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

ecoming the norm for both male and female users (Grinspoon and
Bakalar 1976; Weiss and Mirin 1987).
What applies to powder cocaine with regard to sexual stimulation and
functioning also would apply to crack cocaine. Curiously, however, there
is the rather contradictory evidence that crack appears to engender what
has been referred to as “hypersexual” behavior among many users. This
has been observed in a number of ethnographic studies (Inciardi et al.
1993; Ratner 1993). Many crack addicted women and men engage in any
manner of sexual activity, under any circumstances, in private or in
public, and with multiple partners of either sex (or both sexes
simultaneously). Indeed, the tendency of some crack users to engage in
high-frequency sex with numerous anonymous partners is a feature of
crack dependence and crack house life in many locales, Furthermore,
sex-for-drugs exchanges seem to be far more common among female
crack addicts now than they ever were among female narcotics addicts,
even at the height of the 1967 to 1974 heroin epidemics (Ball and
Chambers 1970; Rosenbaum 1981).
The pharmacological effects of crack (the rapid onset, extreme euphoria,
and short duration), as well as the economic need to pay for the drug,
have a special impact on women. Because crack makes its users ecstatic
and yet is so short-acting, it has an extremely high addiction potential.
Use rapidly becomes compulsive use. Crack acquisition thus becomes
enormously more important than family, work, social responsibility,
health, values, modesty, morality, or self-respect. This makes sex-forcrack
exchanges psychologically tolerable as an economic necessity.
Further, the disinhibiting effects of crack enable users to engage in sexual
acts they otherwise might not even consider. Crack-using male
customers involved in sex-for-crack exchanges, although they
consistently report difficulties in maintaining an erection and ejaculating
under the influence of the drug, also state that sex while smoking not only
enhances the drug’s effects but also gives them a sense of power and
control that they typically do not have in other aspects of their lives
(Inciardi et al. 1993).
A second independent risk factor relates to the impact of crack use on
physical health and hygiene. Because of the pharmacology and addiction
potential of crack, it is rare that smokers take only a single hit of the drug.
More likely they spend $50 to $500 during what they call a mission—a
3- or 4-day binge, smoking almost constantly, 3 to 50 rocks per day.
During these cycles, crack users rarely eat or sleep. This tendency to
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