HSV-2 and HIV Among MSM Who Use Cocaine and Heroin in New York City

Background: Men who have sex with men (MSM) are at an increased risk for HIV and other sexually transmitted infections.  We examined HIV infection among MSM in relationship to factors including race/ethnicity, HSV-2 infection, and variations in MSM behavior, including male with female sexual behavior, and route of drug administration (injecting vs. non-injecting) among males drug users.

Methods: Subjects were recruited from entrants into the Beth Israel Medical Center drug treatment programs in New York City. Qualitative questionnaires were administered along with blood testing for HIV and HSV-2.  Bivariate and multivariable regression analyses was used to assess factors associated with being HIV seropositive. 

Results: 3091 male subjects were recruited from 2005 to 2013; 8.4% reported MSM behavior; 37% reported injection drug use (IDUs) within the last six months.  Subjects were predominantly African-American (48%) and Hispanic (35%). Cocaine and heroin were the most commonly used drugs; methamphetamine use was rare.  MSM subjects had much higher HIV prevalence than the non-MSM males, 41% vs. 10% among NIDUs, and 21% vs. 10% among IDUs.  HSV-2 infection was strongly related to HIV seropositivity among all subjects (NIDUs, IDUs, and MSM, AORs from 1.77 to 3.93). HIV and HSV-2 prevalence were higher among MSM only subjects compared to MSM subjects who also reported sex with women (MSMW).  In multivariable analyses of NIDUs and IDUs, MSM behavior, race/ethnicity, HSV-2 and HCV infection were associated with HIV seropositivity.  In multivariable analysis of MSM subjects, HSV-2, race/ethnicity, and not reporting sexual activity with women were associated with HIV seropositivity.

Conclusions:  HIV prevalence was high among MSM subjects, particularly MSM NIDUs and MSM who did not have sex with women.  Additional targeted outreach programs may be needed to provide prevention materials and promote testing and treatment for MSM who use heroin and cocaine, particularly for those infected with HSV-2.