among the incarcerated population is done by (a) conducting a census of persons in prisons and jails reported to be infected with HIV or diagnosed with AIDS, (b) seroprevalence surveys in selected correctional facilities, and (c) population-based HIV/AIDS case surveillance by state health depar...

We determined proportions of high-risk persons tested for HIV, the reasons for testing and not testing, and attitudes and perceptions regarding HIV testing, information that is critical for planning prevention programs. Cross-sectional interview study of persons at high risk for HIV infection (men who have sex with men [MSM]; injection drug users [...

To assess the level of HIV-related risk behavior among the general US adult population, we analyzed data from the first sexual behavior questions available for states to use with the Behavioral Risk Factor Surveillance System. The Behavioral Risk Factor Surveillance System is a state-specific, population-based, random telephone survey. In 1997, 25...

Theory and research suggest that behavioral interventions to prevent HIV/AIDS may be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present...

This study evaluated 1995 guidelines for HIV testing of pregnant women. Analysis focused on Behavioral Risk Factor Surveillance System data for the years 1994 through 1999. Data were aggregated across states. Percentages of pregnant women tested for HIV increased from 1995 to 1996 (from 41% to 53%) and again from 1997 (52%) to 1998 (60%). After imp...

HIV/STD prevention programs are increasingly guided by behavioral rather than by disease indicators. Relevant HIV/STD-related behavioral information is currently available from a variety of surveys and surveillance systems at three levels: general population, infected populations, and high-risk populations. However, the utility of these systems for...

An increasing number of cases of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among women is reported to state and territorial health departments without exposure risk information (i.e., no documented exposure to HIV through any of the recognized routes of HIV transmission). Because surveillance data are used to...