People who smoke crack cocaine are at increased risk of becoming HIV-infected, report researchers in a new CMAJ (Canadian Medical Association Journal) study. The study also found that smoking crack cocaine has dramatically increased over the last several years.

These findings point to the urgent need for innovative public-health programs targeted at crack cocaine smokers.

The study looked at 1048 injection drug users participating in the Vancouver Injection Drug Users Study in Vancouver, British Columbia. Almost 36% of participants were female, 26% self-identified as Aboriginal and the median age at the start of the study was 34 years. The participants were HIV negative at enrolment but by the end of the 9 year study, 137 people contracted HIV.

In addition, the proportion of people who smoked crack cocaine daily jumped from 11.6% in the first 3 ½ year period to 39.7% in the last period.

“We have observed that use of crack cocaine has become one of the strongest risk factors for HIV seroconversion in Vancouver,” stated Dr. Evan Wood of the BC Centre for Excellence in HIV/AIDS. Study authors suggest this could be because of mouth wounds caused from crack pipes which make people more vulnerable to infection, or association with more HIV-positive individuals, which could increase likelihood of HIV infection through sex and needle sharing. However, they were unable to assess these possible risk factors in the study.

The authors urge adoption and rigorous evaluation of innovative - but controversial - harm reduction programs to help crack cocaine smokers, such as distribution of safer crack kits and provision of safe inhalation rooms. These interventions would provide opportunities for health workers to engage with crack smokers and help address their other health care needs.

In a related commentary, Dr. David Celentano and Dr. Susan Sherman of Johns Hopkins Bloomberg School of Public Health write that “with the increasing proportion of injection drug users who are smoking crack cocaine, harm reduction programs need to address the unique needs of these people as part of a comprehensive HIV prevention strategy. Although controversial, the distribution of “crack kits” (glass stem with mouth piece, metal screen, lip balm and hand wipes) to this population has the potential to reduce HIV transmission.”

Link to paper

Link to commentary

Source
Canadian Medical Association Journal

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