The association between cocaine use and HIV/STDs among soup kitchen attendees in New York City

We examined the associations of cocaine use with HIV/sexually transmitted d iseases (STDs) in a sample of 184 soup kitchen attendees using a mobile med ical van in Manhattan (male = 66%; black or Hispanic = 818; cocaine use, pr imarily crack = 75%; ever injected drugs = 22%). In addition to confirming the association between years of cocaine use and HIV antibodies in this sam ple (odds ratio [OR] = 2.11; p < .05) we examined the pattern of associatio ns of cocaine use and non-HIV STDs under the hypothesis that the strength o f an association depends on the efficiency of sexually transmitting a parti cular STD (high, moderate, and low for syphilis, heparitis B and hepatitis C, respectively). As predicted, years of cocaine use was strongly associate d with syphilis (OR = 207; p < .05), moderately associated with hepatitis B core antibodies (OR = 1.50; p < .05), and not significantly associated wit h hepatitis C antibodies (OR = 1.58; p < .05). A reverse pattern of associa tions between opiate use (injection drug use) and the three STDs points to the singular significance of cocaine use in the sexual transmission of STDs , and by inference, HIV. This conclusion is further bolstered by correlatio ns of biologic (hair assays) and self-reported measurements of cocaine use (but not opiates) with self-reports of high risk sexual behavior among the women (number of partners and selling sex) and men (number of partners and buying sex). These data underscore the need for effective cocaine treatment and HIV interventions tailored to the large numbers of cocaine users in in ner cities.