HIV infection among heterosexual people who take drugs without injecting them has doubled during the last two decades in New York City, and researchers say herpes may be behind the increase.
The infection rates increased from 7 percent to 14 percent. During the same time period, HIV infection among people who inject drugs fell to 10 percent.
More than half of the people who take drugs orally or nasally in the study were infected with herpes simplex virus 2 (HSV-2).
“Heterosexual intercourse is usually not very efficient for transmitting HIV, but the efficiency of heterosexual transmission nearly triples in the presence of herpes simplex virus type 2,” notes the study’s lead author, Don Des Jarlais, a professor of psychiatry and of preventive medicine at Mount Sinai Beth Israel. “In New York City, we have done an excellent job of reducing HIV among persons who inject drugs and we must now put more efforts into reducing sexual transmission associated with non-injecting drug use.”
The study concludes that an increase in HIV infection among these non-injecting drug users is better considered as an increase in herpes and HIV co-infection rather than simply an increase in HIV prevalence.
The City Department of Health and Mental Hygiene has initiated a program “treatment as prevention,” in which people infected with HIV are given anti-viral medications to both protect their own health and to reduce the chances that they will transmit HIV to others.
There are also new federal recommendations to provide anti-retroviral medications to HIV uninfected persons at high risk for becoming infected.
“If we can implement these programs on a large scale, we should be able to control sexual transmission of HIV in the city,” says Des Jarlais.
The National Institutes of Health funded the study, which appears in the journal PLOS ONE.