Crack users, sexual behavior and risk of HIV infection

Azevedo, Renata Cruz Soares de; Botega, Neury José; Guimarães, Liliana Andolpho Magalhães

doi:10.1590/s1516-44462006005000017

Cited by 36 publications

(11 citation statements)

References 27 publications

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“…In an attempt to further contribute to this discussion, we aggregated studies according to period of data collection (pre-HAART era [until 1995] vs. pos-HAART era [since 1996]). Thirteen studies were conducted with IDU/NIDU in the pre-HAART era [63,64,68,69,71,77,79,81,83,85] and thirteen in the pos-HAART era [53,74,76,82,67,39,79,59,67,62,61,60,72]. Studies conducted in the pre-HAART period identified a higher HIV-prevalence: 29.5% (95% CI: 20.0 - 39.9) than studies conducted in the post-HAART period: 17.8% (95% CI: 9.09 - 28.8), see Figures 7a and 7b, respectively.…”

Section: Resultsmentioning

confidence: 99%

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

et al. 2010

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BackgroundThe Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.MethodsNine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.ResultsThe studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).ConclusionsFSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

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Section: Resultsmentioning

confidence: 99%

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

et al. 2010

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“…The statistics describing HIV as the second most prevalent cause of death among crack users [14] are explained by some factors related to the lifestyle of users. Apart from the vast literature on the risky sexual behavior adopted by crack users (particularly sexual activity to obtain money or drugs) [9,11,39], this study has shown that users consider condom use to be optional. Thus, the use of condoms is inconsistent.…”

Section: Discussionmentioning

confidence: 98%

“…Regarding HIV, this infection is more prevalent among crack users compared to the general population [9]. The statistics describing HIV as the second most prevalent cause of death among crack users [14] are explained by some factors related to the lifestyle of users.…”

Section: Discussionmentioning

confidence: 99%

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Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug

2010

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BackgroundDue to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users.MethodA qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years). The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software.ResultsThere was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms) and those arising from its illegality (e.g., clashes with the police and trafficking). Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival.ConclusionsThe strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they involved risks of triggering additional problems (e.g., other dependencies) in the long term.

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“…79 HIV and HCV infection rates specifically among crack cocaine users is also accounted for by sharing of pipes among users with open mouth sores, increased risky sexual behavior, and sex work (i.e., trading sex for crack or money). 80–82 Similarly, methamphetamine use, whether injected, snorted, or smoked, is associated with increased risk for HIV and other STDs, particularly among men who have sex with men. 83 Regardless of sexual orientation, however, sexual risk practices such as reduced condom use, being high during sex, and having multiple sexual partners is prevalent among methamphetamine users.…”

Section: Discussionmentioning

confidence: 99%

Substance Use and Associated Health Conditions throughout the Lifespan

2013

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A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood.Findings: 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder).Conclusion: Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.

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Crack users, sexual behavior and risk of HIV infection

Cited by 36 publications

References 27 publications

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

Surviving crack: a qualitative study of the strategies and tactics developed by Brazilian users to deal with the risks associated with the drug

Substance Use and Associated Health Conditions throughout the Lifespan

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