Drug use patterns and infection with sexually transmissible agents among young adults in a high-risk neighbourhood in New York City

Aims: To determine relationships between drug use 'hardness' (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) and prevalences of several sexually transmissible infections among young adults in a high-risk neighbourhood. Drug users, particularly injection drug users and crack smokers, may be a core group for some sexually transmitted infections. Design: Cross-sectional survey and assays of young adults from (a) a household probability sample and (b) a targeted sample of youth who have used injected drugs, crack, other cocaine or heroin. Setting: Bushwick, an impoverished New York City minority neighbourhood, with major drug markets. Participants: A total of 363 18-24-year-olds from a household probability sample: 165 Bushwick 18-24-year-olds who have used injected drugs, crack, other cocaine or heroin. Measurements: Drug use by self-report; serum- and urine-based assays for HIV, hepatitis B and C, syphilis, gonorrhoea, chlamydia and herpes simplex (type 2). Findings: Household-sample prevalences: HIV, hepatitis C and syphilis. 1%; gonorrhoea 3%; chlamydia 5%; past or present hepatitis B infection 8%; herpes simplex (type 2) 18%. In combined household and targeted samples, hepatitis C and HIV were concentrated among drug injectors. Herpes simplex (type 2). syphilis and hepatitis B increased among women with 'hardest drug ever used'. Conclusions: Using 'harder' drugs is associated with some but not all of these infections, Prevention efforts should help youth avoid unsafe sex and higher-risk drugs.