Abstract
ObjectivesTo examine the potential contribution of herpes simplex virus 2 (HSV-2) infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.MethodsSubjects were recruited from entrants to the Beth Israel drug detoxification program in New York City 2005-11. All subjects reported current use of heroin and/or cocaine and no lifetime injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were calculated for associations between HSV-2 infection and increased susceptibility to HIV.Results1745 subjects were recruited from 2005-11. Overall HIV prevalence was 14%. Females had higher prevalence than males (22% vs. 12%) (p<0.001), African-Americans had the highest prevalence (15%), Hispanics an intermediate prevalence (12%), and Whites the lowest prevalence (3%) (p<.001). There were parallel variations in HSV-2 prevalence (females 86%, males 51%, African-Americans 66%, Hispanics 47%, Whites 36%), HSV-2 prevalence was strongly associated with HIV prevalence (OR = 3.12 95% CI 2.24 to 4.32). PAR%s for HSV-2 as a cause of HIV ranged from 21% for Whites to 50% for females. Adjusting for the effect of increased susceptibility to HIV due to HSV-2 infection greatly reduced all disparities (adjusted prevalence = males 8%, females 11%; Whites 3%, African-Americans 10%, Hispanics 9%).ConclusionsFemale/male and racial/ethnic variations in HSV-2 infection provide a biological mechanism that may generate female/male and racial/ethnic disparities in HIV infection among non-injecting heroin and cocaine users in New York City. HSV-2 infection should be assessed as a potential contributing factor to disparities in sexually transmitted HIV throughout the US.
Highlights
There are substantial racial/ethnic disparities in HIV/AIDS in the United States, with African-Americans comprising 46% of newly diagnosed HIV infections despite comprising only 12% of the US population [1]
We report here on relationships between herpes simplex virus 2 (HSV-2), HIV, sex and race/ethnicity, among non-injecting heroin and cocaine users in New York City
Significant female/male and racial/ ethnic disparities in HIV prevalence existed, with females having higher HIV prevalence than males (22% vs 12%), and a pattern of lowest HIV prevalence among Whites (3%), intermediate prevalence among Hispanics (12%), and highest prevalence among African-Americans (15%)
Summary
There are substantial racial/ethnic disparities in HIV/AIDS in the United States, with African-Americans comprising 46% of newly diagnosed HIV infections despite comprising only 12% of the US population [1]. There are important female/male disparities among the heterosexual contact cases in the US. In 2010, there were a total of 12,875 newly reported heterosexual contact cases, of whom 4416 (34%) were among males and 8459 (66%) were among females. This disparity differs from that seen among female commercial sex work networks, in which a small number of females transmit HIV to large numbers of males, and differs from that seen in the ‘‘mature’’ heterosexual generalized epidemic in which HIV seropositive females outnumber HIV seropositive males, but typically only by a modest percentage, e.g., [5,6]
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