A Perfect Storm: Crack Cocaine, HSV-2, and HIV Among Non-Injecting Drug Users in New York City

Abstract

Prevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983–2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed.

Keywords :

• HSV-2
• HIV
• non-injecting drug users
• crack cocaine

THE AUTHORS

Don C. Des Jarlais, PhD, is director of research for the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center, professor at Columbia University Medical Center, and guest investigator at Rockefeller University in New York.Dr. Des Jarlais is a leader in the fields of AIDS and injectable drug use, and has published extensively on these topics including: New England Journal of Medicine, JAMA, Science, and Nature. He is active in international research, having collaborated on studies in many different countries. He serves as consultant to various institutions, including the Centers for Disease Control and Prevention (CDC), National Institutes on Drug Abuse (NIDA), the National Academy of Sciences, and World Health Organization (WHO). He is a former commissioner for the National Commission on AIDS, and currently a Core Group Member of UNAIDS Reference Group on HIV and Injecting Drug Use and a member of the Scientific Advisory Board of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board.

Courtney McKnight is the assistant director of research at the Chemical Dependency Institute at Beth Israel Medical Center, as well as a doctoral candidate in Public Health at the City University of New York, Graduate Center. Her dissertation is investigating the impact of differential access to medication assisted therapy for the treatment of opioid dependence in the United States. Ms. McKnight's research interests include health services and health policy research, particularly among substance users.

Kamyar Arasteh, PhD, is an investigator and biostatistician at the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center. His interests include behavioral pharmacology, substance use, and behavioral epidemiology of HIV/AIDS.

Jonathan Feelemyer, MS, is an epidemiologist with the Chemical Dependency Institute at Beth Israel Medical Center. Mr Feelemyer's research interests include harm reduction and behavioral interventions, particularly focused on drug users. His meta-analysis work focuses on examining these factors in low- and middle-income countries.

David C. Perlman, MD, is professor of Medicine, associate chief, Division of Infectious Diseases, Beth Israel Medical Center. He is an investigator in the Baron Edmond de Rothschild Chemical Dependency Institute and is director of the Infectious Diseases Core in the Center for Drug Use and HIV Research. His research interests include human immunodeficiency virus, tuberculosis, sexually transmitted infections, and hepatitis C and infectious and other complications of drug use. He is an active educator and clinician.

Holly Hagan, RN, MPH, PhD, is a professor at the NYU College of Nursing. Her program of research has focused on the infectious disease consequences of illicit drug use; these include studies of the etiology of blood-borne viral transmission associated with drug-administration practices, and the incidence of viral hepatitis, HIV, and sexually transmitted infections in people who use drugs.

Emily F. Dauria, MPH, is a doctoral student at the Rollins School of Public Health at Emory University. Her research interests include the social determinants of HIV and other sexually transmitted infections especially among women, minorities, and vulnerable populations. Supported by a National Research Service Award from the National Institute of Mental Health (NIMH) (1F31MH096630-01), her dissertation research applies mixed-methods to examine how male incarceration and the healthcare service environment influence individual and community-level sexual health outcomes.

Hannah Cooper, ScD, is an associate professor in the Department of Behavioral Sciences and Health Education at Emory University's Rollins School of Public Health. Her research centers on the social determinants of health, and she has a particular focus on applying multilevel, geospatial, and qualitative methods to understanding whether and how structural factors and place characteristics affect health and well-being.