RISK OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AMONG PREGNANT CRACK COCAINE USERS IN A RURAL-COMMUNITY

Objective: To investigate why women who use crack cocaine are at incre ased risk of human immunodeficiency virus (HIV) infection. Methods: On e thousand one hundred fifty-two (99.7%) of 1155 consecutive prenatal patients attending a rural public health clinic were interviewed about drug use and sexual practices and tested for HIV infection and other sexually transmitted diseases. Results: Fifty-one (4.7%) of 1096 pregn ant women reported ever using crack cocaine, but only five (10%) of th e crack cocaine users had ever injected drugs. Eighteen (35%) of the c rack users were HIV infected compared with 22 (2%) of the 1045 women w ho reported never using crack (odds ratio 25, 95% confidence interval 12-52; P < .001). Crack users were more likely to have had a known HIV -infected sex partner, exchanged sex for money or drugs, and tested po sitive for syphilis than were non-crack users (for each comparison, P (.001). Before using crack, 18% of crack users had exchanged sex for m oney or drugs and 8% had averaged three or more sex partners per month ; in contrast, after beginning to use crack, 76% of crack users exchan ged sex for money or drugs and 63% averaged three or more sex partners per month (for both comparisons, P < .001). Crack users who were not HIV infected were more likely to have almost always used condoms and/o r had fewer than three sex partners per month than were HIV-infected c rack users (P < .01). Conclusion: Women who reported using crack cocai ne were at an increased risk of HIV infection because crack use was as sociated with a significant increase in unprotected sexual contact.