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HIV/AIDS And Smoking Crack

Research has shown that crack users experience a disproportionate rate of infectious diseases, such as HIV, Hepatitis C, Tuberculosis and other serious health problems.

After a long bout or binge of using crack, users often experience a crash, which is very unpleasant. Usually a user will be physically and mentally exhausted and will sleep for 12 to 18 hours and wake up very hungry. Some users also report paranoia, feelings of sadness and depression, sweating, muscle twitching and hallucinations. For women who are pregnant, there is an increased chance of stillbirths, miscarriages, labor difficulties and birth defects.

Crack, like other stimulants, lowers a userís immune system. This is especially worrisome for users living with HIV/AIDS. Smoking crack appears to weaken the crack smokerís natural resistance to infection in the lungs. Many users experience respiratory problems, such as shortness of breath, chronic cough, chest pains, asthma, bronchitis and pneumonia. In the extreme, crack smoking can cause bleeding in the lungs and users may cough up black phlegm or blood. Many users use brillo pad as a screen for their glass stem. Unfortunately metal used for screens (i.e. brillo pads, hash pipe screens, etc.) breaks apart due to the high heat that is used when smoking crack and can be inhaled by the smoker. These bits of metal can cause damage and bleeding.

When people mix crack and alcohol they create a new compound called Coacaethylene, which intensifies crackís euphoric effects, while possibly increasing the risk of sudden death. Many users rely on crack as a form of self-medication in order to cope with social and environmental factors, such as poverty, homelessness, violence, isolation, history of abuse, lack of resources and discrimination.

There has been a lack of comprehensive research done on the harms of crack smoking. Most of the research has been conducted in the United States and has focused on sexual health issues. Crack smokers are at an increased risk for STIís, HIV, Hepatitis C, TB and other serious health issues due to high risk behaviors, socio-economic factors and a lack of comprehensive health and social services targeting crack users.

Studies have shown that crack addicts are at an increased risk of Hepatitis C and HIV/AIDS due to the following situations: Risky sexual behaviours related to crack use, such as exchanging sex for money or drugs, having sex with injection drug users, using crack before or during sex, having unprotected sex and having multiple partners (many of whom are anonymous, have STDís, HIV/AIDS and /or Hepatitis B). These activities have been extensively documented. An American study examined the prevalence of risky sexual behaviors and HIV and STI infection rates among a large sample of street-recruited crack smoking sex workers (Jones DL, et al 1998).

From 1991 to 1992, 419 people were recruited from urban areas, interviewed and serologically tested. They found that many female and male sex workers reported sex with injectors (30% to 41%) or HIV-infected persons (8% to 19%), past STIís (73% to 93%), and inconsistent condom use (> 50% for all types of sex). Sex workers who worked in crack houses or vacant lots, were paid with crack or injected drugs had the riskiest sex practices. Most sex workers initiated sex work before they first smoked crack. 27.9% were infected with HIV, 37.5% with syphilis and 66.8% with herpes simplex virus type 2. They concluded that interventions to prevent HIV/STI transmission among crack-smoking sex workers are urgently needed. Crack users are twice as likely to be infected with HIV and other STDs than non-users. Crack users are at high risks of HIV infection due to the co-infection of ulcerative STIS such as chancroid, syphilis and herpes. During the rise in popularity of crack [late eighties] cases of syphilis doubled in many American cities. In Philadelphia, the numbers of reported cases of syphilis increased by 550 % during 1985 to 1989.

HIV risks are extremely high for users who engage in crack specific prostitution. Inciardi (1993) reports that in observations made at eight American crack houses, from 1989 through 1992, 50% of the men and 89% of the women had had 100 or more sex partners during a 30-day period. They participated in sex for crack or money. The sexual activities were anonymous, extremely frequent, varied, uninhibited, with multiple partners, and condoms were not used. A study of crack cocaine users recruited from the streets in three urban neighborhoods found that 68% of women who were regular crack smokers had exchanged sex for drugs or money. Of those, 30% had not used a condom in the past 30 days. Studies done in New York City looking at HIV rates among female sex workers found that 21.3% of those who smoked crack and had no history of IDU tested HIV positive compared with 13.2 % of those who did not smoke crack. Of women who performed oral sex (without condoms) 23.9% of those who smoked crack tested HIV positive compared with 16.7% who did not smoke crack. One study of a crack house in Texas showed that among 435 crack users 12% were HIV infected and 41% were Hepatitis C infected. Researchers noted that the level of injection drug use alone could not explain the high Hepatitis C rate in this population. They came to the conclusion that the sharing of crack pipes may have played a role.

The prevalence of Hepatitis C among crack users who do not inject drugs is unknown. A survey conducted by the Harm Reduction Task Force (1997) of 93 crack users in Toronto revealed that 41% of the respondents reported Hepatitis C infections and 91% shared pipes. Many users suffer from burns, sores and cuts on their lips due to the use of unsafe pipes.

It is believed that people who smoke crack with extremely hot pipes or broken glass pipes sustain cuts, burns and ulceration on their lips and inside their mouths, thus creating an entry point for HIV, Hepatitis C and other diseases. One American study that interviewed 153 crack smokers showed that 80% reported burns on their lips, 11% reported cuts, 66% shared pipes and 62% gave oral sex. Faruque et al. (1996) studied 1202 (60%) young crack smokers and 919 (40%) non-smokers from inner city neighborhoods in New York, Miami and San Francisco. They found that crack smokers were twice as likely to report having oral sores over the past 30 days and oral sores were associated with HIV infection. The study provides evidence that these oral sores may facilitate HIV transmission.

Due to the illegal nature of crack use many users have been incarcerated and/or are at risk of future incarceration. Unfortunately, incarcerated users are at a greater risk of acquiring HIV/AIDS and/or Hepatitis C due to the high-risk behaviors that occur in prison settings and the lack of harm reduction and risk reduction materials (i.e. syringes, safer crack use kits, condoms, etc.). The HIV infection rate in prison is more than 10 times higher than the general population and the Hepatitis C infection rate is 30-40 times higher.Ē

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