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.
Extract |
Full Text
N Engl J Med 1995;
332:1233-1235, May 4, 1995.
Correspondence
This article has been cited by other articles:
Jarlais, D. C. D., Semaan, S.
(2008). HIV Prevention for Injecting Drug Users: The First 25 Years and Counting. Psychosom. Med.
70: 606-611
[Abstract][Full Text]
Lightfoot, M., Rotheram-Borus, M. J., Tevendale, H.
(2007). An HIV-Preventive Intervention for Youth Living With HIV. Behav Modif
31: 345-363
[Abstract]
Romero, E. G., Teplin, L. A., McClelland, G. M., Abram, K. M., Welty, L. J., Washburn, J. J.
(2007). A Longitudinal Study of the Prevalence, Development, and Persistence of HIV/Sexually Transmitted Infection Risk Behaviors in Delinquent Youth: Implications for Health Care in the Community. Pediatrics
119: e1126-e1141
[Abstract][Full Text]
Rizkalla, C., Sue, Y.-J., Adam, H. M.
(2006). Cocaine.. Pediatr. Rev.
27: 436-438
[Full Text]
Bowen, A., Williams, M., Dearing, E., Timpson, S., Ross, M.
(2006). Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention. Health Educ Res
21: 549-559
[Abstract][Full Text]
Degenhardt, L, Hall, W, Warner-Smith, M
(2006). Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS. Sex. Transm. Infect.
82: iii56-iii63
[Abstract][Full Text]
Roth, M. D., Whittaker, K. M., Choi, R., Tashkin, D. P., Baldwin, G. C.
(2005). Cocaine and {sigma}-1 receptors modulate HIV infection, chemokine receptors, and the HPA axis in the huPBL-SCID model. J. Leukoc. Biol.
78: 1198-1203
[Abstract][Full Text]
Lightfoot, M., Rotheram-Borus, M. J., Milburn, N. G., Swendeman, D.
(2005). Prevention for HIV-Seropositive Persons: Successive Approximation Toward a New Identity. Behav Modif
29: 227-255
[Abstract]
Wynn, G. H., Cozza, K. L., Zapor, M. J., Wortmann, G. W., Armstrong, S. C.
(2005). Antiretrovirals, Part III: Antiretrovirals and Drugs of Abuse. Psychosomatics
46: 79-87
[Abstract][Full Text]
Wood, E., Montaner, J. S.G., Yip, B., Tyndall, M. W., Schechter, M. T., O'Shaughnessy, M. V., Hogg, R. S.
(2003). Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ
169: 656-661
[Abstract][Full Text]
McClelland, G. M., Teplin, L. A., Abram, K. M., Jacobs, N.
(2002). HIV and AIDS Risk Behaviors Among Female Jail Detainees: Implications for Public Health Policy. Am. J. Public Health
92: 818-825
[Abstract][Full Text]
Tyndall, M W, Patrick, D, Spittal, P, Li, K, O'Shaughnessy, M V, Schechter, M T
(2002). Risky sexual behaviours among injection drugs users with high HIV prevalence: implications for STD control. Sex. Transm. Infect.
78: i170-175
[Abstract][Full Text]
Timpson, S. C., Pollak, K. I., Bowen, A. M., Williams, M. L., Ross, M. W., McCoy, C. B., McCoy, H. V.
(2001). Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users. Health Educ Res
16: 541-553
[Abstract][Full Text]
Radcliffe, K W, Ahmad, S, Gilleran, G, Ross, J D C
(2001). Demographic and behavioural profile of adults infected with chlamydia: a case-control study. Sex. Transm. Infect.
77: 265-270
[Abstract][Full Text]
Bruneau, J., Lamothe, F., Soto, J., Lachance, N., Vincelette, J., Vassal, A., Franco, E. L.
(2001). Sex-specific determinants of HIV infection among injection drug users in Montreal. CMAJ
164: 767-773
[Abstract][Full Text]
Ward, H, Pallecaros, A, Green, A, Day, S
(2000). Health issues associated with increasing use of "crack" cocaine among female sex workers in London. Sex. Transm. Infect.
76: 292-293
[Abstract][Full Text]
Haywood, T. W., Kravitz, H. M., Goldman, L. B., Freeman, A.
(2000). Characteristics of Women in Jail and Treatment Orientations: A Review. Behav Modif
24: 307-324
[Abstract]
Committee on Pediatric AIDS,
(2000). Identification and Care of HIV-Exposed and HIV-Infected Infants, Children, and Adolescents in Foster Care. Pediatrics
106: 149-153
[Abstract][Full Text]
Pao, M., Lyon, M., D'Angelo, L. J., Schuman, W. B., Tipnis, T., Mrazek, D. A.
(2000). Psychiatric Diagnoses in Adolescents Seropositive for the Human Immunodeficiency Virus. Arch Pediatr Adolesc Med
154: 240-244
[Abstract][Full Text]
Fournier, A. M., Carmichael, C.
(1998). Socioeconomic Influences on the Transmission of Human Immunodeficiency Virus Infection: The Hidden Risk. Arch Fam Med
7: 214-217
[Abstract][Full Text]
Gunn, R. A., Rolfs, R. T., Greenspan, J. R., Seidman, R. L., Wasserheit, J. N.
(1998). The Changing Paradigm of Sexually Transmitted Disease Control in the Era of Managed Health Care. JAMA
279: 680-684
[Abstract][Full Text]
SCHILLING, R. F., IVANOFF, A., EL-BASSEL, N., SOFFA, F.
(1997). HIV-Related Behaviors in Transitional Correctional Settings. Criminal Justice and Behavior
24: 256-277
[Abstract]
Kelleher, P., Cox, S., McKeogh, M.
(1997). HIV infection: the spectrum of symptoms and disease in male and female patients attending a London hospice. Palliat Med
11: 152-158
[Abstract]
Sugarman, K., Herman, M., Fernando, D., Edlin, B. R., Faruque, S., McCoy, C. B., Word, C. O., Des Jarlais, D. C., Padian, N.
(1995). Crack Cocaine and HIV in the Inner City. NEJM
332: 1233-1235
[Full Text]
(1995). Crack Use and HIV. AIDS Clin Care
1995: 7-7
[Full Text]
Des Jarlais, D. C., Padian, N. S., Winkelstein, W.
(1994). Targeted HIV-Prevention Programs. NEJM
331: 1451-1453
[Full Text]
Previous
