The relationship of cocaine use and human immunodeficiency virus serostatus to incident sexually transmitted diseases among women.

BACKGROUND AND OBJECTIVES: To assess the incidence of sexually transmitted diseases (STD) in a group of heterosexual women as a function of human immunodeficiency virus (HIV) serostatus and to ascertain the effect of crack cocaine use on these relationships.

STUDY DESIGN: At baseline, 445 HIV type 1 (HIV-1) seronegative and 232 seropositive women were provided interviews ascertaining demographic and behavioral risk factors. All participants were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline and at 6-month intervals.

RESULTS: HIV serostatus was not related to STD incidence. Although HIV-positive women reported more condom use than did HIV-negative women (P < .01), only 65% reported using them consistently. Increases in the frequency of crack cocaine use, measured on a 4-point scale, were positively associated with rates of new STDs (relative risk [RR] = 1.23, P < .01). Crack cocaine use was also associated with greater numbers of sexual partners and less consistent condom use. The relationship between HIV status and the probability of acquiring an STD was not influenced by frequency of crack use.

CONCLUSION: Women infected with HIV or who use crack cocaine are at risk for transmitting HIV and acquiring other STDs. Whether women are infected with or at risk for HIV, programs are needed to prevent and treat crack addiction. Interventions should target high-risk sexual practices among both female crack users and women living with HIV.