While crack cocaine's role in accelerating the HIV epidemic among heterosexual populations has been well-documented, the authors noted that "little is known about crack use as an HIV risk factor among African-American men who have sex with men (AA MSM), a group disproportionately infected with HIV."
The team set out to compare the social and sexual network characteristics of crack-using vs. non-crack-using AA MSM in Baltimore and to examine associations of crack use with sexual risk. Street-based and Internet-based outreach, as well as print ads and word-of-mouth, were used to recruit participants. All those included were age 18 or older, African American or of black race/ethnicity, and self-reported sex with a male in the preceding 90 days. Crack use was operationalized as self-reported crack use in the previous 90 days. Variables independently associated with crack use were identified through logistic regression.
A total of 230 AA MSM were enrolled. Of these, 84 (37 percent) reported crack use. Compared to non-crack-using AA MSM, the sexual networks of the AA MSM who used crack were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners, as well as fewer networks with whom they always used condoms.
"Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use," the authors concluded. "Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors."