BACKGROUND TO CRACK COCAINE ADDICTION AND HIV HIGH-RISK BEHAVIOR - THE NEXT EPIDEMIC

Background: Increasing rates of sexually transmitted diseases among us ers of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunode ficiency virus) infection. Methods: A street recruitment technique was employed to enroll 331 primarily African-American men aged 18-29 in a n area of San Francisco where crack cocaine is sold openly. One-half w ere regular crack users, and the other half had never used the drug. F ew reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Followin g counseling, each was tested for HIV and syphilis. Results: Compariso ns showed that demographically similar, crack users reported more sexu al partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, e xchanging sex for drugs, and having sex with injection drug users. Use rs reported greater current depression, anxiety, and social isolation. They reported earlier initiation into alcohol use and less positive p arenting experiences during their adolescence. Conclusions: These resu lts are consistent with findings that report the comorbidity of drug a buse and mental illness. Implications are drawn for reducing HIV infec tion among this high-risk population for early adolescent, community m ental health, and substance abuse treatment programs.