Estimating Populations of Men Who Have Sex with Men in the United States Midwestern Region

1. Estimating Populations of Men Who Have Sex with Men in the United States Midwestern Region Based on the 2009-2013 American Community Survey

2. NCHHSTP Epidemiologic and Economic Modeling Agreement (NEEMA) This work was supported by the CDC/NCHHSTP Epidemiologic and Economic Modeling Agreement (5U38PS004646). The findings and conclusions are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. NEEMA is a 5-year cooperative agreement funded by CDC/NCHHSTP to further modeling efforts in five areas: NEEMA’s purpose is to create and adapt models to support public health decision-making and effectiveness at national, state and local levels.

3. Emory Coalition for Applied Modeling for Prevention (CAMP) CAMPwas developed as a collaboration between CDC scientists, academic researchers, and public health providers from institutions across the United States to create, refine, and disseminate models to improve public health practice. CAMP Government, Academic, & Applied Public Health Partners The Emory Coalition for Applied Modeling for Prevention (CAMP) is the Emory University-coordinated workgroup funded by NEEMA.

4. Methods Overview aPurcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, Gau Z, Weinstock H, Su J, Crepaz N. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS 2012;6(Suppl 1):98-107. bOster AM, Sternberg M, Lansky A, Broz D, Wejnert C, Paz-Bailey G. Population size estimates for men who have sex with men and persons who inject drugs. J Urban Health 2015;92(4):733-743. • The detailed methodology was published in 2016: Grey JA, Bernstein KT, Sullivan PS, Purcell DW, Chesson HW, Gift TL, Rosenberg ES. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR Public Health Surveill 2016;2(1):e14. DOI: 10.2196/publichealth.5365 • The method uses data from 5-year ACS summary files: • Number of adult males • Number of households • Number of male-male households (male householder and male partner) • It also incorporates estimates from published analysesa,b: • Percentage of US men who had sex with another man in the past 5 years (3.9%)a • Percentage of US men who had sex with another man in the past year within four urban-rural categoriesb • Central counties of large metropolitan areas (4.4%) • Fringe counties of large metropolitan areas (2.5%) • Counties in medium or small metropolitan areas (1.4%) • Counties that are not in metropolitan areas (1.1%)

5. United States Using the estimates, Emory CAMP created maps showing: • Number of MSM by US state • Percentage of MSM among adult men by US state • Number of MSM by US county • Percentage of MSM among adult men by US county United States Highlights (2013) • Estimated men who had sex with men (MSM) in the past 5 years: 4,503,084 • Largest state population of MSM: California, 792,750 (17.6% of all MSM in the United States) • Highest percentage of MSM among adult men in a state: Rhode Island, 6.0% • Percentage of MSM among adult men in the District of Columbia: 15.3% • Percentage of US MSM residing in central or fringe counties of large metropolitan areas: >75%

6. Estimated Number of Men Who Have Sex with Menby US State, 2013

7. Estimated Percentage of Men Who Have Sex with Men Among Adult Men by US State, 2013

8. Estimated Number of Men Who Have Sex with Men by US County, 2013

9. Estimated Percentage of Men Who Have Sex with Men Among Adult Men by US County, 2013

10. US Regions Regional Highlights (2013) • Largest MSM population: South, 1,521,543 MSM (33.8% of all MSM in the United States) • Smallest MSM population: Midwest, 807,174 (17.9% of all MSM in the United States) • Highest percentage of MSM among men: West, 4.8% • Lowest percentage of MSM among men: Midwest, 3.2% Number of MSM by US Region Percentage of MSM Among Adult Men by US Region

11. States in the Midwest Number of MSM in States in the Midwest Percentage of MSM Among Adult Men in States in the Midwest

12. Estimated Number of Men Who Have Sex with Men by State in the Midwest, 2013

13. Estimated Percentage of Men Who Have Sex with Men Among Adult Men by State in the Midwest, 2013

14. Counties in the Midwest • Approximately 70% of MSM in the Midwest (561,180 of 807,174) resided in central or fringe counties of large metropolitan areas. • Over 50% (404,707) resided in one of 16 counties or county-equivalent areas. 16 counties or county-equivalent areas in the US Midwest where over half of the MSM in the region reside, in alphabetical order by state and county

15. Estimated Number of Men Who Have Sex with Men by County in the Midwest, 2013

16. Estimated Percentage of Men Who Have Sex with Men Among Adult Men by County in the Midwest, 2013

17. Caveats & Limitations of Maps The statistics and maps reflect indirect estimates based on same-sex households, male population sizes, and behavioral findings from peer-reviewed publications. Behavioral data were not collected directly. The data used to construct the estimates are from pooled, five-year American Community Survey (ACS) summary files. Therefore, they reflect data collected over a period of time. Map users should exercise caution when interpreting data from areas with few estimated MSM (e.g., <100) and with sparse populations in general.

18. Additional Resources For information regarding the American Community Survey (ACS), including sampling and data considerations, visit the Census Bureau’s ACS site: https://www.census.gov/programs-surveys/acs/ For information regarding the methodology or underlying assumptions, refer to the following articles: Grey JA, Bernstein KT, Sullivan PS, Purcell DW, Chesson HW, Gift TL, Rosenberg ES. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR Public Health Surveill 2016;2(1):e14. DOI: 10.2196/publichealth.5365 Oster AM, Sternberg M, Lansky A, Broz D, Wejnert C, Paz-Bailey G. Population size estimates for men who have sex with men and persons who inject drugs. J Urban Health 2015;92(4):733-743. DOI: 10.1007/s11524-015-9970-3 Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, Gau Z, Weinstock H, Su J, Crepaz N. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS 2012;6(Suppl 1):98-107. DOI: 10.2174/1874613601206010098 For MSM-specific information regarding HIV/AIDS or STDs, refer to the following CDC sites: HIV/AIDS: http://www.cdc.gov/hiv/group/msm/ STD: http://www.cdc.gov/std/life-stages-populations/msm.htm

19. Contact Emory CAMP Regional MSM slide sets, state MSM profiles, county-level denominator data, updates, and additional resources are available online at EmoryCAMP.org. For more information about Emory CAMP, including information about custom maps and images, please email EmoryCAMP@emory.edu.

20. Index