Sexual Drug Research Articles

Powerlessness and HIV prevention among people who trade sex for drugs ('strawberries')

Researchers and members of the drug culture have employed the term 'strawberries' to describe African American women who trade sex for drugs. Data from six US cities participating in a community-based drug research project were analysed to examine the determinants of trading sex for drugs. As shown by our data, some African American women match the street description commonly attributed to 'strawberries'. However, our results also show that trading sexual favours for drugs is not limited to African American women, nor solely to women. Rather, trading sex for drugs is an economic behaviour that occurs among women and men of any race/ethnicity who use crack cocaine. Trading sex for drugs is closely related to conditions of poverty and homelessness, conditions that especially affect many crack smokers. The discussion urges educators and researchers to be alert for 'strawberry behaviours' exhibited by drug-users of any racial/ethnic background or gender.

Background to Crack Cocaine Addiction and HIV High-Risk Behavior: The Next Epidemic

Background: Increasing rates of sexually transmitted diseases among users of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunodeficiency virus) infection. Methods: A street recruitment technique was employed to enroll 331 primarily African-American men aged 18–29 in an area of San Francisco where crack cocaine is sold openly. One-half were regular crack users, and the other half had never used the drug. Few reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Following counseling, each was tested for HIV and syphilis. Results: Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex with injection drug users. Users reported greater current depression, anxiety, and social isolation. They reported earlier initiation into alcohol use and less positive parenting experiences during their adolescence. Conclusions: These results are consistent with findings that report the comorbidity of drug abuse and mental illness. Implications are drawn for reducing HIV infection among this high-risk population for early adolescent, community mental health, and substance abuse treatment programs.

Determinants of HIV seroprevalence rates among sites participating in a community-based study of drug users.

The National Institute on Drug Abuse's National Cooperative Agreement Project is a nationwide study of the injection and sexual behaviors of three populations of out-of-treatment drug users: injecting drug users (IDUs) who did not smoke crack cocaine, non-injecting crack smokers, and those engaging in both types of use. The goal of the analyses we present was identification of subsets of behavioral variables that would, within each type of drug use, distinguish sites by HIV seroprevalence level. Among non-crack-smoking IDUs high seroprevalence rates were associated with race and sex, the overall frequency of injection, the frequency of cocaine injection, and geographic location. Among noninjecting crack smokers, cities were distinguished by the frequency of exchanging sex for money, the number of sex partners, the local seroprevalence rate among IDUs, and location. Among subjects engaging in both types of use, seroprevalence rates among sites was distinguished by the frequency of exchanging sex for drugs and location.

Will Preventive HIV Vaccine Efficacy Trials Be Possible With Female Injection Drug Users?

This article examines whether preventive HIV vaccines trials will be viable among female injection drug users (IDUs). Of the 137 women who completed baseline serologic and behavioral assessments, 121 (88%) were seronegative; all enrolled in Project Jumpstart in Philadelphia (PA, U.S.A.), a vaccine preparedness initiative cosponsored by NIAID and NIDA. Subjects were seen every 3 months for risk and vaccine opinion assessment, risk reduction counseling, and HIV antibody testing. The baseline prevalence rate of HIV infection was 12% (16 of 137) with an annual incidence rate of 3.5% (4 of 114) during the first year. Of the 121 baseline seronegative women, 28% shared needles and 52% engaged in unprotected intercourse. Sixty percent of the baseline seronegative women reported being willing to be one of the first people to try an HIV vaccine. According to logistic regression, needle sharers were 12.8 times more likely, women who engaged in sex for drugs or money 6.6 times more likely, out-of-treatment women 3.5 times more likely, and those who believed that vaccines can prevent disease acquisition 3 times more likely to report willingness to try an HIV vaccine than their respective counterparts. At 1-year postbaseline assessment, 98% of the women had behavioral data collected and 95% had serologic specimens collected. Given that seroconversions occur and that these women engage in risk behaviors, report willingness to try an HIV vaccine, and can be retained for longitudinal assessment, they appear to be suitable participants for preventive HIV vaccine efficacy trials. Nonetheless, work is required to insure that these women make informed and knowledgeable decisions regarding trial enrollment.

Sexual behaviour and its relationship to drug-taking among prostitutes in south London.

The precise manner in which the use of different types of drugs is related to prostitution has not been adequately researched. This study investigates patterns of drug-taking and sexual behaviour among a group of women working as prostitutes in south London; it also looks at prostitution in which sex is offered in return for drugs, at the links between heroin, cocaine and alcohol use and sexual behaviour, and at the association between severity of dependence and sexual behaviour. All of the women in our sample (n = 51) were actively working as prostitutes. More than half of them had given sex for drugs, though this was a relatively infrequent occurrence. The majority of them were using heroin and many of them were moderately or severely dependent upon heroin. More than one-third had shared injecting equipment after it had already been used. Almost two-thirds reported that they only worked as a prostitute in order to fund their use of drugs (predominantly heroin), and that they would not continue working as a prostitute if they were not still using drugs. The more severely dependent upon heroin they were, the more likely they were to report these links between heroin use and prostitution. About half of the women in our sample said that they first started to work as a prostitute in order to pay for drugs. The women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin. Very few women regularly used cocaine in association with their prostitution. There are grounds for concern about the alcohol consumption of these women. About one-quarter of the women said that they used alcohol every day; some of them reported drinking at levels which greatly exceed recommended limits for women, and some were drinking at levels which were likely to be physically damaging.

Leading by Losing: Sex and Fertility on Crack Cocaine

Women who use crack cocaine have been characterized as promiscuous and careless about unintended pregnancy or sexually transmitted diseases. To evaluate the validity of these claims, we used the grounded theory approach to analyze transcripts from 100 interviews with women crack users, exploring their experiences and views on sexuality, fertility, contraception, and pregnancy-related decisions. Many women told of unforeseen events in the social world of crack cocaine use, such as pressures to trade sex for drugs, in a cultural and economic milieu already restrictive of women's reproductive and personal goals. The women accommodated shrinking control over their reproductive lives through "learning by losing,"finding out through failure how to protect their remaining options for seljhood. This process included stages of reappraising, limiting, and settling for less, as choices diminished over time. Women's actions were tied to their changing attitudes on motherhood, fertility, and sexuality issues.

Crack cocaine and the exchange of sex for money or drugs. Risk factors for gonorrhea among black adolescents in San Francisco.

In contrast to rates for the United States as a whole, the incidence rate of gonorrhea increased 11% in San Francisco between 1986 and 1988, with substantial increases observed among black adolescents. Reports by health department personnel and police suggested that crack cocaine use, specifically the exchange of sex for drugs, contributed to this increase. To test this hypothesis, the authors conducted a case-control study from August 1988 to October 1988 that compared 68 prospectively identified adolescent gonorrhea patients with 136 neighborhood control patients. Thirty-two percent of the female gonorrhea patients had received money or drugs in exchange for sex, while none of the control patients reported having done so (P = 0.0001). Most of the female patients (89%) who had received money or drugs in exchange for sex had used crack. Crack use was less common among female patients who denied receiving money or drugs in exchange for sex (11%) and among control patients (6%). Crack use and providing money or drugs in exchange for sex were not risk factors for gonorrhea among the male patients, but were reported frequently by both gonorrhea patients and control patients. Not living with parents was a risk factor for male patients (odds ratio 4.9, 95% confidence limit 1.4 to 19.5). For all patients, a history of a sexually transmitted disease appeared to be an independent risk factor for gonorrhea. The conclusion is made that crack-related exchange of sex for money or drugs is a risk factor for gonorrhea among black adolescent girls in San Francisco.(ABSTRACT TRUNCATED AT 250 WORDS)