Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers.

This study was designed to assess gender differences in high-risk sex behaviors related to the transmission of HIV among injection drug users (IDUs) and crack smokers. Using a standard national survey instrument, 593 verified drug users were questioned about their sexual activities and drug use in the 30 day period prior to the interview. High-risk sex behaviors included nonuse of condoms, exchanging sex for drugs or money, sex with an IDU, and sex with more than one partner. Results showed that IDUs who engaged in needle risk practices were more likely report nonuse of condoms than IDUs who practiced safer needle use. African-American ethnicity was a more powerful determinant of exchanging sex than smoking crack cocaine. Sex with more than one partner in the previous 30 day was reported by 11% of married males and 15% of married females. Independently, marital status was found to be a marker for high-risk sex behaviors, in particular, sex with an IDU and nonuse of condoms, behaviors reported more often by married than unmarried respondents. Needle risk, more common among females than males, was associated with sex with an IDU. Approximately one-fourth of the injectors reporting sex with only non-IDUs also reported needle risk, sex with more than one partner, and nonuse of condoms. These findings show the dual threat drug injectors face for HIV infection, through sex and needle risk behaviors, and the pivotal role IDUs play in the heterosexual transmission of HIV to noninjectors.