The Context of HIV Risk Among Drug Users and Their Sexual Partners

prostitution and use of crack in women and a history of syphilis, crack
use, and sexual contact with a crack-using prostitute in men.
The potential for a male in sex-for-crack exchanges to come into contact
with an HIV positive female partner was demonstrated in a study of 87
New York City women who had been admitted to a municipal hospital
with a diagnosis of pelvic inflammatory disease (PID) (Des Jarlais et al.
1991). Crack use was reported by 56 percent of the subjects (N = 49),
and of these, 20 percent were HIV seropositive. Crack use was
significantly related to both traditional AIDS risk behaviors (injecting
drugs and sex with an IDU) and other unsafe sexual behaviors
(exchanging sex for money or drugs and having casual sex partners).
In 1989, given the potential of sex-for-crack exchanges for spreading
HIV to new populations, NIDA supported ethnographic studies of the
phenomenon in eight cities: Chicago, Denver, Los Angeles, Miami,
Newark, New York, Philadelphia, and San Francisco (Ratner 1993). A
total of 340 crack users were interviewed in depth, 69 percent of whom
were women. Of the 233 women, 108 had participated in sex-for-crack
exchanges, as had 69 of the men. HIV testing was done with 168 of the
subjects, and a total of 14 percent were found to be positive for the HIV
antibody. Of the 24 males who were non-IDUs and who had engaged in
heterosexual sex-for-crack exchanges, 12 percent were HIV positive.
CRACK, SEX, AND THE SECONDARY SPREAD OF HIV
The potential for transmission of HIV from women to heterosexual male
non-IDUs within the context of sex-for-crack exchanges is related to a
number of considerations, including two important independent risk
factors. The first is the cocaine/sexuality connection. Cocaine has long
had a reputation as an aphrodisiac, although sexuality is notoriously a
playground of legend, exaggeration, and rumor. In all likelihood, much
of cocaine’s reputation may be from the mental exhilaration and
disinhibition it engenders, thus bringing about some heightened sexual
pleasure during the early stages of use. At the same time, cocaine users
have consistently reported that the drug tends to delay the sexual climax,
and that after prolonged stimulation, an explosive orgasm occurs. Users
also report that chronic use of the drug results in sexual dysfunction, with
impotence and the inability to ejaculate the common complaints of male
users, the inability to climax among females, and decreased desire for sex
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