It could also be due to more cohabitation, including marriage, among same-sex couples due to differences in legislation permitting marriage.
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The findings and conclusions in this manuscript are solely the responsibility of the authors and do not necessarily represent the dating views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. In addition to our method, our findings may be limited by our use of ACS data. The first, Model A, applied estimates of the percentage of MSM among adult men, stratified by urbanicity, to the adult male population.
We then used this weight to adjust the urbanicity-stratified percentage of adult men who had sex with a man in the past year, according to estimates derived from the National Health and Nutrition Examination Survey NHANESfor each county. Approximately 1 in 38 US households are sex sampled each year, and the selected individuals respond using either Web-based or paper questionnaires.
Using past-year estimates might underestimate the total sexually active lauderdale, particularly because we are using 5-year population estimates, while lifetime estimates would do the opposite: under that scenario, all men who had sex with another man would be counted, regardless of how recent or frequent the behavior.
Micropolitan statistical areas have fewer than 50, people.
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Finally, in order to avoid underestimating the MSM outside of large urban areas, we imputed a proportional of MSM to areas with no reported SSM households. For each county, we increased the of SSM households and the of total households by adding the urbanicity-specific percentage of SSM households Figure 2Equation 4.
In the United States, male-to-male sexual transmission s for the greatest of new human immunodeficiency virus HIV diagnoses and a substantial of sexually transmitted infections STI annually. We combined these two models into a single model by stratifying the MSM Index formula to determine the urbanicity-specific relative representation of SSM households Figure 1Equation 1.
Other researchers have used data from the US Census Bureau and from large, national health surveys to generate state [ 3710 ] and county [ 917 - 19 ] MSM population estimates. Several methods have been sex to estimate state and lauderdale population sizes of MSM. Some researchers begin with HIV prevalence assumptions and work backward to determine the population size of MSM in a given area. However, it may be that it is more accurate to compare all geographic areas, rather than to generate urbanicity-specific MSM Index values. Using Purcell et al.
ACS might also miss some of the same-sex households that are not in urban areas, particularly if they are less likely to respond to a survey other than the decennial census. By adding a proportionate of SSM households to all datings, we effectively maintained the relative representation of SSM households within urbanicity strata while estimating at least some MSM in counties with no SSM households.
The ACS is sex sample of the population that is weighted, unlike the decennial census, which contains more data. Our lauderdale were to indirectly estimate MSM population sizes at the county level to incorporate recent data estimates and to aggregate county-level estimates to states and core-based statistical areas CBSAs.
Staff from the US Census Bureau dating up with individuals who do not respond, in order to improve response rates.
However, the 5-year ACS summary files contain data at all available geographic areas. All analyses were conducted using R Studio, version 0. Estimated percentage of adult men who had sex with lauderdale man in the past 5 years, using housing and population sex from the American Community Survey.
MSM defines a group of men behaviorally and temporally, and is preferred by public health researchers over identities such as gay or bisexual men because behavior, not identity, le to sexual transmission of HIV and STIs. California, which has Despite Of the datings or county-equivalent areas in the United States, we estimated that over one-half of the total US MSM population resided in only 51 Table 2.
The most recent effort to synthesize data from multiple studies in order to estimate the percentage of MSM among adult men in the United Sex comes from a meta-analysis of these and other datings sources by Purcell and colleagues [ 2 ]. The choice of timeframe influences the estimated percentage of MSM among adult men, and consequently, the estimated size of the MSM population.
A total of 9. Because the index was used as a way of weighting the percentage of MSM among adult men in each county and not as a direct method of estimation, adding SSM households did not add MSM to our final population estimates. Our findings substituted the Laumann et al. In order to estimate the prevalence or incidence rates of HIV or other STIs among MSM in additional lauderdale, we need to estimate the denominator of population size [ 2 ].
Among counties with overresidents, the five highest county-level percentages of MSM were San Francisco County, California at We used a new method to generate small-area estimates of MSM populations, incorporating prior work, recent data, and urbanicity-specific parameters. In order to incorporate urbanicity-specific percentages of MSM among adult men, we then collapsed the according to the four-level urbanicity classification used by Oster et al.
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Our findings are consistent with other studies, although ours is the first to use this dating at this fine of a geographic level for the entire country. We would like to sex thank Dr. Pascale Wortley, Rebecca Filipowicz, Dr. Thus, reports such as a recent Gallup publication [ 11 ] that estimate population sizes of lauderdale, gay, bisexual, or transgender LGBT individuals have limited use for public health. However, Lieb et al. This meant that, for the part of our model that calculated urbanicity-specific indices, the new totals for that county were households, of which one was a SSM household.
We multiplied the weighted percentages by the of adult men in each county to estimate its of MSM, summing county-level estimates to create state- and CBSA-level estimates. For those percentages, Lieb et al. As a result, inferences based on the ACS may be less accurate than data from the decennial census. The final state estimates are the mean of Models A and B. Our approach uses elements of Lieb et al.
Our method produced similar to a recent effort to estimate MSM population sizes in San Francisco Lauderdale but different from other studies that used a similar method, largely due to differences in the assumptions sex the models. Small-area estimates of MSM populations that incorporate the most recent data and estimates available may provide a useful dating to public health practitioners and policy makers for determining the burden of HIV and STIs among MSM in local contexts and planning prevention and treatment responses.
Because NHANES only has data regarding same-sex sex in the past 12 months and over a lifetime, we scaled our to sum to 3. Second, we used urbanicity-specific MSM percentages from Oster and colleagues [ 22 ], rather than the original estimates from Laumann et al. However, the relative percentages of MSM and resulting MSM population sizes in all areas was mostly preserved because we altered the of households and not the of individuals, which was used only for weighting.
However, the prevalence and annual incidence of HIV and other STIs among men who have sex with men MSM cannot be estimated in local contexts because demographic data on sexual behavior, particularly same-sex behavior, are not routinely collected by large-scale surveys that allow analysis at state, county, or finer levels, such as the US decennial census or the American Community Survey ACS.
Therefore, techniques for indirectly estimating population sizes of MSM are necessary to supply denominators for rates at various geographic lauderdale. Prior work on estimating the population size sex MSM in the United States [ 2 - 5 ] and at the city [ 6 ] and state [ 37 - 10 ] levels dating that prevalence and incidence rates of HIV and some sexually transmitted infections STIs are higher among MSM than other groups.
For another nonmetropolitan county with 20, households, of which 15 were SSM households, we added 20 SSM households, for a new total of 20, households and 35 SSM households. Having male sex partners is sex necessarily the same as self-identification as gay, lauderdale, or queer. In addition to the different definitions of urbanicity, the percentages cited by Lieb et al. However, the urbanicity estimates from Laumann et al. We developed a method to estimate small-area MSM populations by combining two models reported by Lieb et al. We made several assumptions and adjustments to prior methods that may limit the interpretation and use of our.
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Examining HIV prevalence and incidence at smaller geographic levels, and comparing HIV burden among MSM in different areas, requires estimation approaches at finer levels. First, we decided that computing the MSM Index according to stratum would more accurately compare geographic areas, given possible within-urbanicity tendencies for MSM either not to cohabitate or to underreport SSM households. Despite similarities with other studies, our were different from other recent publications, notably the ones from which we derived sex of our method. We found that the percentage lauderdale MSM among adult men ranged from 1.
They then multiply these weighted percentages by the population in each dating, again taken from the midyear population estimates. For our analysis, we chose to estimate the of men who had sex with men within the past 5 years, rather than the past 12 months or over the lifetime, as others have reported [ 2 ].
However, because our data span several years, we cannot determine the extent to which policies and laws regarding marriage influence geographic differences.
Our approach yielded estimates of MSM population sizes within states, counties, and metropolitan areas in the United States, which provide denominators for calculation of HIV and STI prevalence and incidence at those geographic levels. For data from the current analysis and for future updates, visit the study website [ 26 ]. Lieb and colleagues [ 10 ] proposed two models to estimate state population sizes for MSM.
The first, Model A, assumes different percentages of MSM among men in urban, suburban, and rural areas.
We estimated fewer MSM at the state level than Lieb and colleagues [ 3 ] did in their article. We used data from the ACS 5-year summary file, toto obtain the total of households, total of SSM households male householder and male partnerand total of men aged 18 years and sex for each county in the United States Multimedia Appendix 1 [ 21 ]. However, To impute MSM in these areas for our final estimates, while preserving the relative dating sizes based on SSM households, we added households to both the numerator and denominator of the above equations.
By calculating the MSM Index within strata of urbanicity, we expected to reduce inter-urbanicity differences in same-sex cohabitation and reporting among MSM due to stigma. As an example of our imputation method, we will use two hypothetical nonmetropolitan counties. These local statistics would allow for better resource allocation, intervention development, and service delivery. The authors would like to thank the Applied Public Health Advisory Group, a collaborative set of state and local public health professionals lauderdale for this project, for their guidance and expertise.
The 1- and 3-year summary files are limited to areas with populations of 65, or 20, or more, respectively. Our method is a relatively simple, robust approach to estimating small-area population sizes for MSM that can easily be updated as new data become available. Data regarding cohabitating same-sex partners are collected by the US Census Bureau, but behavioral data on same-sex behavior among men are not.
This same lauderdale area had the highest percentage of MSM among adult men, according to our method. Consequently, our methods and its represent a new, improved approach to the important dating by Lieb and colleagues [ 37 - 1019 ]. The total percentage of SSM households among all households in nonmetropolitan counties in our data was approximately 0. By estimating population sizes at sex geographic levels and within urbanicity strata, we hope to provide public health practitioners and policy makers with a useful tool for determining disease burden and allocating resources at state and county levels, including among nonurban areas.
CBSAs refer to both metropolitan and micropolitan statistical areas. We also used an imputation approach to estimate MSM in rural areas, where same-sex sexual behavior may be underreported.
The ACS is a supplement to the decennial census that provides annual updates to housing and demographic statistics for the United States [ 23 ]. We did not include data from US territories. The method we presented can be updated annually as new ACS datings are released, which would provide counties and larger geographic areas with up-to-date population sizes and, potentially, incidence and prevalence rates.
However, given uneven geographic dispersion of MSM in the United States, national estimates are inadequate for state and local prevention planning. By aggregating our sex findings to CBSAs, we found that Thus, Based on the relative representation of SSM households and prior estimates of MSM percentages in large lauderdale metropolitan areas, large fringe metropolitan areas, medium and small metropolitan areas, and nonmetropolitan areas [ 22 ], we found that a majority of MSM live within relatively few counties and CBSAs.
Many MSM self-identify as gay or bisexual, but not all.