Crack cocaine: a risk factor for human immunodeficiency virus infection type 1 among inner-city parturients

To define the relationship between crack cocaine use and human immunodeficiency virus (HIV) infection while controlling for other HIV risk factors.

We performed a case-control study among inner-city pregnant women who were followed at a large urban hospital in Atlanta, Georgia; 79 of the women were HIV-1-infected and 525 were seronegative. We identified the women from a prenatal population undergoing routine voluntary HIV-1 antibody screening.

From July 1, 1989 to December 31, 1990, we screened 13,469 pregnant women; 80 (5.9 per 1000) were HIV-1-infected. One seropositive woman who did not complete a risk-behavior questionnaire was excluded from the study. Seropositivity was associated with a history of crack cocaine use (odds ratio 2.3, 95% confidence interval [CI] 1.1-4.8), intravenous drug use (odds ratio 14.5, 95% CI 4.5-46.3), and a history of sexually transmitted diseases (odds ratio 2.6, 95% CI 1.5-4.5). We found a significant interaction (P = .01) between a history of crack cocaine use and employment status: Unemployed women who used crack cocaine were 3.5 times more likely to be HIV-1-infected than were employed women who used crack cocaine.

Crack cocaine use was found to be a risk factor associated with HIV-1 infection among pregnant women, particularly those who were unemployed. This finding suggests that the impact of crack cocaine use on HIV transmission may be related to economic factors and possibly to either trading sex for money to buy cocaine or trading sex for the drug.