Patterns of cocaine use and HIV infection among injection drug users in a methadone clinic.

To investigate patterns of cocaine use, a total of 440 injection drug users (IDUs) in two consecutive cohorts were recruited from a methadone maintenance program in New York City. IDUs who had injected cocaine more frequently during the prior year were more likely to be found HIV positive than IDUs who had injected cocaine less frequently, even after controlling for age, gender, and ethnicity. The study investigated noninjecting cocaine use among IDUs, such as snorting and smoking cocaine, which is often overlooked in epidemiological research investigating the relationship between HIV infection rate and drug use behaviours among IDUs. This study revealed that older IDUs were more likely to use IV cocaine and speedball, whereas younger IDUs were more likely to use crack or snort cocaine. In the 1987 cohort, after statistically controlling for age, analyses revealed that Hispanic IDUs snorted cocaine more frequently than other groups, and that black female IDUs used crack more frequently than other groups. Future research should investigate whether these crack and cocaine users, particularly black and Hispanic female IDUs, have changed their drug behaviors because of an awareness of the high risk of IV drug use for HIV infection, or whether they have started using these drugs as stepping stones for future IV cocaine and speedball use.