High-Risk Behaviors for HIV: A Comparison Between Crack-Abusing and Opioid-Abusing African-American Women

Abstract

High rates of unprotected sexual behaviors and the exchange of sex for crack have been reported among female crack cocaine users. This subpopulation of drug users is at significant risk for contracting and transmitting HIV and AIDS. To date, there has been no research comparing crack- and opioid-abusing women, particularly regarding their involvement in high-risk behaviors and other key background indicators for different subgroups of drug-abusing women. Sixty-one crack-abusing African-American women who recently entered an intensive outpatient treatment program were compared to 64 matched women whose primary drug of abuse was heroin. The opioid subgroup represented both those who were involved in methadone maintenance and those who were out of treatment. Higher rates of high-risk sexual behaviors were reported by the crack subgroup, including prostitution, number of sexual partners, and infrequency of condom use. As expected, i.v. drug use and high-risk behaviors associated with needle use were much higher among the opioid subgroup. Other significant differences were found between the two groups across key indicators. Individuals in the crack subgroup were younger, cared for more children, were less employable, were less likely to be married, and had more extensive lifetime substance abuse. Quantitative and qualitative background and clinical data are also presented. The nature of crack versus heroin abuse is also discussed, particularly in relation to high-risk sexual behaviors. Finally, the impact of the findings on developing appropriate treatment interventions for both groups is addressed.

What You Think You Know Can Hurt You: Perceptual Biases About HIV Risk in Intimate Relationships

“…Sexual behaviors that put one at risk for HIV infection are higher among individuals who use crack cocaine (e.g., Hoffman et al 2000) or methamphetamines (Somlai et al 2003) than other drugs such as heroin (e.g., Cohen et al 1994), resulting in higher risk severity weightings. Club drugs are very similar to methamphetamines (NIDA 2005c), and were therefore weighted the same.…”

A Peer-Based Substance Abuse Intervention for HIV+ Rural Women: A Pilot Study

“…Women who abuse crack cocaine are at high risk themselves and at high risk of passing HIV to others because of the sexual practices associated with procuring and using cocaine (Cohen et al, 1994;Eldridge et al, 1997). Crack users report more sex partners including injection-drug users, less condom use, and frequent bartering of sex for cocaine (Eldridge et al, 1997).…”

“…Forty-six percent of women's cases of HIV infection have been attributed to injection-drug use, and 18% to women's heterosexual contacts with injection-drug users (Coyle, 1998). Recent studies suggest that women, especially minorities, frequently contract HIV while engaging in unprotected sex for crack cocaine (Cohen, Navaline, & Metzger, 1994;Weissman et al, 1995). Additionally, AOD abuse has been associated with poorer outcomes such as more depressive symptoms, poorer HIV disease management, and poorer quality of life (Hans, 1999;Kettinger, Nair, & Schuler, 2000;Mynatt, 1998;Nair et al, 1997;Nelson-Zlupko, Kauffman, & Dore, 1995;Westermyer, Kopka, & Nugent, 1997).…”

Substance Abuse and Medication Adherence Among HIV-Positive Women with Histories of Child Sexual Abuse

“…The increased risk of HIV/AIDS among substance abusing women, especially among those with multiple partners, has been well documented (Cohen et al, 1994). Variables associated with the increasing HIV/AIDS rates for this population include IDU or sex with an injection drug user, crack cocaine use, and sex with multiple partners (Longshore and Anglin, 1995).…”