Background to crack cocaine addiction and HIV high-risk behavior: the next epidemic

Increasing rates of sexually transmitted diseases among users of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunodeficiency virus) infection.

A street recruitment technique was employed to enroll 331 primarily African-American men aged 18-29 in an area of San Francisco where crack cocaine is sold openly. One-half were regular crack users and the other half had never used the drug. Few reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Following counseling, each was tested for HIV and syphilis.

Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex with injection drug users. Users reported greater current depression, anxiety, and social isolation. They reported earlier initiation into alcohol use and less positive parenting experiences during their adolescence.

These results are consistent with findings that report the comorbidity of drug abuse and mental illness. Implications are drawn for reducing HIV infection among this high-risk population for early adolescent, community mental health, and substance abuse treatment programs.