W. Rees Davis

Supporting the habit: income generation activities of frequent crack users compared with frequent users of other hard drugs.

US Federal sentencing guidelines punish possession of crack cocaine very differently from powder cocaine, based partially upon the assumption that crack users engage more frequently in criminal behavior to pay for their habit. This article analyzed frequent users (those who have used at least 15 of the last 30 days) of crack with subgroups of less frequent hard drug users in terms of various income generation activities reported during the past 30 days. The sample consists of 602 African-Americans who were current (in past 30 days) users or sellers of cocaine powder, crack, and heroin. They were carefully recruited from randomly selected blocks in the Central Harlem area of New York City and interviewed extensively in 1998-1999. Their IGAs were classified into six categories. Compared with not-frequent (less than 15 days) hard drug users, frequent crack and multiple hard drug users were equally likely to be involved in drug distribution activities, but were significantly less likely to have full-time jobs, part-time jobs, aid to families with dependent children or welfare support. They had much higher odds ratios for non-drug related illegal (theft mainly) income generation activities and sex work among women. Often, gender and birth cohort variables had higher odds ratios with specific income generation activities than the frequent use of the primary drug(s). This evidence suggests that very frequent crack users have been stigmatized by, are largely excluded from, and perform very marginal economic roles in the legal economic system (jobs and welfare), the illegal economic system, and even in the hard drug distribution system.

Dominican, Mexican, and Puerto Rican Prostitutes: Drug Use and Sexual Behaviors

Although Hispanics are overrepresented in AIDS cases in the United States, little information is available to help understand differences in drug and sex risk behaviors in Hispanic subgroups, needed to develop appropriate prevention programs. This study reports on HIV-related risk behaviors in three groups of Hispanic prostitutes recruited in the United States: Dominican (77), recruited in Washington Heights, NY, Mexican (151), recruited in El Paso, 7X; and Puerto Rican (48), recruited in East Harlem, NY Ethnographic interviews were conducted with a subsample of subjects to examine cultural meaning of risk behaviors; structured interviews were conducted with subjects to describe demographic characteristics and summarize levels of risk behaviors. Results indicated that the labels Hispanic and prostitute obfuscated important differences related to geographic and cultural factors. To be effective for diverse Hispanic groups, HIV prevention efforts and interventions must be based on knowledge of these differences.

Women at High Risk for HIV: Pregnancy and Risk Behaviors

Pregnancy may provide an opportunity for behavior change among women at high risk for HIV. Baseline and six-month follow-up data were collected from a national sample of female injection drug users (IDUs) and sexual partners of injection drug users (SPs). Repeated measures analyses were conducted separately for three groups of IDUs (pregnant at baseline, became pregnant between baseline and follow-up, and not pregnant during the study) and three similar groups of SPs. Results indicated that both pregnant and not pregnant high risk women reported significant levels of risk reductions at follow-up. IDUs who were pregnant or became pregnant reported greater reductions in drug injection rates, were more likely to report entering drug treatment and reported the greatest reduction in sex risks compared to IDUs who were not pregnant. Results suggest that the period of pregnancy provides an opportunity for changes in risk behaviors. Innovative outreach efforts and increases in treatment options are needed.

Risks for HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem: Implications for interventions

Abstract This article investigates behaviours that may be associated HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem. Chain referral sampling and other strategies were combined to acquire a sample of 637 (Users = 546; Sellers = 91) who provided urine specimens that were tested for the presence of drugs and HIV. Nearly a quarter (23.9%) of all respondents were HIV positive. Drug injectors were more than 2.5 times more likely to have HIV infections than other respondents (OR = 2.66; 95% CI 1.66–4.26). Those involved in frauds/cons were almost as likely to be HIV positive (OR = 2.58; 95% CI 1.64–4.06). Those with a marital status of being separated, divorced or widowed were twice as likely to be HIV infected (OR 2.16; 95% CI 1.43–3.25). Respondents currently having multiple partner sex (OR = 1.66; 95% CI 1.1–2.51) or who were female (OR = 1.66; 95% CI 1.12–2.45) were more than 1.5 times more likely to be HIV positive. Thus, controlling for lifetime drug injection and current multiple partner sex, other factors, such as participating in frauds/cons, as well as relationship status and being female, were also associated with HIV infection.

Socioeconomic Marginality and Health Services Utilization Among Central Harlem Substance Users

The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The sample consisted of 658 “hard drug” (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999. Chain referral and social networking were used in order to gain access to hidden users. The sample was stratified according to operational measures indicating socioeconomic marginality, one calculated using indices of income, education, and employment and another designed to measure lived homelessness. Rates of self-reported utilization of 10 health services were compared across strata. In this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. When the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. Results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems.

Characteristics of Hidden Status among Users of Crack, Powder Cocaine, and Heroin in Central Harlem

This article analyzes hidden status among crack, powder cocaine, and heroin users and sellers, in contrast to more accessible users/sellers. Several sampling strategies acquired 657 users (N=559) and sellers (N=98). Indicators of hidden status were those who (1) paid rent in full in the last 30 days, (2) used nonstreet drug procurement, (3) had legal jobs, and (4) earned

Prescription opioid use, misuse, and diversion among street drug users in New York City.

1,000 or more in legal income in the last 30 days. Nearly half had at least one indicator; approximately 16% of users/sellers had two to four indicators. In logistic regression analyses, those who had not panhandled in the last 30 days, those who had used powder cocaine in the last 30 days, and those never arrested were the most likely to have hidden status, whether the analysis predicted those having any indicators or those having two to four indicators. The four indicators begin to operationally define hidden status among users of cocaine and heroin.