Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
How crack cocaine spreads AIDS
San Francisco Chronicle - Monday February 13, 1989 Randy Shilts
Miami - The young black women from Miami's impoverished Overtown and Liberty City neighborhoods are coming in more frequently now, shocked at the news that they are infected with the AIDS virus and telling remarkably similar stories. "They tell me they stopped shooting drugs because of AIDS, so instead they started smoking crack," says Sonja Singleton, who works with the University of Miami's Health Crisis Network. "And now they're infected." It turns out that the women get infected by having sex in exchange for the high-grade crack cocaine. "Every crack house has an extra room for sex," sighs Singleton. "There are only two things that go on in crack houses - drugs and sex." NOT JUST MIAMI Such stories are not unique to Miami. Around the country, crack cocaine suddenly has emerged as the newest challenge to fighting the AIDS epidemic. Crack is rapidly forcing the public health community to rethink entirely its strategy for battling the already complicated problem of AIDS among drug addicts. The surge of AIDS among crack users seized center stage at the annual AIDS and Chemical Dependency Conference last week in Miami. Few of the addiction program staff members at the conference were without tragic stories like Singleton's. The explosion of crack use in the inner cities has poured gasoline on the already flaming problem of AIDS among heroin users. Numerous studies have shown that the rate of AIDS infection among crack addicts is soaring far beyond the already dismal infection rates among heroin users. A study by researchers at the University of California at San Francisco, for example, found that crack addicts were 6.4 times more likely than heroin addicts to be infected with the human immunodeficiency virus. MANY INJECTIONS Because a crack high does not last as long as the effects of heroin, cocaine addicts who inject the drug shoot up far more frequently, as often as 10 times a day. This enormously increases the chances of getting infected by a contaminated needle. Although heroin deadens the sexual appetite, cocaine excites it, creating a serious problem of sexual transmission of AIDS within crack houses, even among those who never use a needle. From a policy standpoint, the emerging crack problem could not be less opportune. After years of dawdling, public health experts have arrived at a consensus on what to do about AIDS among heroin addicts. Most proposals have called for vastly expanding the nation's methadone treatment programs. In such programs, addicts receive methadone, a legal drug that satisfies their craving for heroin and keeps them away from the dirty needles that spread AIDS. Former President Ronald Reagan's AIDS commission made methadone expansion the most expensive element of its AIDS battle plan, calling for $3 billion in drug-treatment spending. NO SUBSTITUTE DRUG Unfortunately, such programs do nothing to help the crack problem. In fact, many crack users already are in such treatment projects and use cocaine to augment their methadone highs. Among crack addicts who want to kick the habit, there is no drug comparable to methadone that can substitute for cocaine. Proposals to give free needles to addicts similarly will have little effect on the problem of smoked cocaine and sex activity related to it. "Cocaine has gummed up everything," says Dr. David Smith, who is director of the Haight-Ashbury Free Clinic and a leading authority on the problem of AIDS among drug addicts. "We've been thinking of AIDS and crack as two separate problems - and now it's clear that they're not separate at all." The policy quandary is that no new dramatic solutions for the crack-AIDS connection are on the drawing boards. MONEY NEEDED The most sensible solution lies in treatment programs that will provide recovery from addiction altogether, because a methadone-style maintenance drug is not available. Such programs cost money - lots of it - and they have been far less successful than the maintenance programs in attracting addicts. For Singleton, the lack of solutions means more conversations with frightened young men and women who have learned that they are infected with a deadly virus. The problem strikes close to home for the 34-year-old counselor: A heroin addict for 18 years, Singleton was in a treatment center only four days when she was told she was infected with HIV. She now spreads warnings about AIDS through the mean streets she once walked as a prostitute, but she worries that her efforts may prove futile. "Something needs to be done," she says. "More people are falling through the cracks than are getting help." As of last week, 85,590 cases of acquired immune deficiency syndrome have been reported to the U.S. Centers for Disease Control. Of these, 48,957 people have died.
Keywords: AIDS; COCAINE 890213
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
