Smoking crack increases risk of HIV infection

Although intravenous drug use has been known to increase risk of HIV infection for decades, people are only recently beginning to realize the possibility of smoking crack as an independent risk factor.

Infection risk factors
Smoking crack poses the possible risk of infection through the sharing of pipes, however, this risk is considered to be negligible. Smoking crack often produces wounds, sores, or cuts around the mouth, which does allow an entry route for HIV; however, there is no published evidence of HIV transmission specifically through the sharing of crack pipes.1 The heightened likelihood for unprotected sex, particularly oral sex, while smoking crack is thought to contribute to high HIV infection rates in crack users.

Research and studies
Research is often limited and disputed, even though crack use in Canada among injection drug users (IDUs) is known to be widespread.

A nine-year Vancouver study, started in 1996, found that daily crack users were four times more likely to become infected with HIV than those who rarely or never smoked. From this, researchers concluded crack smoking as a means of transmission.2

An American study interviewed 153 crack smokers. Of this, 80 per cent reported burns on their lips, 11 per cent reported cuts, 66 per cent shared pipes, and 62 per cent gave oral sex. All such situations, especially combined, are known to allow for extremely high-risk opportunities for infection.3

Another Canadian study, based in Ontario, found that 63 per cent of IDUs reported smoking crack, often due to the drug’s affordability and availability. The 2007 report also noted a lessened amount of injection use when safer inhalation kits were available. With the high-risk group less likely to share pipes and/or needles, infection risk significantly lowered.4

Canadian harm reduction efforts
Some Canadian cities, including Calgary, Toronto, Montreal, Vancouver and Edmonton, currently allow for the provision of safer inhalation kits, or crack kits, to individuals in an effort to reduce the spread of HIV through crack use. Such kits usually include pipes, filters, mouth pieces, push sticks, lip balm and sometime disinfectant.

Safe inhalation rooms
Injection sites, like Vancouver’s Insite, are already in use in an effort to stop the spread of HIV through needle-sharing. Many harm reduction advocates would like to see the same system employed for crack users.

Safe inhalation rooms would provide a safe environment for crack use under the supervision of health professionals. Ultimately, and not unlike injection sites, they would function as a public health-care facility, where individuals would have access to nurses, addiction counsellors, and support workers. Not only would the risks involved with using the drug be reduced, but people would have immediate access to help should they need it.


References:
1. Canadian AIDS Society. HIV Transmission: Guidelines for Assessing Risk (2005), pg 31.
2. DoBeck K MPP, Kerr T PhD, Li K PhD, Fischer B PhD, Buxton J MD, Montaner J MD, Wood E MD PhD. Smoking of crack cocaine as a risk factor among people who use injection drugs. October 2009. Canadian Medical Association Journal
3. Safer Crack Use Coalition of Toronto (SCUC). Fact Sheet: Health Issues Affecting Crack Smokers. www.canadianharmreduction.com.
4. Leonard L, DeRubies E, Pelude L, Medd E, Birkett N, Seto J. Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking reserouces are distributed. University of Ottawa. February 2007. International Journal of Drug Policy


This article was submitted by Jess Howat. Jess was a practicum student at AIDS Calgary in March. She is currently working towards a Communication Studies degree between SAIT and the University of Calgary.