Gender and age patterns in HSV-2 and HIV infection among non-injecting drug users in New York City

Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City. METHODS:: Subjects were recruited from patients entering the Beth Israel drug detoxification program. Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behavior was administered, and a blood sample was collected for HIV and HSV-2 antibody testing. Results: A total of 1418 subjects who had never (lifetime) injected drugs (NIDUs) were recruited between July 2005 through June 2009. Subjects were primarily male (76%), and black (67%) or Hispanic (25%), reported recent crack cocaine use (74%), and had a mean age of 42 years. Eleven percent of males reported male-with-male sexual (MSM) behavior. The prevalence of both viruses was high: for HSV-2, 61% among the total sample, 50% among non-MSM males, 85% among females, and 72% among MSM; for HIV, 16% among the total sample, 12% among non-MSM males, 20% among females, and 46% among MSM. HSV-2 was associated with HIV (OR = 3.2, 95% CI: 2.3-4.5; PR = 2.7, 95% CI: 2.0-3.7). Analyses by gender and age groups indicated different patterns in mono- and coinfection for the 2 viruses. Discussion: HSV-2 and HIV rates among these NIDUs are comparable with rates in sub-Saharan Africa. Additional prevention programs, tailored to gender and age groups, are urgently needed. New platforms for providing services to NIDUs are also needed.