title: Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection.
abstract: OBJECTIVE
  Previous studies have examined the practices of injecting drugs or smoking crack cocaine as high-risk, but independent, factors for HIV transmission. To explore the independent and dual risks of injection practices and crack smoking, this study examined HIV seroprevalence rates among distinct drug user groups, based on patterns of daily administration.
  
  
  METHODS
  A sample of 3,555 drug users and neighborhood controls in urban Miami, FL and rural Belle Glade and Immokalee, FL were partitioned into four mutually-exclusive groups: 1) injection drug users (IDUs); 2) crack-cocaine smokers; 3) dual users who both smoked crack and injected drugs; and 4) non-drug-user controls.
  
  
  RESULTS
  HIV seroprevalence rates were 45.1% for IDUs, 30.5% for dual users, 20.1% for crack smokers and 7.3% for controls. Multivariate logistic regression analysis found that when compared with controls odds ratios for HIV seropositivity were 9.81 for IDUs, 5.27 for dual users, and 2.24 for crack smokers.
  
  
  CONCLUSIONS
  These findings provide evidence of: 1) behavioral and structural co-factors that influence HIV exposure patterns among drug users; and 2) the substantially higher risk of HIV infection among IDUs compared with other drug users. Intervention strategies must be tailored for the specific drug use subpopulations to optimize efficacy.
authors.affiliation: Comprehensive Drug Research Center, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida 33136, USA. cmccoy@med.miami.edu
authors.forename: Clyde B
authors.initials: CB
authors.lastname: McCoy
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Messiah
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000097:blood / Q000145:classification / Q000453:epidemiology*; D016578:Crack Cocaine / Q000097:blood; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012309:Risk-Taking; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000097:blood; D014505:Urban Population
chemical_list: D016578:Crack Cocaine