418                                                                            A. R. WOHL ET AL.

TABLE 4.  Injection drug use behavior in women with HIV and AIDS
interviewed in Los Angeles County, 1990-1997


 Race/ethnicity of women

Black White Latina Other
No. % No. % No. % No. %

Behavior

(n = 168) (n = 87) (n = 357) (n = 12) ORa

95%

Cl

Ever injected a drug with a needle?
   Yes 38 23 28 32 45 13 3 25 1.5 0.9 2.3
   No 130 77 59 68 312 87 9 75
Age first injected drugsb
   <19 y 18 47 15 54 17 38 1 33
   20-29 y 14 37 10 36 23 51 2 67
   30 39y 5 13 3 11 4 9 0
   >=40 y 1 3 0 1 2 0
   t-Test on difference in mean age = 0.2; p = 0.8
The drugs mainly shot?b
   Heroin 21 55 9 32 29 64 0 1.2 0.6 2.7
   Cocaine 6 16 8 29 5 11 1 33 0.8 0.3 2.4
Ever shared a needle or syringesb
   Yes 36 95 24 86 39 87 0 3.7 0.9 16.1
   No 2 5 4 14 6 13 3 100
How often did YOU share needles or syringesc
   Sometimes 23 64 10 42 23 59 0
   Usually 7 19 8 33 10 26 0
   Every time 5 14 6 25 6 15 0
   Unknown 1 3 0 0 0
ORa for comparing every time with usually and sometimes = 0.7; 95% CIs = 0.2, 2.2

OR, odds ratio; CI, confidence interval.
a OR and 95% CIs were calculated comparing African-American women with women of all other races.
b The totals for these analyses include only those women who have ever injected drugs with a needle.
c The totals for these analyses include only those women who have ever shared a needle or syringe.

(50%) compared with women of other races (15%). Similar findings were not observed in populations at high-risk for HIV studied on the East Coast, among whom a history of ever using crack was reported to be 18% in two high-risk African-American female study groups (5,7). Excessive crack use among African American women in this sample of LAC women with HIV and AIDS is consistent with patterns of crack use in high-risk women in Los Angeles (4,8). It has been purported that crack, a smokable form of cocaine, reduces sexual inhibition and judgment, placing someone at greater risk for unprotected sex and other high-risk sexual behaviors (20). In addition, the culture of crack use promotes the exchange of sex for drugs and evidence suggests that crack use is a risk factor for high levels of sexual activity and STDs among African-American teenagers in Northern California (21). Other evidence also suggests that crack use may result in oral sores that may promote the transmission of HIV orally (22). These data infer that crack use is likely to play a larger role in HIV risk in African-American women in LAC than elsewhere. There is still more, however, that we need to learn about crack use in African-American women, such as the extent to which the economic livelihood of AfricanAmerican women depends on the sale !!!of crack, the degree to which sex is exchanged for crack, more detailed information on the high-risk sexual behaviors that may result from crack use, and the role of oral sores from crack use in the transmission of HIV.
   Certain limitations in this analysis should be considered. First, the lack of a control group of AfricanAmerican women uninfected with HIV limited our ability to assess more fully the risk factors for HIV in African-American women. Second, that the study group was composed of a population-based sample of AfricanAmerican women with AIDS and an additional group of HIV-infected African-American women seen at a single large county clinic may have limited the generalizability of our findings. However, the demographic and behavioral characteristics of each group did not differ appreciably, suggesting that the combined analyses are valid and are likely to be generalizable to African-American women with AIDS in LAC.
   The findings from this analysis can be used to direct HIV prevention interventions in African-American women in LAC and underscore the barriers to conducting effective prevention in a socially and economically disenfranchised population. Previous education efforts in African-American women who were methadonedependent injection drug users and non-injection drug

Journal of Acquired Immune Deficiency Syndromes and Human Retroviro/ogy, VoL 19, No 4, December 1, 1998

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