INTERSECTING EPIDEMICS - CRACK COCAINE USE AND HIV-INFECTION AMONG INNER-CITY YOUNG-ADULTS
INTERSECTING EPIDEMICS - CRACK COCAINE USE AND HIV-INFECTION AMONG INNER-CITY YOUNG-ADULTS
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DOI：
10.1056/nejm199411243312106
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发表时间：
1994-11-24
影响因子：
158.5
通讯作者：
DUSHKU, J
中科院分区：
文献类型：
--
作者：
EDLIN, BR;IRWIN, KL;DUSHKU, J
背景和方法。吸食“快克”可卡因被认为与高风险的性行为有关，这种性行为加速了人类免疫缺陷病毒（艾滋病毒）感染的传播。我们研究了2323名18至29岁的年轻人，他们经常吸烟或从未吸烟。研究参与者从纽约、迈阿密和旧金山弗朗西斯科的市中心街道招募，接受了采访和艾滋病毒检测。本报告介绍了1967名从未注射过毒品的参与者（85%）的研究结果。在1137名吸食者中，15.7%的人艾滋病毒抗体呈阳性，而在830名不吸烟者中，这一比例为5.2%（根据城市调整的患病率为2.4; 99%置信区间为1.7至3.6）。在纽约（29.6%）和迈阿密（23.0%），吸食可卡因的妇女中艾滋病毒感染率最高。在这两个城市中，283名以金钱或毒品为交换条件的女性中，30.4%感染了艾滋病毒，而其他286名女性中的感染率为9.1%（患病率，3.1; 99%置信区间，1.9至5.1）;在91名与其他男性发生肛交的男性中，42.9%感染了艾滋病毒，而在582名未与其他男性发生肛交的男性中，感染率为9.3%（患病率为4.7; 99%置信区间为3.0 ~ 7.4）。在多变量分析中，这些高风险的性行为占较高的艾滋病毒感染率之间的裂缝吸烟者，与那些谁不吸烟裂缝。最近为换取金钱或毒品而进行无保护性行为的妇女与与男男性行为的男子一样有可能被感染（40.9%对42.9%）。在贫穷的市中心社区，吸食快克可卡因的年轻人，特别是以性行为换取金钱或毒品的妇女，感染艾滋病毒的风险很高。快克的使用促进了艾滋病毒的异性传播。
Background and Methods. The smoking of ''crack'' cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs.Results. Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). In these two cities, of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with HIV as compared with 9.1 percent of the 286 other women (prevalence ratio, 3.1; 99 percent confidence interval, 1.9 to 5.1); of the 91 men who had anal sex with other men, 42.9 percent were infected with HIV as compared with 9.3 percent of the 582 men who did not have anal sex with other men (prevalence ratio, 4.7; 99 percent confidence interval, 3.0 to 7.4). In multivariable analyses, these high-risk sexual practices accounted for the higher prevalence of HIV infection among the crack smokers, as compared with those who did not smoke crack. Women who had recently had unprotected sex in exchange for money or drugs were as likely to be infected as men who had had sex with men (40.9 percent vs. 42.9 percent).Conclusions. In poor, inner-city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection. Crack use promotes the heterosexual transmission of HIV.