Journal of Community Health

, Volume 29, Issue 2, pp 117–127 | Cite as

Crack Cocaine Use and Adherence to Antiretroviral Treatment Among HIV-Infected Black Women

  • Tanya Telfair Sharpe
  • Lisa M. Lee
  • Allyn K. Nakashima
  • Laurie D. Elam-Evans
  • Patricia L. Fleming


Since the appearance of crack cocaine in the 1980s, unprecedented numbers of women have become addicted. A disproportionate number of female crack users are Black and poor. We analyzed interview data of HIV-infected women ≥ 18 years of age reported to 12 health departments between July 1997 and December 2000 to ascertain if Black women reported crack use more than other HIV-infected women and to examine the relationship between crack use and antiretroviral treatment (ART) adherence among Black women. Of 1655 HIV-infected women, 585 (35%) were nonusers of drugs, 694 (42%) were users of other drugs and 376 (23%) were crack users. Of the 1196 (72%) Black women, 306 (26%) were crack users. We used logistic regression to examine the effect of crack use on adherence to ART, controlling for age and education among Black women. In multivariate analysis, crack users and users of other drugs were less likely than non-users to take their ART medicines exactly as prescribed (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.24–0.56), OR = 0.47; 95% CI = 0.36–0.68), respectively. HIV-infected Black women substance users, especially crack cocaine users, may require sustained treatment and counseling to help them reduce substance use and adhere to ART.

crack cocaine antiretroviral treatment HIV/AIDS black women 


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  1. 1.
    Fleming, PL, Ward, JW, Karon, JM, Hanson, DL, DeCock, KM. Declines in AIDS incidence and deaths in the USA: A signal change in the epidemic. AIDS 1998; 12(supplA);S55-S61.Google Scholar
  2. 2.
    Hader, SL, Smith, DK, Moore, JS, Holmberg, SD. HIV infection in women in the United States: status at the millennium. JAMA 2001; 285: 1186-1191.Google Scholar
  3. 3.
    Lee, LM, Fleming, PL. Trends in human immunodeficiency virus diagnoses among women in the United States, 1994–1998. JAMWA 2001; 56: 94-99.Google Scholar
  4. 4.
    Rapita, E, Porta, D, Forastiere, F, Fusco, D, Perucci, CA. Socioeconomic status and survival of persons with AIDS before and after the introduction of highly active antiretroviral therapy. Epidemiology 2000; 11: 496-501.Google Scholar
  5. 5.
    Shapiro, MF, Morton, SC, McCaffrey, DF, Senterfitt, JW, Fleishman, JA, Perlman, JF, Athey, LA, Keesey, JW, Goldman, DP, Berry, SH, Bozzette, SA. Variations in the care of HIV-infected adults in the United States. JAMA 1999; 218: 2305-2315.Google Scholar
  6. 6.
    Sollito, S, Mehlman, M, Youngner, S, Lederman, MM. Should physicians withhold highly active antiretroviral therapies from HIV-AIDS patients who are thought to be poorly adherent to treatment? AIDS 2000; 15:153-159.Google Scholar
  7. 7.
    Williams, A, Wolf, H, Yu, C, Singh, M. Adherence to antiretroviral therapy among HIV-positive women. 12th International Conference on AIDS 1998 Geneva; Abstract # 32374.Google Scholar
  8. 8.
    Holzemer, WL, Nokes, KM, Brown, MA, Powell-Cope, GM, Henry, SB, Portillo, CJ. Predictors of self-reported adherence in persons living with HIV Disease. AIDS Patient Care and STDs 1999;13:185-197.Google Scholar
  9. 9.
    Gordillo, V, del Amo, J, Soriano, V, Gonzalez-Lahoz, J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999;13: 1763-1769.Google Scholar
  10. 10.
    Belzer, M, Fuchs, D, Tucker, D, Slonimisky, G. High risk behaviors are not predictive of anti-retroviral non-adherence in HIV+ youth. International Conference on AIDS 1998 Geneva;12:596 Abstract # 32372.Google Scholar
  11. 11.
    Tyndall, M, Yip, B, Hogg, R, Currie, S, Montaner, J, O'Shaughnessy, M, Schechter, M. Coverage, adherence and sustainability of antiretroviral therapy among injection drug users in Vancouver, Canada. International Conference on AIDS 2000 Durban. Abstract # ThPeB44990.Google Scholar
  12. 12.
    Campsmith, ML, Nakashima, AK, Jones, JL. Association between crack cocaine use and high risk sexual behaviors after HIV diagnosis. J Acquir Immune Defic Syndr 2000; 25:192-198.Google Scholar
  13. 13.
    Buehler, JW, Diaz, T, Hersh, BS, Chu, SY. The supplement to HIV-AIDS surveillance project: an approach for monitoring HIV risk behaviors. Public Health Rep. 1996; 111: 134-137.Google Scholar
  14. 14.
    Centers for Disease Control and Prevention 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR Mor Mortal Wkly Rep 1992; 41:961-962.Google Scholar
  15. 15.
    CentersforDiseaseControlandPreventionRecommendationsandReportsGuidelinesforNationalImmudeficiencyVirusCaseSurveillanceIncludingMonitoringforHIVInfectionandAIDS. Case Definitions, Page 11 MMWR Mor Mortal Wkly Rep 1999, 48 (RR-13)Google Scholar
  16. 16.
    Kleinbaum, DG, Klein, M. Applied Regression, A Self-Learning Text. Springer Verlag; 1994.Google Scholar
  17. 17.
    Inciardi, JA, Lockwood, D, Pottieger, AE. Women and Crack Cocaine. New York: Macmillan Publishing Company; 1993.Google Scholar
  18. 18.
    Ratner, MS, editor. Crack Pipe as Pimp. New York: Lexington Books of Macmillian, Inc. 1993.Google Scholar
  19. 19.
    Fullilove, MT, Lown, EA, Fullilove, R. Crack ho's and skeezers: traumatic experiences of women crack users. The Journal of Sex Research 1992; 29: 275-287.Google Scholar
  20. 20.
    Mahan, S. Crack Cocaine, Crime and Women: Legal Social and Treatment Issues. London: Sage Publications; 1996.Google Scholar
  21. 21.
    United State Department of Health and Human Services. Drug Abuse Warning Network Data (DAWN). Substance Abuse and Mental Health Services Administration (SAMHSA). Washington, D. C.: Office of Applied Studies; 1997.Google Scholar
  22. 22.
    National Institute of Justice. Arrestee Drug Abuse Monitoring Program. Annual Report on Cocaine Use Among Arrestees. Office of Justice Programs. Washington, D.C.; 1998.Google Scholar
  23. 23.
    Bourgois, P. In search of Horatio Alger: culture and ideology in the crack economy. Contemporary Drug Problems; 1989;Winter:619-649.Google Scholar
  24. 24.
    Sharpe, TT. Sex for crack exchange, poor black women and pregnancy. Qualitative Health Research. 2001; 11.5:612-630.Google Scholar
  25. 25.
    Elwood, WN, Williams, ML, Bell, DC, Richard, AJ. Powerlessness and HIV prevention among people who trade sex for drugs. AIDS Care 1997; 9(3): 273-284.Google Scholar
  26. 26.
    Booth, RE, Watters, J, Chitwood, D. HIV risk related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. Am J Public Health 1993; 83:1144-1148.Google Scholar
  27. 27.
    Kenen, RH, Armstrong, K. The why and the whether of condom use among female and male drug users. J Community Health 1992; 17: 303-317.Google Scholar
  28. 28.
    Centers for Disease Control and Prevention Report of the NIH Panel to Define Principals of Therapy of HIV Infection. MMWR Mor Mortal Wkly Rep 1998 Page 3, Summary of the Principles of therapy of HIV Infection. 47 (RR-5):3.Google Scholar
  29. 29.
    Chiasson, MA, Stoneburner, RL, Hildebrandt, DS, Ewing, WE, Telzak, EE, Jaffe, HW. Heterosxual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack). AIDS 1991; 5:1121-6.Google Scholar
  30. 30.
    Jones, DL, Irwin, K, Inciardi, JW, Bowser, B, Schilling, R, Word, C, Evans, P, Faruque, S, McCoy, HV, Eldin, BR. The high-risk sexual practices of crack-smoking sex workers recruited from the streets of three American cities. The Multicenter Crack Cocaine and HIV Infection Study Team. Sex Transm Dis 1998; 25:187-93.Google Scholar
  31. 31.
    McNaghten, AD, Hanson, DL, Dworkin, MS, Jones, JL. Differences in prescription of highly active antiretroviral therapy in a large cohort of HIV-infected patients. JAIDS 2003;32:499-505.Google Scholar
  32. 32.
    Nakashima, AK, Hanson, DL, Dworkin, MS, et al. Antiretroviral therapy, adherence, and outcomes: comparison of data collected through interviews and medical records. 2001 National HIV Prevention Conference, August 12–15, 2001; Atlanta; Abstract # 509.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2004

Authors and Affiliations

  • Tanya Telfair Sharpe
    • 1
  • Lisa M. Lee
    • 2
  • Allyn K. Nakashima
    • 2
  • Laurie D. Elam-Evans
    • 3
  • Patricia L. Fleming
    • 2
  1. 1.Centers for Disease Control and PreventionNational Center on Birth Defects and Developmental Disabilities/Fetal Alcohol Syndrome Prevention TeamAtlanta
  2. 2.NCHSTP/Division of HIV/AIDS PreventionUSA
  3. 3.Division of Reproductive HealthSurveillance Unit/ITSSBUSA

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