8th International AIDS Conference Amsterdam, Netherlands — July 19-24, 1992

Int Conf AIDS 1992 Jul 19-24; 8:We50 (abstract no. WeC 1032)
Genser SG, Ratner MJ; National Institute on Drug Abuse, Rockville, MD.

OBJECTIVE: To ascertain the geographic generality, context and implications for HIV transmission of involvement in the exchange of sex for "crack" cocaine.

METHODS: Experienced research teams in 8 US cities conducted ethnographic field work among hard-core crack users and completed 340 taped interviews with participants in sex-for-crack exchanges. Topics addressed included (a) social, drug use, and sexual history, (b) extent of involvement in sex-for-crack exchanges, (c) AIDS knowledge and attitudes, and (d) social, economic and cultural context. In five of the sites a second sample totaling 195 subjects matched on demography and participation in these exchanges was tested for HIV and screened for syphilis.

RESULTS: Participants in sex-for-crack exchanges were easily identified at all sites. The study concentrated on the female (69%) providers of sex. African-Americans predominated (73%) in the sample. The vast majority of the sex was heterosexual, prolonged and oral, without condom use. The multiple male partners often had difficulty with erection and ejaculation, probably related to cocaine use. Frequency of participation in these exchanges ranged from once per week or less, depending on opportunity or need, to over 70 per week. The most frequent female participants were characteristically so dominated by their craving for crack that they were willing to provide sexual services in exchange for small amounts of crack or money that was then used to buy crack. The low price of sex attracted non-drug-using heterosexual males to the setting. Exchanges could be classified along a dimension of increasing loss of control as casual, sex-for-money (then used for crack) or sex-for-crack-or-money. Significant rates of HIV infection ranging from 8 to 67% were found among both women and men engaging in sex-for-crack exchanges (both gay and heterosexual) whether or not there was a history of injection drug use. Data on associated drug use and sexual and drug history will be presented.

CONCLUSION: These exchanges are widespread at sites of group crack use and provide an arena in which individuals who are often HIV seropositive and have a history of other STDs engage in unprotected prolonged sex with multiple partners in the context of open sores on the tongue and lips from crack pipe burns and penile abrasions due to prolonged sex. Because of these multiple factors associated with high HIV transmission rates this population should be targeted for public health intervention.

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