Perceptions of Sexual Risks and Injection for HIV among African American Women Who Use Crack Cocaine in Nashville, Tennessee

By MacMaster, Samuel A.; Rasch, Randolph F. R. et al. | Health and Social Work, November 2009 | Go to article overview

Perceptions of Sexual Risks and Injection for HIV among African American Women Who Use Crack Cocaine in Nashville, Tennessee


MacMaster, Samuel A., Rasch, Randolph F. R., Kinzly, Mark L., Cooper, R. Lyle, Adams, Susan M., Health and Social Work


There is a growing awareness of disparities in the incidence of HIV/AIDS, access to care, and survival rate in the context of race in access to health care that disproportionately affects African Americans (Institute of Medicine, 2003). Although these inequalities are important to the larger community, there appear to be further inconsistencies that primarily affect African American women who use crack cocaine. These women are subject to a unique environmental context, with specific stressors, that has a direct and dramatic effect on health outcomes, specifically related to HIV/AIDS.

LITERATURE REVIEW

Gender and Racial Disparities in HIV/AIDS Prevalence

Although African Americans represent only 12.3 percent of the U.S. population, they make up approximately 40 percent of all AIDS cases (Centers for Disease Control and Prevention [CDC], 2006). For African American women, this disparity is significantly increased, as African American women represent 60 percent of all female AIDS cases nationally (CDC, 2006). In Tennessee, the gap is further widened as African Americans constitute 16 percent of Tennessee's population yet account for 81 percent of AIDS cases among women. Of greater concern, AIDS rates were 28 times greater for African American women compared with white women, and 3.5 times greater than the rates for other women of color (Tennessee Department of Health, 2002). Currently, AIDS is the leading cause of death among young (25 to 34 years old) African American women in the United States (National Center for Health Statistics [NCHS], 2002).

Substance Use and HIV Risk Behaviors for Users of Crack Cocaine

Drug use represents a well-established risk behavior for HIV and hepatitis C infections, primarily as it relates to injection drug use. Other drug users are increasingly at high risk for contracting HIV as the awareness of the relationship of noninjection drug use to HIV risk has grown. Specifically, crack cocaine smokers have been found to be three times more likely than nonsmokers to be infected with HIV (Friedman et al., 2003), are less likely to adhere to medical care (Sharpe, Lee, Nakashima, Elam-Evans, & Fleming, 2004), and more likely to continue high-risk sexual behaviors after being diagnosed with HIV (Campsmith, Nakashima, & Jones, 2000). Use of crack cocaine can contribute to the spread of the epidemic when users trade sex for drugs or money, when they engage in risky sexual behaviors that they might not engage in when not under the influence, or when their use affects access to health care services (Cottler et al., 1998; Ross, Ywang, Leonard, Teng, & Duncan, 1999; Sharpe, 2001;Weiss Kluger, & McCoy, 2000). Women appear to be at particular risk for HIV infection due to the nature of their role both in the larger society and in the crack-using subculture (Brown, 2006; Brown, Hill, & Giroux, 2004; Evans, Forsyth, & Gauthier, 2002; Mallory & Stern, 2000). In addition to these sexual risks associated with crack cocaine use, there is a growing body of literature that suggests that some crack cocaine users in larger metropolitan areas are also injecting the drug, thus increasing their risk of contracting HIV through the sharing of syringes and other injection equipment (Buchanan et al., 2005; Johnson & Ouellet, 1996; Kinzly, Irwin, & Cavalieri, 2004; Santibanez et al., 2005).

Although there is ample research to describe the risk behaviors of women using crack cocaine, there is a dearth of information on these women's perceptions of these risks. To fill this gap in the literature, this exploratory study sought to answer this question: What are the perceptions of the risk for contracting HIV/AIDS by engaging in high-risk behaviors related to crack cocaine use among active crack cocaine users? We plan to use the findings of this study to develop services to address not only the prevalence of risk behaviors among African American women, but also their perceptions about these risks. …

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