Public Service Announcements National Institute on Drug Abuse - Keep Your Body Healthy Sex Related HIV Risk Behaviors

Booth RE, Kwiatkowski CF, and Chitwood DD. Sex related HIV risk behaviors: Differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug and Alcohol Dependence, 58(2000): 219-226. Synopsis: This analysis focused on 26,982 out-of-treatment IDUs and crack smokers recruited from 22 U.S. cities as part of NIDA’s Cooperative Agreement for AIDS Community-Based Outreach/ Intervention Research Program. The study sought to assess differences in sex-related risk behaviors between IDUs who did not smoke crack cocaine, crack smokers who did not inject drugs, and drug users who both injected and smoked crack. Of the 26,982 drug users, 28% injected only, 42% smoked crack only, and 30% both injected and smoked crack. Overall, 10.4% were HIV+, 26% had no sex partners in last mo; 28% had sex w/> 2 partners; 23% sex w/IDU partner; 24% exchange sex for drugs+$$; >80% had sex w/out condom in past mo. Crack users & crack users who also injected reported most risky sex & significantly more alcohol consumption. Drug users who used alcohol were more likely than those who did not to engage in unprotected sex, and risk increased with the number of days alcohol was used; those who drank daily were 1x more likely to have engaged in sex without a condom. Drug users who had an IDU sex partner were nearly 2 x more likely to have had unprotected sex in the past 30 days. Those who exchanged sex for drugs or $ were slightly less likely than sexually active persons who did not exchange sex to have had unprotected sex. Conclusions: Sexually active drug users in this study engaged in a variety of sex risks known to be associated with HIV infection, including sex with multiple partners, sex with an IDU, and exchanging sex for drugs or money. More than 80% of drug users who were sexually active reported sex without a condom in the past 30 days. Crack users were at particular risk of HIV infection through sexual transmission. Crack only users (7.8% HIV+) and crack users who also injected (11.4% HIV+) were far more likely to have unprotected, high-risk sex than IDUs who did not use crack (12% HIV+). Increased days of alcohol use was independently associated with unprotected sex. Crack smokers, both those who were IDUs and those who used crack only, reported significantly more days of alcohol consumption than IDUs who did not smoke crack. Crack smoking was significantly associated with STDs; >37% who smoked crack only and 39% who smoked crack and injected had been previously diagnosed with gonorrhea; 13% who smoked crack only and 12% who smoked crack and injected had been previously diagnosed with syphilis.