Risk of sexually transmitted disease among black adolescent crack users in Oakland and San Francisco, Calif

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Abstract
Crack cocaine is a smokable form of cocaine hydrochloride that has been associated with increases in crime, increases in admissions to drug treatment programs, and, recently, increases in the incidence of sexually transmitted diseases (STDs) among black teenagers. In an exploratory, cross-sectional study of the prevalence of risk behaviors that would promote the dissemination of STDs (including human immunodeficiency virus) among 222 black teenaged crack users, 41% of those interviewed reported a history of an STD. A history of an STD was more likely to be reported by girls (55%) than by boys (34%) and by those who combined crack use with sexual relations (51%) than those who did not (32%). The number of risk behaviors for STDs or human immunodeficiency virus reported by respondents (including failure to use a condom in one's most recent sexual encounter, having had a history of an STD, engaging in exchanges of sex for drugs or money, combining sexual activity with drug use, and reporting five or more sexual partners per year) was evaluated using multiple regression analysis stratified by gender. For girls, a history of selling crack and the number of drugs used on a daily basis were associated with the number of reported risk behaviors (R=.46); for boys who chose the description "I don't know ahead of time if I'm going to have sex—it just happens" and the number of drugs used on a daily basis were associated with the number of reported risk behaviors (R=.31). Because of the impetuous nature of some crack-related sexual activity and because 76% of respondents acknowledged that they were either "very worried" or "somewhat worried" that they might get acquired immunodeficiency syndrome, it is possible that a program of widespread distribution of condoms in neighborhoods where crack use is prevalent might make it possible for the worried, impulsive crack user to practice "safer sex." (JAMA. 1990;263:851-855)