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Robert E. Fullilove, EdD; Mindy Thompson Fullilove, MD; Benjamin P. Bowser, PhD; Shirley A. Gross, MPH

JAMA. 1990;263(6):851-855.

Abstract
Crack cocaine is a smokable form of cocaine hydrochloride that has been associated with increases in crime, increases in admissions to drug treatment programs, and, recently, increases in the incidence of sexually transmitted diseases (STDs) among black teenagers. In an exploratory, cross-sectional study of the prevalence of risk behaviors that would promote the dissemination of STDs (including human immunodeficiency virus) among 222 black teenaged crack users, 41% of those interviewed reported a history of an STD. A history of an STD was more likely to be reported by girls (55%) than by boys (34%) and by those who combined crack use with sexual relations (51%) than those who did not (32%). The number of risk behaviors for STDs or human immunodeficiency virus reported by respondents (including failure to use a condom in one's most recent sexual encounter, having had a history of an STD, engaging in exchanges of sex for drugs or money, combining sexual activity with drug use, and reporting five or more sexual partners per year) was evaluated using multiple regression analysis stratified by gender. For girls, a history of selling crack and the number of drugs used on a daily basis were associated with the number of reported risk behaviors (R =.46); for boys who chose the description "I don't know ahead of time if I'm going to have sex—it just happens" and the number of drugs used on a daily basis were associated with the number of reported risk behaviors (R =.31). Because of the impetuous nature of some crack-related sexual activity and because 76% of respondents acknowledged that they were either "very worried" or "somewhat worried" that they might get acquired immunodeficiency syndrome, it is possible that a program of widespread distribution of condoms in neighborhoods where crack use is prevalent might make it possible for the worried, impulsive crack user to practice "safer sex."

(JAMA. 1990;263:851-855)

Author Affiliations
From the Center for AIDS Prevention Studies, University of California, San Francisco (Drs R. E. Fullilove and M. T. Fullilove and Ms Gross); Bayview—Hunter's Point Foundation for Community Improvement, San Francisco, Calif (Drs R. E. Fullilove, M. T. Fullilove, and Bowser and Ms Gross); and the Department of Sociology, California State University, Hayward (Dr Bowser).

Footnotes
Reprint requests to the HIV Center for Clinical and Behavioral Studies, Columbia University College of Physicians and Surgeons, 722 W 168th St, New York, NY 10032 (Dr R. E. Fullilove).

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