HIV/STD PREVENTION NEEDED FOR CRACK USERS

NEW YORK (Reuters) -- HIV/STD prevention efforts are "urgently needed" for
crack cocaine users who sell sex, according to a report in the April issue
of Sexually Transmitted Diseases. Such individuals are at very high risk of
both transmitting and acquiring HIV and other sexually transmitted diseases
(STDs), say researchers.

Previous studies have found correlations between crack-smoking sex workers
and high rates of HIV infection, noted Dr. Kathleen L. Irwin of the Centers
for Disease Control and Prevention in Atlanta, Georgia, and colleagues.
However, no large quantitative studies have focused on the sexual practices
in this high-risk population.

In the current study, Irwin and members of the Multicenter Crack Cocaine and
HIV Infection Study Team evaluated 419 crack-smoking sex workers in three
large urban areas. They found that 30% to 41% of both males and females
reported having sex with injection drug users, and 8% to 19% reported having
sex with individuals infected with HIV. More than 50% said they used condoms
inconsistently and 73% to 93% had a history of a sexually transmitted disease.

"Sex workers who worked in crack houses or vacant lots, were paid with
crack, or injected drugs had the riskiest sex practices," the authors wrote.

They also noted high rates of HIV/STDs in these subjects. "More than 25%
were infected with HIV (27.9%), syphilis (37.5%) or herpes simplex virus
type 2 (66.8%)."

Based on these findings, Irwin's group concludes that more effective
prevention and treatment methods for crack addiction, along with better
access to treatment, "...especially for women and youth, will be critical to
sustaining success in (HIV/STD) prevention." Previous studies have also
shown that prompt diagnosis and treatment of STDs can substantially reduce
the rates of HIV infection.

Other areas that require attention include "...the underlying hardships,
psychological stressors, psychiatric morbidity, and community disintegration
that are associated with initiation of sex work, crack smoking, and HIV/STD
risk behaviors." SOURCE: Sexually Transmitted Diseases (1998;25:187-193)