History of Sexually Transmitted Infection, Drug-Sex Behaviors, and the Use of Condoms Among Midwestern Users of Injection Drugs and Crack Cocaine

BACKGROUND AND OBJECTIVES: This study describes self-reported histories of sexually transmitted diseases (STD) with respect to gender and ethnicity and examines the factors that influence the use of condoms among heterosexual users of injection drugs and/or crack cocaine. STUDY DESIGN: A cross-sectional design was used to interview 1046 active users of illicit drugs living in Columbus and Dayton, Ohio. RESULTS: STD was common among 29% of the white men, 53.6% of the black men, 55.9% of the white women, and 64.7% of the black women self-reporting previous infection. Among women, stepwise logistic regression showed that cohabitating with a spouse or a sex partner (OR 0.28; 95% CI, 0.06 to 0.77) and exchanging sex for drugs (OR 0.31; 95% CI, 0.11 to 0.88) were associated negatively with always using a condom during vaginal sex in the previous month, whereas exchanging sex for money (OR 4.48; 95% CI, 1.88 to 10.95) was associated positively. Among men, cohabitating with a spouse or a sex partner (OR 0.13; 95% CI, 0.06 to 0.31), having had an STD (OR 0.53; 95% CI, 0.33 to 0.85), and currently using injection drugs (OR 0.52; 95% CI, 0.33 to 0.84) were associated negatively with condom use. CONCLUSIONS: Users of illicit drugs are at high risk for the acquisition and transmission of STD. More research is needed to understand better the sex practices of users of injection drugs and crack cocaine so that appropriate interventions can be developed. PIP: During 1992-95, in Ohio, outreach workers at various sites in Dayton and Columbus interviewed 749 men and 297 women about their drug use practices, sexual behaviors, drug-sex behaviors, and history of some sexually transmitted diseases (STDs). Researchers aimed to assess baseline behaviors of injection drug users and crack cocaine users. 73.2% of the men and 57.2% of the women used injection drugs. 26.8% of the men and 42.8% of the women used crack cocaine. About 25% of both groups were homeless. 79.7% of men and 68.7% of the women were Black. Among men, Blacks were more likely than Whites to have had syphilis and gonorrhea or any STD (6.2% vs. 2%, 48.6% vs. 19.1%, and 53.6% vs. 29%, respectively; p 0.05). Among women, Blacks were more likely to have had trichomonas (40.2% vs. 26.1%; p 0.05). For men, variables associated with not always using condoms in the last 30 days included STD history (odds ratio [OR] = 0.53; p = 0.0069), cohabitation (OR = 0.13; p = 0.00001), and injection drug use (when compared with crack cocaine use) (OR = 0.52; p = 0.0063); for women, they were exchanging sex for drugs (OR = 0.31; p = 0.0252) and cohabitation (OR = 0.22; p = 0.0157). Women who traded sex for money were significantly more likely to always use condoms in the last 30 days than those who did not (OR = 4.48; p = 0.0008). These findings show that injection drug users and crack cocaine users face a high risk of acquiring and transmitting STDs. They suggest that intervention efforts to target these two groups need to be sensitive to ethnic and gender differences