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.”

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Link to commentary

Source
Canadian Medical Association Journal

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dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org.

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The Thai AIDS Treatment Action Group recently called on the country to launch a comprehensive harm reduction program for injection drug users in an effort to help curb the spread of HIV, Thailand’s nationmultimedia.com/search/read.php?newsid=30103711&keyword=Govt+Scheme+needed+to+help+drug+users” target=”_new”>The Nation reports. According to the group, many IDUs are unable to access drug treatment and substation therapy because of the stigma surrounding drug use in the country. Karyn Kaplan, director of development and policy for the group, said, “Health care workers have denied many injecting drug users access to an antiviral drug and the use of methadone.”

Public Health Minister Witthaya Kaewparadai recently announced that the country’s harm reduction programs have helped to curb the spread of HIV among IDUs, adding that local substitution programs have reduced the number of HIV-positive IDUs and that the country needs increased support from UNAIDS for such efforts. TTAG called for the government to provide prevention and treatment options, such as substitution therapy and needle-exchange programs. The Nation reports that methadone treatment is offered at hospitals across the country as part of the national health care scheme, but many health care workers refuse to administer treatment. In addition, government treatment is offered for 45 days. Kaplan said that the government should revise its policy regarding treatment access for IDUs, as a majority of IDUs are incarcerated and living with HIV or hepatitis-C without treatment access. She called on the government to “implement the international standards of medical treatment for [IDUs], without discrimination and human rights violations” (The Nation, 5/27).

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