title: Risk of human immunodeficiency virus infection among pregnant crack cocaine users in a rural community.
abstract: OBJECTIVE
  To investigate why women who use crack cocaine are at increased risk of human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  One thousand one hundred fifty-two (99.7%) of 1155 consecutive prenatal patients attending a rural public health clinic were interviewed about drug use and sexual practices and tested for HIV infection and other sexually transmitted diseases.
  
  
  RESULTS
  Fifty-one (4.7%) of 1096 pregnant women reported ever using crack cocaine, but only five (10%) of the crack cocaine users had ever injected drugs. Eighteen (35%) of the crack users were HIV infected compared with 22 (2%) of the 1045 women who reported never using crack (odds ratio 25, 95% confidence interval 12-52; P < .001). Crack users were more likely to have had a known HIV-infected sex partner, exchanged sex for money or drugs, and tested positive for syphilis than were non-crack users (for each comparison, P < .001). Before using crack, 18% of crack users had exchanged sex for money or drugs and 8% had averaged three or more sex partners per month; in contrast, after beginning to use crack, 76% of crack users exchanged sex for money or drugs and 63% averaged three or more sex partners per month (for both comparisons, P < .001). Crack users who were not HIV infected were more likely to have almost always used condoms and/or had fewer than three sex partners per month than were HIV-infected crack users (P < .01).
  
  
  CONCLUSIONS
  Women who reported using crack cocaine were at an increased risk of HIV infection because crack use was associated with a significant increase in unprotected sexual contact.
authors.affiliation: Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: T V
authors.initials: TV
authors.lastname: Ellerbrock
authors.forename: P E
authors.initials: PE
authors.lastname: Harrington
authors.forename: T J
authors.initials: TJ
authors.lastname: Bush
authors.forename: S A
authors.initials: SA
authors.lastname: Schoenfisch
authors.forename: M J
authors.initials: MJ
authors.lastname: Oxtoby
authors.forename: J J
authors.initials: JJ
authors.lastname: Witte
mesh_terms: D000328:Adult; D016578:Crack Cocaine; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000209:etiology*; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D012423:Rural Health; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications*; D011795:Surveys and Questionnaires
chemical_list: D016578:Crack Cocaine