Oster Alexandra M, Sternberg Maya, Nebenzahl Samara, Broz Dita, Xu Fujie, Hariri Susan, Miles Isa, Paz-Bailey Gabriela
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.
Sex Transm Dis. 2014 Apr;41(4):272-9. doi: 10.1097/OLQ.0000000000000110.
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.
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.
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.
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.
男男性行为者（MSM）、注射吸毒者（IDU）以及某些异性恋亚群体受艾滋病毒、其他性传播感染和病毒性肝炎共病的影响尤为严重。虽然了解这些人群中这些感染按城市化程度（地理区域的城市化程度）划分的负担对于确定预防项目的目标至关重要，但很少有研究这样做。
我们分析了1999年至2010年全国健康和营养检查调查中具有全国代表性的18至59岁人群的数据。我们估计了总体样本、男男性行为者、注射吸毒者和异性恋者按城市化水平分层的艾滋病毒、2型单纯疱疹病毒（HSV - 2）、人乳头瘤病毒、衣原体、乙型肝炎和丙型肝炎的加权患病率。人口至少为100万的地理区域被划分为大型中心和大型边缘大都市县。
总体而言，大型中心大都市地区的艾滋病毒、HSV - 2和乙型肝炎患病率较高。大型中心和大型边缘大都市地区男男性行为者中的艾滋病毒患病率有所上升（分别为14.5%和16.9%）。在异性恋者中，大型中心大都市地区的HSV - 2、衣原体和乙型肝炎患病率有所上升。对于任何人群，包括注射吸毒者，人乳头瘤病毒和丙型肝炎患病率在城市化程度方面没有显著差异。
在城市地区患病率较高的感染需要采用以地理区域为重点的筛查和预防项目方法，而在不同城市化水平上患病率一致的感染则将从普遍预防方法中受益。这些具有全国代表性的基于人群的数据有助于更有效地规划预防项目。
