Intersecting Epidemics -- Crack Cocaine Use and HIV Infection among Inner-City Young Adults
Brian R. Edlin, Kathleen L. Irwin, Sairus Faruque, Clyde B. McCoy, Carl Word, Yolanda Serrano, James A. Inciardi, Benjamin P. Bowser, Robert F. Schilling, Scott D. Holmberg, for The Multicenter Crack Cocaine and HIV Infection Study Team
Background and Methods The smoking of "crack" cocaine is thoughtto be associated with high-risk sexual practices that acceleratethe spread of infection with the human immunodeficiency virus(HIV). We studied 2323 young adults, 18 to 29 years of age,who smoked crack regularly or who had never smoked crack. Thestudy participants, recruited from the streets of inner-cityneighborhoods in New York, Miami, and San Francisco, were interviewedand tested for HIV. This report presents the findings for the1967 participants (85 percent) who had never injected drugs.
Results Of the 1137 crack smokers, 15.7 percent were positivefor HIV antibody, as compared with 5.2 percent of the 830 nonsmokers(prevalence ratio adjusted for the city, 2.4; 99 percent confidenceinterval, 1.7 to 3.6). The prevalence of HIV was highest amongthe crack-smoking women in New York (29.6 percent) and Miami(23.0 percent). In these two cities, of the 283 women who hadsex in exchange for money or drugs, 30.4 percent were infectedwith HIV as compared with 9.1 percent of the 286 other women(prevalence ratio, 3.1; 99 percent confidence interval, 1.9to 5.1); of the 91 men who had anal sex with other men, 42.9percent were infected with HIV as compared with 9.3 percentof the 582 men who did not have anal sex with other men (prevalenceratio, 4.7; 99 percent confidence interval, 3.0 to 7.4). Inmultivariable analyses, these high-risk sexual practices accountedfor the higher prevalence of HIV infection among the crack smokers,as compared with those who did not smoke crack. Women who hadrecently had unprotected sex in exchange for money or drugswere as likely to be infected as men who had had sex with men(40.9 percent vs. 42.9 percent).
Conclusions In poor, inner-city communities young smokers ofcrack cocaine, particularly women who have sex in exchange formoney or drugs, are at high risk for HIV infection. Crack usepromotes the heterosexual transmission of HIV.
Source Information
From the Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta (B.R.E., K.L.I., S.D.H.); the Association for Drug Abuse Prevention and Treatment, New York (S.F., Y.S.); the University of Miami, Miami (C.B.M.); Bayview-Hunter's Point Foundation, San Francisco (C.W.); the University of Delaware, Newark (J.A.I.); California State University, Hayward (B.P.B.); and Columbia University, New York (R.F.S.). Presented in part at the First National Conference on Human Retroviruses, Washington, D.C., December 14, 1993.The members of the Multicenter Crack Cocaine and HIV Infection Study Team are listed in the Appendix.
Address reprint requests to Dr. Edlin at the Division of HIV/AIDS (E-45), Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.
Crack Cocaine and HIV in the Inner City
Sugarman K., Herman M., Fernando D., Edlin B. R., Faruque S., McCoy C. B., Word C. O., Des Jarlais D. C., Padian N.
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N Engl J Med 1995;
332:1233-1235, May 4, 1995.
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