High-Risk Behaviors in Women Who Use Crack: Knowledge of HIV Serostatus and Risk Behavior
Introduction
Increasing individuals' knowledge of their human immunodeficiency virus (HIV) serostatus to reduce high-risk sexual behaviors among individuals known to be HIV infected (HIV+) is an important HIV-prevention goal in the United States (1). Compared with HIV-seronegative (HIV−) women, HIV+ women report more frequently that they are abstinent or use condoms consistently 2, 3. However, subpopulations of HIV+ women, such as inner-city crack cocaine users, have been noted to engage in high-risk sexual activities, including the exchange of sex for money and drugs 4, 5, 6, as do their HIV− counterparts, who have a risk for acquiring HIV infection equal to that of men who have anal intercourse in the same population (7). Because crack cocaine use is associated with both delayed entry into HIV primary care and reduced medication adherence 8, 9, HIV+ crack-using women are likely to have high viral loads and are at high risk of transmitting HIV to sexual partners (10). In addition, the use of crack cocaine is associated with high rates of sexually transmitted infections and vaginitis 11, 12, which increase the efficacy of HIV transmission (13). Thus, crack-using women are an important group affecting the spread of the HIV epidemic in their communities because of the high risks of becoming infected as well as transmitting to others 7, 14.
Although it is widely acknowledged that drug users engage in more high-risk behaviors than nondrug users, several studies have shown that some HIV+ drug users attempt to reduce high-risk sexual behaviors 15, 16, 17. Among HIV+ intravenous drug users who consistently use condoms to protect regular sexual partners from infection, this has been called “informed altruism” (18). However, other studies have shown HIV+ drug users to be especially resistant to reducing sexual risk behaviors 19, 20, perhaps because of social and structural constraints imposed by poverty, unemployment, low levels of education, and addiction (21).
Little attention has been devoted to examining whether knowledge of HIV+ serostatus has led to modification of risk behaviors among seropositive crack cocaine-using women compared with that of their HIV− counterparts. Knowledge of the impact, if any, of HIV seropositivity self awareness on behavior and attitudes is important for the development of interventions to decrease risk behaviors in this population. In the present study, we compared a sample of HIV+ and HIV− crack-smoking women who were aware of their HIV serostatus with respect to demographics, sexual behaviors, normative beliefs regarding condoms and condom use, and the prevalence of sexually transmitted infections and vaginitis. We also examined correlates of unprotected sex among HIV+ and HIV− crack using women. We hypothesized that, given the highly addictive nature of crack and the social disenfranchisement of these women, risk behaviors would not be significantly reduced in HIV+ users compared with HIV− users.
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Study Participants
Street outreach workers in Miami, Florida, located, screened, and recruited participants in areas known to have women with a high prevalence of drug use and HIV to participate in this cross-sectional study. Eligible participants were female, at least 18 years of age, English-speaking, self-reported having vaginal or anal sex in the past 30 days, and self-reported having smoked crack or snorted or injected cocaine or heroin in the last 30 days and having not been in drug treatment in the last 30
Demographics
Two hundred thirty-three drug-using women were enrolled in the study between July 2000 and September 2001. Twenty-two women who had not used crack in the last 30 days, 15 women with discordant results between their answer as to whether they were HIV+ and their test results, as well as 18 women who were unsure of their HIV status, were excluded from the analysis. One hundred seventy-eight women (61 HIV+ and 117 HIV−) were included in the analysis. Although HIV+ women were significantly more
Discussion
We found that, among crack-using women aware of their HIV serostatus, there were no significant differences in illicit drug or alcohol use, exchanging sex for drugs or money, or prevalence of STIs or vaginitis between HIV− and HIV+ women in this sample. Although the majority of HIV+ women reported unprotected sex, they were significantly less likely to do so compared with HIV− women. These data suggest that knowledge of HIV+ serostatus has had some impact on the risk-taking behaviors of
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses
2017, Drug and Alcohol DependenceCitation Excerpt :No consistent associations were evident between crack-cocaine use or consistent sharing of crack-cocaine paraphernalia (‘crack pipes’) and HIV seroconversion or seroprevalence in injection drug users (IDU) (Berbesi Fernández et al., 2016; Booth et al., 1993; Broz et al., 2014; Buchanan et al., 2006; Craib et al., 2003; de Azevedo et al., 2007; DeBeck et al., 2009; Deren et al., 2001; Doherty et al., 2000; Friedman et al., 2003, 1995; Iguchi and Bux, 1997; Hartgers et al., 1991; Kerr et al., 2016; Kral et al., 2001, 1998; Kuo et al., 2011; McCoy et al., 2005; Mesquita et al., 2001; Miller et al., 2002a, 2002b; Ouellet et al., 2000; Phelan et al., 2009; Santibanez et al., 2005; Smereck and Hockman, 1998; Theall et al., 2003; Tyndall et al., 2003; Warner and Leukefeld, 1999; Weiss et al., 2008; Young et al., 2016) and other drug users (Bouscaillou et al., 2016; de Carvalho and Seibel, 2009; Des Jarlais et al., 2014; Fischer et al., 2006, 2005; Fuller et al., 2005; Grella et al., 1995; Hagan et al., 2011; Howard et al., 2002; Hwang et al., 2000; Inciardi et al., 2005; Kunins et al., 2004; Latkin et al., 2001; Mahler et al., 1994; McCoy et al., 1999a, 1999b; Miller et al., 2008, 2007b; Millson et al., 2003; Neaigus et al., 2007; Pechansky et al., 2006; Reid, 2004; Swaminathan et al., 2007; Theall et al., 2003; Trenz et al., 2013; Turchi et al., 2002; Van Ness et al., 2004; Wilson et al., 1998; Wolfe et al., 1992). No association with HIV seroprevalence was evident based on dose, frequency, duration or persistence of crack-cocaine use among populations of crack-cocaine users (Brewer et al., 2007; Dias et al., 2011; Gyarmathy et al., 2002; McCoy and Miles, 1992; Nilsson Schonnesson et al., 2009; Tolentino et al., 2007; von Diemen et al., 2010). Positive associations were found between crack-cocaine use and progression from HIV to AIDS (Baum et al., 2010, 2009; Cook et al., 2008; Nacher et al., 2009; Webber et al., 1999) and acquiring AIDS-defining illnesses including HCV, herpes zoster, pneumonia, tuberculosis and STIs (Burton et al., 2009; Cook et al., 2008; Grant et al., 1999; Kalichman et al., 2000; Morano et al., 2013; Nacher et al., 2013, 2009; Pinto et al., 2014; Webber et al., 1999; Wolff et al., 2008).
Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil
2017, Journal of Infection and Public HealthCitation Excerpt :It is estimated that there are 370,000 crack cocaine users in this country [3], and crack addiction is one of the most common causes of cocaine-related hospitalization [4]. Crack users generally exhibit multiple risk behaviors that expose them to diseases with sexual and parenteral transmission, such as hepatitis B virus (HBV) infection [5–7]. The hepatitis B vaccine, which is considered the most effective means of preventing HBV infection, has been recommended for drug users since its creation.
Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients
2016, Journal of Substance Abuse TreatmentCitation Excerpt :Substance abusers may also visit locations like shooting galleries, crack houses, and other environments that are breeding grounds for infectious diseases like tuberculosis (Kaushik, Kapila, & Praharaj, 2011; Leonhardt, Gentile, Gilbert, & Aiken, 1994; Singer, 2014; Story, Bothamley, & Hayward, 2008). Substance use also often leads to poor decision making with respect to sexual partners and safe sex practices, increasing the individual's risk of contracting HIV and other sexually transmitted infections (Brewer, Zhao, Metsch, Coltes, & Zenilman, 2007; Celentano, Latimore, & Mehta, 2008; Cheng et al., 2010; Kwiatkowski & Booth, 2000; Royce, Sena, Cates, & Cohen, 1997; Thamotharan, Grabowski, Stefano, & Fields, 2015). These are just a few examples of the lifestyle factors that increase substance abusers' susceptibility to a host of medical conditions.
Behavioral risk assessment for infectious diseases (BRAID): Self-report instrument to assess injection and noninjection risk behaviors in substance users
2016, Drug and Alcohol DependenceCitation Excerpt :These include noninjection risks such as sharing intranasal drug use equipment (Koblin et al., 2003) and binge drug use (Miller et al., 2006), and injection behaviors that incur heightened risk, such as transitioning between noninjection and injection drug use (Griffiths et al., 1992; Strang et al., 1992; Griffiths et al., 1994; Darke et al., 1994a, 1994b; Crofts et al., 1996; Irwin et al., 1996; Fuller et al., 2002; Abelson et al., 2006), assisting someone with injections or being a new intravenous drug user (Hagan et al., 2001; Vidal-Trecan et al., 2002; Wood et al., 2003; Roy et al., 2004; O'Connell et al., 2005; Fairbairn et al., 2006), and being a former but not current intravenous drug user (Friedman et al., 1995; Neaigus et al., 2001b). Additional sexual risk behaviors have also been identified, including the frequency of anal and vaginal sexual intercourse and whether the act was insertive or receptive (Benotsch et al., 1999; Hoffman et al., 2000), sex with other drug users (Neaigus et al., 2001a; Bravo et al., 2003; Roy et al., 2004; Purcell et al., 2006), having sex while under the influence of drugs (Celentano et al., 2006), having sex for an extended duration of time (Semple et al., 2009), having a lifetime history of a sexually transmitted disease (Hwang et al., 2000; Kalichman et al., 2005), and being sexually active following an HIV diagnosis (Campsmith et al., 2000; Aidala et al., 2006; Carrieri et al., 2006; Niccolai et al., 2006; Brewer et al., 2007). Finally, risks specific to the drug class being abused, including alcohol (Fitterling et al., 1993; Rasch et al., 2000; Stein et al., 2000; Rees et al., 2001; Kalichman et al., 2005; Raj et al., 2006), stimulants (Booth et al., 2000; Logan and Leukefeld, 2000; McCoy et al., 2004; Edwards et al., 2006; Volkow et al., 2007), and opioids (Sanchez et al., 2002; El-Bassel et al., 2003; Conrad et al., 2015) have also been associated with increased disease risk.
Examining the efficacy of a computer facilitated HIV prevention tool in drug court
2016, Drug and Alcohol DependenceCitation Excerpt :Clearly, drug and alcohol use can affect economic status, social network membership, and decision making with respect to partner selection and condom use. These factors frequently enable unsafe sexual practices (e.g., Kwiatkowski and Booth, 2000; Royce et al., 1997; Brewer et al., 2007; Celentano et al., 2008; Cheng et al., 2010). Finally, some research has indicated that the biological effects of drug abuse can affect a person's susceptibility to HIV and progression of AIDS (e.g., Bagby et al., 2006; Samet et al., 2003, 2004).
Mental Health, Medical Illness, and Treatment with a Focus on Depression and Anxiety
2016, Encyclopedia of Mental Health: Second Edition
This work was funded by the Minority Supplement to National Institute on Drug Abuse #R01 DA09953 “Miami injecting drug users and their sexual risk for HIV.”