An underestimated route of HIV transmission is the use of cocaine, particularly crack-cocaine. Around 13.4 million people use cocaine worldwide, nearly half of whom live in North America. 11 Although HIV prevalence among crack cocaine users is lower than among IDUs, studies are now revealing that infection rates are on the rise.
Some crack smokers suffer from burns, blisters and cuts on the lips and inside the mouth caused by the intense heat from the vaporising smoke being conducted through poorly constructed smoking devices. Blood from these wounds can contaminate the ‘stem’ - usually a small metal pipe - and be passed along to the next smoker. If two smokers both have open sores then there is a risk of HIV or hepatitis C transmission. Oral sex may also be risky for heavy crack-cocaine smokers who have open oral sores due to the potential for blood transfer through frequent fellatio.
A study in Canada found that 37% of 550 enrolled drug users reported sharing smoking equipment every time they took the drug. The programm supplied clean crack-smoking apparatus for 12 months and sharing fell to 13%. This study emphasized the need for better harm reduction strategies as more evidence reveals the extent of this overlooked route of HIV transmission.