Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack.

This study was designed to assess differences in sex-related risk behaviors between drug injectors who did not smoke crack cocaine, crack smokers who did not inject drugs, and drug users who both injected drugs and smoked crack. Current drug users (i.e. used within the past 30 days) from 22 cities were recruited and assessed. The sample (n = 26,982) included 28% who injected only, 42% who smoked crack only, and 30% who both injected and smoked crack. Results showed that active drug users were at risk of HIV infection through sexual transmission: in the 30 day period prior to their interview, 28% reported sex with two or more individuals, 23% had an IDU sex partner, and 24% had exchanged sex for drugs or money. In addition, more than 80% did not use a condom during sex. Crack only smokers and crack smoking injectors were more likely than injectors only to report multiple sex partners and exchanging sex. Because of these high risk behaviors, condom use was of particular importance. The number of days of alcohol use and having an IDU sex partner were independently associated with not using a condom. Crack smoking injectors reported the highest average number of days of alcohol consumption and were the most likely to have had an IDU sex partner.