HIV risk behavior and drug use among heterosexual male crack users by prostitution involvement

Crack and prostitution, or sex exchange, have been linked to the heterosexual spread of HIV (e.g. Inciardi 1993, 1995). Previous studies have found that among female crack users there are subgroups who do and do not become involved in prostitution (e.g. Logan, Farabee and Leukefeld 1998; Logan and Leukefeld 1998). However, there has been little focus in the literature on subgroups of male heterosexual crack users who are or are not involved in prostitution. The purpose of this study was to examine differences in male heterosexual crack users who reported no involvement in prostitution as clients (n = 4,208), males who reported involvement in prostitution as clients but not in the month preceding the interview (n = 2,774), and males who reported involvement in prostitution as clients the month preceding the interview (n = 2,283) from a multi-site sample of male crack users who participated in the National Institute of Drug Abuse (NIDA) AIDS Cooperative Agreement Project from 20 sites across the nation. Results of the logistic regression indicated that having an STD three or more times and using drugs during sex were associated with ever being involved in prostitution as clients, while using drugs during sex and having 5 or more sexual partners the month preceding the interview were significantly associated with being involved in prostitution as clients at the time of the interview. Implications for interventions are discussed.