Non-injecting crack cocaine use and HIV risk in Castries, Saint Lucia

Objectives: To determine if crack cocaine users had a higher prevalence rate of HIV and other STI when compared to non-crack cocaine users from the same social and economic and geographical area.

Methods: A modified targeted sampling method was used to recruit consenting street engaged poor and homeless crack cocaine users and non-crack cocaine users in urban Castries. Participants were administered structured questionnaires in anonymous interviews and STI nurses following VTC protocols tested all participants for HIV1, HTLV1, HVB, and VDRL.

Results: The 106 crack cocaine users tested, eight (7.5%) were HIV-infected compared to none (0%) of 45 non-crack using controls recruited in a similar manner. Of the persons testing positive 6% were male and 11% were female. Drug users were marginally significantly more likely to test positive for HIV than were non-drug users (7.5% vs. 0.0%, =0.047). Women who were drug users were significantly more likely to test positive for VDRL than women who were not drug users (94.4% vs. 66.7%, p=0.046); the same trend emerged among men but less strong (50.0% vs. 30.3%). Female drug users compared to non-drug users were more likely to report exchanging sex for money or crack (76.5% vs. 25%, p=0.049). A larger percentage of female drug users reported exchanging crack for money or sex than did female non-drug users (35.3% vs. 0.0%). Conclusions: Street engaged crack cocaine users are a high risk group for acquisition of HIV. HIV education messages must be included in intervention programs targeting street crack cocaine users.