National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-B1004
Santibanez S
CDC, Atlanta, GA

BACKGROUND/OBJECTIVES:: Crack-cocaine is injected by injection drug users (IDUs) who may engage in other high-risk injecting and sexual behaviors. We sought to estimate the frequency of crack-cocaine injection (CCI) among young IDUs in the US, and to identify bloodborne infections and risk behaviors associated with this practice.

METHODS: An interviewer-administered cohort study of 18-30 year old street-recruited IDUs was conducted in five cities to assess risk factors for and prevalence of HIV, HBV, and HCV infection. In a secondary analysis of all IDUs in this study, we calculated the overall and site-specific CCI prevalence. After excluding sites with CCI prevalence <10% to reduce bias due to site differences, we calculated the CCI prevalence in various socio-demographic groups. Lastly, we compared behavioral and serological differences between crack-cocaine injecting IDUs (CC-IDUs) and non crack-cocaine injecting IDUs (NCC-IDUs) using cross-tabulation and Chi-Square.

RESULTS: Overall, 15% (329/2198) of IDUs reported ever injecting crack-cocaine: New Orleans (28.0%), New York's Lower East Side (24.6%), Los Angeles (16.7%), Chicago (12.3%), Baltimore (1.6%), and Harlem (1.5%). In sites with CCI prevalence > 10%, this behavior was most common among white (21.5%) followed by African-American (14.2%) and Hispanic (8.3%) IDUs. By sexual preference, CCI was most common among men who have sex with men and inject drugs (24.1%), followed by women who have sex with women and inject drugs (19.5%), heterosexual male (19.1%) and heterosexual female (14.3%) IDUs (p = 0.067). By drugs injected, CCI was most frequent among IDUs who also injected methamphetamine (30.9%), cocaine (28.9%) or speedball (28.6%). No IDUs reported injecting crack-cocaine exclusively. Regarding risk behaviors, CC-IDUs were more likely than NCC-IDUs to have shared syringes (54.2% vs. 40.1%; p <0.001) or cookers, cotton or water (79.2% vs. 66.1%; p <0.001) in the past 6 months, ever injected in a shooting gallery (56.7 vs. 34.5%; p <0.001), and ever initiated another person into injection drug use (49.7 vs. 30.2%; p <0.001). Stratified by gender, male CC-IDUs were more likely than male NCC-IDUs to have unprotected sex with high-risk partners (75.1 vs. 49.2, p <0.001), while female CC-IDUs were more likely than female NCC-IDUs to exchange sex for money or drugs (34.7 vs. 22.2, p = 0.009). HBV (25.4% vs. 16.5%, p = 0.001) and HCV seropositivity (46.2% vs. 28.0%, p < 0.001) were more common among CC-IDUs than NCC-IDUs, while HIV prevalence was < 5% in both groups.

CONCLUSIONS: Although CCI prevalence varied significantly, it was reported in all sites. CC-IDUs reported more risk factors for HIV, HBV, and HCV infection and were more likely to be infected with HBV and HCV than NCC-IDUs. CCI is a supplemental behavior among IDUs that may be a marker for other high-risk behaviors which could be used to target prevention efforts.

030727
M1-B1004

Copyright notice: The National HIV Prevention Conference is collaborative effort by the Centers for Disease Control and Prevention, a U.S. Government agency and other governmental and non-government organizations. All abstracts published in by the conference organizers are in the public domain and can be used without permission. Proper citation, however, is required.