Association between crack cocaine use and high-risk sexual behaviors after HIV diagnosis

Objective: To describe the prevalence of crack cocaine use in an HIV-infected population and to examine the association between crack use after HIV diagnosis and high-risk sexual behaviors for heterosexual men, heterosexual women, and men who have sex with men (MSM). Methods: Analysis of cross-sectional interviews conducted from January 1995 through December 1998 with HIV infected adults in 12 states. Results: Of 10,415 persons with HIV or AIDS, 66.6% never used crack, 10.7% used crack before HIV diagnosis but not after, and 22.7% used crack after diagnosis. High-risk sexual behaviors were more prevalent among those who had ever used crack and were most prevalent among those who used crack after diagnosis. In multivariable analyses, crack use after diagnosis was associated with having multiple sex partners and trading sex for drugs/money in ail three groups: heterosexual men, heterosexual women, and MSM. For heterosexual women and MSM, crack use after diagnosis was associated with unprotected sex with a main partner, and among heterosexual men and MSM, with unprotected sex with casual partners. Conclusions: Crack use after HIV diagnosis was associated with high-risk sexual behaviors. Treatment programs to assist people in quitting crack are needed to help reduce the risk of HIV transmission from this population.