Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder

AIM: To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. METHODS: The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. RESULTS: Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. CONCLUSIONS: Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems.     

Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans.

Epidemiologic data from three national surveys conducted in 1988, 1990, and 1991 were used to investigate the association between acculturation and use of crack cocaine among Hispanic Americans living in the United States. Poststratification and conditional logistic regression were used to hold constant shared aspects of neighborhood environment, age, sex, and education. The analyses showed a strong inverse relationship between degree of acculturation and crack smoking among Mexican Americans (relative odds = 0.12, 95% confidence interval = 0.04, 0.34) but not among other Hispanics in the study population. This observed variation within the US Hispanic American population deserves special attention in future research.     

Drug use frequency among street-recruited heroin and cocaine users in harlem and the bronx before and after September 11, 2001

We determined if illicit drug use frequency changes after a disaster by comparing drug use frequency in two street-recruited samples of heroin and cocaine users, ages 15–40 years. The users were interviewed between July 11 and November 11 and divided into before- and after-September 11th groups for analysis. The before and after groups were similar in the mean number of days of drug use per month (sniff cocaine 6.8 days vs. 9.4 days, respectively, P=.17; snorted heroin 13.9 vs. 14.0, respectively, P=.96; smoked crack 16.9 vs. 15.6, respectively, P=.96; and smoked marijuana 17.5 vs. 15.3, respectively, P=.36) and in the proportion of daily users: sniffed cocaine 10% versus 17%, respectively (P=.28); snorted heroin 47% versus 40%, respectively (P=.91); smoked crack 33% versus 37%, respectively (P=.68); and smoked marijuana 47% versus 40%, respectively (P=.41). Among street-recruited heroin and cocaine users in Harlem and the Bronx, the frequency of drug use did not increase following the events of September 11, 2001. Dr. Factor is from the Division of Prevention Research and Analytic Methods in the Epidemiology Program Office at the Centers for Disease Control and Prevention and is assigned to     

HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities.

OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection drug users and crack smokers are at high risk for HIV infection.     

Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users.

Interventions to increase condom use in crack users have had mixed results. For interventions to achieve greater success, the mechanisms of behavior change in this population need to be understood. One mechanism, the processes of change, was examined across stages of change for condom use. Results from the analysis of variance for males and females revealed that stage of change was associated with different levels of three experiential processes: consciousness raising, social liberation and self-reevaluation. However, these analyses found that male and females seem to have different patterns of behavioral process use. Specifically, females in the preparation stage were different from those in precontemplation, whereas this difference was not pronounced in males. In general, people had high levels of experimental processes in every stage of change. The patterns of behavior process use mimicked patterns found for other behaviors with a linear increase across the stages of change. This may indicate that for maintaining condom use, more emotional and behavioral activities are required throughout the process of acquisition and maintenance than are necessary for other health-related activities. Implications of this research are that interventions for increasing condom use in drug users may target behavioral steps differently for males and females.     

Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection

PURPOSE: Previous studies have examined the practices of injecting drugs or smoking crack cocaine as high-risk, but independent, factors for HIV transmission. To explore the independent and dual risks of injection practices and crack smoking, this study examined HIV seroprevalence rates among distinct drug user groups, based on patterns of daily administration. METHODS: A sample of 3,555 drug users and neighborhood controls in urban Miami, FL and rural Belle Glade and Immokalee, FL were partitioned into four mutually-exclusive groups: 1) injection drug users (IDUs); 2) crack-cocaine smokers; 3) dual users who both smoked crack and injected drugs; and 4) non-drug-user controls. RESULTS: HIV seroprevalence rates were 45.1% for IDUs, 30.5% for dual users, 20.1% for crack smokers and 7.3% for controls. Multivariate logistic regression analysis found that when compared with controls odds ratios for HIV seropositivity were 9.81 for IDUs, 5.27 for dual users, and 2.24 for crack smokers. CONCLUSIONS: These findings provide evidence of: 1) behavioral and structural co-factors that influence HIV exposure patterns among drug users; and 2) the substantially higher risk of HIV infection among IDUs compared with other drug users. Intervention strategies must be tailored for the specific drug use subpopulations to optimize efficacy.     

Two methods to analyze trends in the incidence of heroin and cocaine use in Barcelona [Spain]

OBJECTIVES: To describe 2 statistical methods for estimating trends in the incidence of heroin and cocaine use in Barcelona. METHODS: Admissions for treatment of heroin and cocaine consumption recorded by the Barcelona Drug Information System between 1991 and 2003 were used. We selected 4,367 subjects initiating treatment for the first time for heroin use, and 2,147 for cocaine use. Two statistical techniques were employed: Reporting Delay Adjustment (RDA) and the Log-linear Model (LLM). RDA was used in subjects who initiated drug consumption between 1991 and 2003, and LLM for those who began heroin use between 1967 and 2003 and cocaine use between 1971 and 2003. In addition, for each drug and method the latency period (LP) was determined (years between first consumption and first treatment). RESULTS: Comparison of the distributions of the LP for each drug revealed that heroin users initiated treatment for the first time sooner than cocaine users, regardless of the method employed. In general, the estimated incidence of heroin use in Barcelona fell progressively after 1982. In contrast, the incidence of cocaine use rose rapidly until 1998, and has been irregular since. The incidence of cocaine use began to be substantial in the early 1990s, but took several years to manifest itself as problematic. CONCLUSION: The estimated incidence was underestimated by RDA compared with LLM, but the incidence of heroin use could be biased before 1991 due to changes in treatment provisions. Although the estimated incidence is relative to individuals who are admitted for treatment at some time in their life, trends in incidence can be used to plan future actions.     

Public crack cocaine smoking and willingness to use a supervised inhalation facility: implications for street disorder

Background  

The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility.     

Characteristics of heroin and cocaine users unknown to treatment agencies. Results from the Swiss Hidden Population Study

Summary The aim of this study was to compare the characteristics of heroin or cocaine users who are not in contact with drug-treatment agencies in Switzerland to the characteristics of a group who are in treatment. A sample of 917 users of heroin and/or cocaine was recruited outside treatment settings by 31 Privileged Access Interviewers. Respondents were divided into a study group of 512 heroin and/or cocaine users not following any treatment, and a control group of 238 users who were following treatment. Respondents in the no-treatment group use drugs less frequently, are less likely to inject drugs, have a more social pattern of use and more often have the impression of controlling their drug use. They have less contact with the legal system and the police, are in a better social situation and more often perceive themselves to be in good health. In both groups, respondents whose main drug of use is heroin generally have a more problematic pattern of use than those who use mainly cocaine. There are no significant differences between the two groups regarding present HIV-risk behaviour and prevention. The data show no significant association between the duration of use of heroin or cocaine and signs for problem use. These findings support the hypothesis that drug users not in treatment and drug users in treatment are two distinct populations, in terms of profile of drug use and prevalence of social or health problems that are associated to it.

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Das Profil von Heroin- und Kokainkonsumentinnen ohne Kontakt mit Behandlungsstrukturen

Zusammenfassung Diese Studie vergleicht Heroin-und Kokainkonsumentinnen ohne therapeutische Behandlung mit Heroin-und Kokainkonsumentinnen in Behandlung. Mittels 31 Privileged Access Interviewers wurde ein Sample von 917 Konsumentinnen von Heroin und/oder Kokain rekrutiert. 512 Personen ohne therapeutische Behandlung bilden die Untersuchungsgruppe, 238 Personen mit Behandlung bilden eine Vergleichsgruppe. Individuen der Untersuchungsgruppe gebrauchen Drogen weniger oft, sind weniger häfig intravenös Konsumierendè, konsumieren öfter in Gesellschaft und haben eher den Eindruck, ihren Drogenkonsum zu kontrollieren. Sie haben auch weniger mit der Polizei oder den Strafverfolgungsbehörden zu tun, befinden sich in einer stabileren sozialen Situation und schätzen ihren Gesundheitszustand öfter als gut ein. In beiden Gruppen haben Personen, die hauptsächlich Heroin konsumieren, ein problematischeres Profil, als solche, die hauptsächlich Kokain konsumieren. Problematischer Konsum ist mit der Konsumdauer nicht signifikant assoziiert. Das HIV-Risikoverhalten beider Gruppen ist identisch. Aus dem Vergleich folgt, dass Drogehkonsumentlnnen ohne Behandlung und solche mit Behandlung signifikant unterschiedliche Merkmalsprofile aufweisen.

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Caractéristiques des consommateurs d'héroïne et/ou de cocaïne inconnus des structures de traitement

Résumé Cet article compare les caractéristiques des consommateurs d'héroine ou de cocaine qui ne sont pas en traitement pour leur consommation de drogue. Un échantillon de 917 consommateurs d'héroïne et/ou de cocaine a été recruté et interviewé par 31 Interlocuteurs Privilégiés. Un groupe de 512 consommateurs d'héroïne et/ou de cocaïne hors traitement est comparé a un groupe contrôle de 238 consommateurs actuellement en traitement. Les répondants hors traitement consomment moins fréquemment des drogues, et sont plus rarement des personnes qui s'injectent des drogues. Ils ont un mode de consommation plus sociable et on davantage l'impression de contrôler leur consommation. Ils sont aussi moins en contact avec la justice et la police, se trouvent en situation sociale plus favorable et s'estiment en meilleure santé. Dans les deux groupes les répondants qui consomment principalement l'héroïne ont un mode de consommation plus problématique que ceux qui consomment principalement de la cocaïne. Les comportements actuels à risque pour le VIH des deux groupes sont identiques. On ne trouve pas d'association entre la durée de consommation et des indicateurs d'un mode de consommation problématique. Ces résultats confortent l'hypothèse que les consommateurs de drogues hors traitement (cachés)_et ceux en traitement sont des populations distinctes, en termes de profil de consommation et de prévalence de problèmes sociaux ou sanitaires associés.

     

Reasons for stimulant use among lation gay men in San Francisco: A comparison between methamphetamine and cocaine users

The literature on drug-using gay men has documented a strong relationship between methamphetamine (MA) use and high-risk sexual practices. Of particular concern is that MA use is associated with powerful sexual effects that may facilitate the transmission of HIV. As a group, Latino gay men show high risk for HIV infection, and such risk has been related to episodes of sex under the influence of drugs. However, little information exists about stimulant use among Latino gay men, and it is not known whether MA use in this population is similarly motivated by sexual effects. This study reports reasons for stimulant use in a sample of 300 Latino gay men randomly selected from social and sexual venues; only men who reported stimulant use in the last 6 months were included in the study. Of stimulant users, 51% (n=153) reported MA, 44% (n=133) reported cocaine, and 5% (n=14) reported crack as their “most frequently used stimulant” (MFS); reasons for use were assessed for the participant’s specific MFS. Reasons for stimulant use clustered by five main factors, including energy, sexual enhancement, social connection, coping with stressors, and focused work productivity. MA users gave reasons more frequently related to sexual enhancement (to have better sex, more sex, and more anal sex) whereas cocaine users gave reasons more often related to social connections (to be more sociable and to fit in with other gay men). These findings suggest that Latino gay men use stimulants for reasons that are important in their social, emotional, work, and sexual lives. Like non-Latino Whites, Latino gay men were found to rely on MA for reasons related to sexual enhancement, possibly to meet cultural expectations and norms of sexual prowess and sexual success in the gay community.     

Characteristics of heroin and cocaine users unknown to treatment agencies. Results from the Swiss Hidden population study

The aim of this study was to compare the characteristics of heroin or cocaine users who are not in contact with drug-treatment agencies in Switzerland to the characteristics of a group who are in treatment. A sample of 917 users of heroin and/or cocaine was recruited outside treatment settings by 31 Privileged Access Interviewers. Respondents were divided into a study group of 512 heroin and/or cocaine users not following any treatment, and a control group of 238 users who were following treatment. Respondents in the no-treatment group use drugs less frequently, are less likely to inject drugs, have a more social pattern of use and more often have the impression of controlling their drug use. They have less contact with the legal system and the police, are in a better social situation and more often perceive themselves to be in good health. In both groups, respondents whose main drug of use is heroin generally have a more problematic pattern of use than those who use mainly cocaine. There are no significant differences between the two groups regarding present HIV-risk behaviour and prevention. The data show no significant association between the duration of use of heroin or cocaine and signs for problem use. These findings support the hypothesis that drug users not in treatment and drug users in treatment are two distinct populations, in terms of profile of drug use and prevalence of social or health problems that are associated to it.     

Demographic,psychological and smoking characteristics of users of an on-line smoking cessation programme in the Spanish language

ObjectiveTo determine the characteristics of users of a smoking cessation programme run by the Open University of Spain (Universidad Nacional de Educación a Distancia [UNED]).MethodsWe examined the demographic, psychological and smoking characteristics of 23,763 smokers who participated in the on-line smoking cessation program of the UNED. The programme was open to any smoker, free of charge, and was fully automated and with direct access.ResultsA total of 93.5% of the users were Spaniards, with an equal percentage of participation among men and women. The mean age was 39 years. Somewhat less than half were married and had a university education. The participants smoked a mean of 19.3 cigarettes per day, showing a mid-range level of nicotine dependence according to the Heaviness of Smoking Index. The results of the Anxiety and Depression subscales of the Symptom Checklist-90-Revised (SCL-90-R) and Perceived Stress Scale were not clinically significant. In a secondary analysis of the data, we found gender differences in all the variables measured.ConclusionsThe results of this study confirm the digital divide, with lower participation among people with a lower educational level. No association was observed between stress, anxiety or depression and cigarette consumption.     

Injecting and HIV prevalence among young heroin users in three Spanish cities and their association with the delayed implementation of harm reduction programmes

OBJECTIVES: To evaluate changes in the prevalence of HIV infection among young heroin users in three Spanish cities, and their association with harm reduction programmes (HRPs). METHODS: Two cross sectional studies. The 1995 study included 596 users; half were street recruited and half were recruited at drug treatment centres. The 2001-03 study included 981 street recruited users. Face to face interviews were conducted using a structured questionnaire. Samples for HIV testing (saliva in 1995 and dried blood spot in 2001-03) were collected. RESULTS: The proportion who had ever injected (IDUs) decreased in all three cities. HIV prevalence in IDUs decreased by half in Barcelona (44.1% to 20.8%) and Seville (44.2% to 22.2%), but remained constant in Madrid (36.8% and 34.9%). This difference was attributable to a decrease in HIV prevalence in long term IDUs in Barcelona and Seville, but not in Madrid. The crude odds ratio for HIV prevalence in Madrid compared with Barcelona in long term IDUs was 2.3 (95%CI 1.4 to 3.7), increasing to 3.1 (95%CI 1.5 to 6.2) after adjusting for sociodemographic and risk factors. HIV prevalence in short term IDUs was similar in all cities. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes (MMPs) per 10 000 population aged 15-49 years; Seville reached this rate in 1994, and Madrid, not until 1998. CONCLUSIONS: The prevalence of HIV infection did not decrease in long term injectors in Madrid. The delayed implementation of HRPs, especially MMPs, may be the most plausible hypothesis. This finding should shed light on decision making in countries in a similar epidemiological and sociological situation.     

Coping with the toll of heroin: 10 years of the Barcelona Action Plan on Drugs, Spain

INTRODUCTION: The epidemic of heroin use began in Barcelona, as in the rest of Spain, in the late 70's, to reach its peak by the end of the 80's. In a first period, responsible officers experimented difficulties to define the specific objectives of opiate control policies. This paper reviews the effects of the adoption of an explicit policy on drug dependence grounded on a wide consensus in the City of Barcelona (Catalonia, Spain). SUBJECTS AND METHODS: Over a period of twelve years, from 1986 to 1997, both demand and offer of care and harm reduction services were analyzed, as well as the evolution of the adverse effects of drug use, such as mortality from acute adverse drug reaction, human immunodeficiency virus (HIV) infection, aids incidence, and incidence of tuberculosis. Data for city residents was compared through four different stages in this period. RESULTS: Despite the lack of data in initial years, relevant changes are apparent. Treatment offer changes clearly, with significant increases in initial treatment, coverage of methadone maintenance programmes, and sterile syringes distribution. Therapeutic compliance of tuberculous intravenous drug users IVDU and risk of HIV infection improve. Emergency service use linked to heroin, overdose, or withdrawal syndrome decreases. Mortality rates decline, although this decline does not reach statistical significance. Discussion: Service offer shows a clear increase, reflected in treatment initiation, while harm reduction services expand. With the development of this process, outcome indicators change, both reflecting changes in the toll of the heroin epidemic (cases of tuberculosis and aids among IVDUs, HIV infection). and changes in a more comprehensive care (better treatment compliance of IVDUs with tuberculosis). There is a lower distortion of emergency services. These changes occur although the predominance of white heroin in Barcelona favors parenteral use.     

Cocaine use and characteristics of young adult users from 1987 to 1992: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

OBJECTIVES: This study examined the relationship of sociodemographic factors and use of substances other than cocaine to cocaine use from 1987 to 1992 in a cohort of Black and White men and women 20 to 32 years of age. METHODS: Data were collected as part of the Coronary Artery Risk Development in Young Adults study. Self-reported cocaine use was analyzed through chi-square tests and repeated measures analyses of variance to determine the bivariate and multivariate relationships of sociodemographics and substance use behaviors to cocaine use over the 5-year period. RESULTS: Cocaine use declined in Whites but remained stable in Blacks from 1987 to 1992. Cross-sectional results showed that use was related to being Black, male and in the older half of the cohort, single, and unemployed; it was also related to higher levels of other substance use in 1987 and 1992. Over time, the magnitude and strength of the relationship were consistent for each variable except for increased odds of cocaine use among the unemployed and Blacks in 1992. CONCLUSIONS: Sociodemographic characteristics and substance use behavior consistently identify individuals at risk for cocaine use. As a result, intervention programs should be targeted at these high-risk groups.     

Access to antiretroviral treatment among French HIV infected injection drug users: the influence of continued drug use. MANIF 2000 Study Group

STUDY OBJECTIVE: To determine the influence of continued drug use and its perception by prescribing physicians on access to antiretroviral treatment among French HIV infected injection drug users (IDUs). DESIGN: Cross sectional including enrollment data (October 1995-1996) of the cohort study MANIF 2000. Access to treatment is compared in three groups: former IDUs (n = 68) and active IDUs whether or not this behaviour remains undetected (n = 38) or detected (n = 17) by physicians. SETTING: Hospital departments for specialist AIDS care in south eastern France and inner suburbs of Paris. PATIENTS: All enrolled patients with CD4+ cell counts < 400 with detailed clinical history, access to treatment, risk behaviours, and past drug use as reported by both physicians and patients (n = 123). MAIN RESULTS: A minority (43.9%) already received an antiretroviral treatment. Active IDUs had worst socioeconomic and psychological conditions but only those detected by physicians were considered as poorly compliant. Logistic regression showed that, with respect to ex-IDUs and independently of clinical stage, active IDUs, whether or not they were perceived as such by physicians, were threefold more likely not to receive antiretroviral treatment. CONCLUSIONS: Even among French HIV infected IDUs who have regular access to AIDS specialised hospital care, continued drug use reduced the likelihood of being prescribed antiretroviral treatment. To reduce delays in access to new treatments, specific efforts must be devoted towards both AIDS specialists and IDU patients to overcome current stereotypes of non-compliance associated with continued injection.     

Cohort study methodology of the ITINERE Project on heroin users in three Spanish cities and main characteristics of the participants

BACKGROUND: Cohort studies make it possible to monitor the health impact of drug use and to identify related factors. We describe the methodology and baseline characteristics of a cohort of heroin users designed with this objective. METHODS: The participants were 991 young, community-recruited heroin users in Barcelona, Madrid and Seville. Most subjects were named by other participants (39.7%) or by non-participating drug users or ex-users (44.7%). A computer-aided questionnaire was administered (self-administered with audio for questions related with sex). A dried-blood spot sample was collected and anthropometric measurements were made. Both participants and recruiters received remuneration. Univariate and bivariate statistical methods were used. RESULTS: Some 42.4% had changed the main route of heroin administration, mainly to injection in Barcelona and to the pulmonary route in Seville. About 75.8% (Barcelona), 49.8% (Madrid), and 15.5% (Seville) had injected drugs in the last 12 months. In Madrid and Seville, 96-97% used heroin in base form, while in Barcelona heroin hydrochloride predominated. Heroin and cocaine were frequently mixed in the same dose (generally base cocaine in Madrid and Seville, and cocaine hydrochloride in Barcelona). CONCLUSIONS: Important geographic differences persist in the prevalence of drug injection and in the patterns of heroin and cocaine use, which could explain the unequal distribution of some health problems. The difficulties encountered in recruiting the sample suggest that the incidence of heroin use has declined considerably.     

National standards of blood pressure for children and adolescents in Spain: international comparisons. The Spanish Group for the Study of Cardiovascular Risk Factors in Childhood and Youth.

This study determined age-specific patterns of blood pressure (BP) in Spanish children aged 1-18 years for the purpose of developing BP guidelines for this population. Age- and sex-specific BP levels were constructed by pooling data from 15 studies conducted in Spain. Pooled mean BP levels were then compared with those reported by the US Second Task Force on Blood Pressure Control in Children and those recently reported from a separate pooled analysis of the relevant published surveys collected worldwide. In the Spanish data, the average 1-year age increment in Systolic BP (SBP) was uniform for boys and girls until 13 years at 2 mmHg; for boys aged 13-18 the increase was 1.3 mmHg/year; in contrast, girls reached their maximum values at age 13 and the means remained basically unchanged for female adolescents. Fifth-phase diastolic BP (DBP5) values showed a uniform increase for both boys and girls from ages 6 to 18 years at 0.9 mmHg/year. In most age-sex subgroups, mean SBP values were higher (7-8 mmHg on average) in Spain than in the US. However, Spanish values for SBP were in general only slightly higher or approximately equal to those for the international data, from ages 6 to 18 years. The patterns of change in SBP with age differed somewhat in the three data sets. Comparisons for DBP were limited to the age groups for which readings of DBP5 were available. For DBP5, only slight differences between the Spanish and International pools were observed (ages 6-18 compared), but these values were notably higher than those from the US (ages 13-18 compared). These findings suggest that the use of any particular age-based standard to evaluate readings in children in diverse populations cannot be recommended, at least until there is a better understanding of the true differences in BP between populations.     

HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.

BACKGROUND. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. METHODS. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. RESULTS. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. CONCLUSIONS. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.     

Prevalence of HIV infection among young adult injecting and non-injecting heroin users in Spain in the era of harm reduction programmes: gender differences and other related factors

The aims were to assess the prevalence of HIV infection among young adult heroin users, including injecting heroin users (IHUs) and non-injecting heroin users (NIHUs), and to explore the differences by gender and other factors. The design was a cross-sectional cohort study between April 2001 and December 2003, which included 961 current heroin users (HU), aged 18-30 years: 422 in Madrid, 351 in Barcelona and 188 in Seville; 621 were IHUs and 340 were NIHUs. All were street-recruited by chain referral methods. Face-to-face interviews were conducted using a structured questionnaire with computer-assisted personal interviewing (CAPI). Samples for HIV testing (dried blood spot) were collected and tested with ELISA and Western Blot. Bivariate, logistic regression, and classification and regression tree analyses were performed. The overall prevalence of HIV infection among IHUs was 25.8% (95% CI 22.3-29.3) [32.4% (95% CI 26.6-38.1) in Madrid, 20.5% (95% CI 15.6-25.4) in Barcelona, and 20.6% (95% CI 9.8-31.4) in Seville], whereas in NIHUs it was 4.0% (95% CI 2.1-6.7), with no differences among cities. The prevalence was significantly higher in women than in men in NIHUs (10.9%, 95% CI 4.3-17.5 vs. 1.7%, 95% CI 0.5-4.2) and was non-significantly higher in IHUs (30.4%, 95% CI 23.0-37.8 vs. 24.1%, 95% CI 20.1-28.1). HIV prevalence in short-term IHUs was 12.9% (CI 8.8-17.02), with no differences among cities. In the logistic analysis, the variables associated with infection in IHUs were ever having injected with used syringes (OR 3.4, 95% CI 2.2-5.3), ever having been in prison (OR 2.6, 95% CI 1.6-4.0), and heroin as the first drug injected at least weekly (OR 2.3, 95% CI 1.1-4.5). Factors positively associated with HIV infection in NIHUs were female sex (OR 8.7, 95% CI 2.6-29.2) and age >25 years (OR 3.1, 95% CI 0.9-11.1), while primary educational level was inversely associated (OR 0.26, 95% CI 0.1-0.9). Although there are important geographic differences, HIV prevalence in IHUs remains high, even in short-term IHUs, whereas it was almost six times lower in NIHUs. The prevalence in women is higher than in men, particularly among NIHUs. A wide range of preventive strategies should be developed, aimed primarily at empowering women to negotiate safe sex.