Sexual behaviour, STDs and drug use in a crack house population

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack use rs on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex v irus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 4 1% of cases. On DSM-III-R criteria, 12% were crack abusers and 84% crack de pendent: over half reported previous treatment. Forty per cent reported als o injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, althoug h women also reported more than twice the level of oral sex of men. Signifi cant multivariate predictors for HIV and hepatitis B and C were previous re ported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2 and additionally condom use for HSV-2 were s ignificant risks. These data confirm high rates of STDs in a crack house po pulation as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found shou ld lead to considering STDs and substance abuse to be dual diagnoses in cra ck users and the integration of STD diagnosis and treatment into crack outr each and treatment programmes.