HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.
BACKGROUND
Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown.


METHODS
Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn.


RESULTS
Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men.


CONCLUSIONS
The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.
Chirgwin
K
K
Department of Medicine, State University of New York, Brooklyn.
DeHovitz
J A
JA
Dillon
S
S
McCormack
W M
WM
D015897:Comorbidity; D016578:Crack Cocaine; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D009519:New York City / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014456:Ulcer
D016578:Crack Cocaine