SEXUALLY-TRANSMITTED DISEASES, SEXUAL-BEHAVIOR, AND COCAINE USE IN INNER-CITY WOMEN

The prevalence of untreated sexually transmitted diseases (STDs) was a ssessed in a cohort of 372 sexually active inner-city women (92% black , 49% US-born) with no history of injection drug use who were recruite d in Brooklyn, New York, in 1990 and 1991. The presence of STDs was as sessed via culture, serologic analyses, and medical history. Sexual an d drug-use histories were obtained, as was a urine sample for toxicolo gic analysis. Thirty-five percent of the women had at least one STD (2 7% Trichomonas vaginalis, 6.8% Chlamydia trachomatis, 5.2% syphilis, 2 .4% human immunodeficiency virus (HIV), and 1.4% Neisseria gonorrhoeae ). US-born women were more likely than foreign-born (96% Caribbean) wo men to have an STD (50% vs. 22%; p < 0.001). Among US-born women, 61% of crack and/or cocaine users had an STD as opposed to 34% of non-user s (OR = 2.9, 95% CI 1.6-5.5). Recent crack cocaine use was the stronge st predictor of syphilis infection (OR = 12.8, p = 0.019), and was rep orted by each of the seven HIV-positive women. This study, based on a large sample with laboratory confirmation of both STDs and drug use, d ocuments that women who use crack cocaine are at substantially higher risk of contracting an STD than other women. STD/HIV prevention progra ms in inner cities should target US-born women, particularly crack coc aine users.