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

2. EmoryCAMP.orgEmoryCAMP.org NCHHSTP Epidemiologic and Economic Modeling Agreement (NEEMA) NEEMA NEEMA is a 5-year cooperative agreement funded by CDC/NCHHSTP to further modeling efforts in five areas: NEEMA NEEMA’s purpose is to create and adapt models to support public health decision-making and effectiveness at national, state and local levels. 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. HIV Tuberculosis Sexually Transmitted Diseases Viral Hepatitis School/Adolescent Health

3. EmoryCAMP.orgEmoryCAMP.org Emory Coalition for Applied Modeling for Prevention (CAMP) CAMP The Emory Coalition for Applied Modeling for Prevention (CAMP) is the Emory University-coordinated workgroup funded by NEEMA. CAMP CAMP was 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

4. EmoryCAMP.orgEmoryCAMP.org Methods Overview 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 analyses a,b : Percentage of US men who have had sex with another man in the past 5 years (3.9%) a Percentage of US men who have had sex with another man in the past year within four urban-rural categories b 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%) a 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. b 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.

5. EmoryCAMP.orgEmoryCAMP.org United States Emory CAMP 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% 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. EmoryCAMP.orgEmoryCAMP.org Estimated Number of Men Who Have Sex with Men by US State, 2013

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

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

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

10. EmoryCAMP.orgEmoryCAMP.org US Regions Number of MSM by US RegionPercentage of MSM Among Adult Men by US Region

11. EmoryCAMP.orgEmoryCAMP.org States in the West Rate of MSM per 100 Adult Men in the States in the WestNumber of MSM in the States in the West Largest MSM population:California, 792,750 MSM Smallest MSM population:Wyoming, 3,225 MSM Highest percentage of MSM among adult men: California, 5.7% Lowest percentage of MSM among adult men: Wyoming, 1.5%

12. EmoryCAMP.orgEmoryCAMP.org Estimated Number of Men Who Have Sex with Men by State in the US West, 2013

13. EmoryCAMP.orgEmoryCAMP.org Estimated Percentage of Men Who Have Sex with Men Among Adult Men by State in the US West, 2013

14. EmoryCAMP.orgEmoryCAMP.org Counties in the West Approximately 83% of MSM in the West (1,071,435 of 1,293,000) resided in central or fringe counties of large metropolitan areas. Over 50% (681,714) resided in one of 7 counties or county- equivalent areas. StateCounty or EquivalentMSM (2013) ArizonaMaricopa County87,894 California Los Angeles County Orange County Riverside County San Diego County San Francisco County 251,521 62,190 70,803 80,968 66,586 WashingtonKing County61,752 7 counties or county-equivalent areas in the US West where over half of the MSM in the region resided, in alphabetical order by state and county

15. EmoryCAMP.orgEmoryCAMP.org Estimated Number of Men Who Have Sex with Men by County in the US West, 2013

16. EmoryCAMP.orgEmoryCAMP.org Estimated Percentage of Men Who Have Sex with Men Among Adult Men by County in the US West, 2013

17. EmoryCAMP.orgEmoryCAMP.org 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. EmoryCAMP.orgEmoryCAMP.org 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/https://www.census.gov/programs-surveys/acs/ For information regarding the methodology or underlying assumptions, refer to the following articles: 1.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.5365Grey 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 2.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- 015-9970-3Oster 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 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: 10.2174/1874613601206010098Purcell 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: 1.HIV/AIDS: http://www.cdc.gov/hiv/group/msm/http://www.cdc.gov/hiv/group/msm/ 2.STD: http://www.cdc.gov/std/life-stages-populations/msm.htmhttp://www.cdc.gov/std/life-stages-populations/msm.htm

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

20. EmoryCAMP.orgEmoryCAMP.org Index About NEEMASlide 2 About Emory CAMPSlide 3 Methods OverviewSlide 4 United States SummarySlide 5 Estimated Number of MSM by US State, 2013Slide 6 Estimated Percentage of MSM Among Adult Men by US State, 2013Slide 7 Estimated Number of MSM in the United States by US County, 2013Slide 8 Estimated Percentage of MSM Among Adult Men in the United States by US County, 2013Slide 9 US Regions SummarySlide 10 States in the US West SummarySlide 11 Estimated Number of MSM by State in the US West, 2013Slide 12 Estimated Percentage of MSM Among Adult Men by State in the US West, 2013Slide 13 Counties in the US West SummarySlide 14 Estimated Number of MSM by County in the US WestSlide 15 Estimated Percentage of MSM Among Adult Men by County in the US WestSlide 16 Caveats & Limitations of MapsSlide 17 Additional ResourcesSlide 18 Contact Emory CAMPSlide 19