Fig. 1.

Pathways between ecological stressors, mental health, risk behaviors, EBV, HSV-1, and HIV. EBV, Epstein Barr Virus; HSV-2, Herpes Simplex Virus Type-2; HIV, Human Immunodeficiency Virus. Path 1 ( ): Ecologic stressors may lead to mental health changes which cause increased sexual and drug-use risk behaviors and consequent increased exposure to HSV-2 and EBV, future reactivation of HSV-2 and EBV and subsequent increased risk of HIV acquisition and progression. Path 2 ( ): Ecologic stressors may cause increased reactivation of HSV-2 and EBV directly, which subsequently increases risk for HIV acquisition and progression. Path 3 ( ): Ecologic stressors may cause endocrine/hormonal changes which lead to reactivation of HSV-2 and EBV and subsequent increased risk for HIV acquisition and progression