In this cross-sectional study, the researchers sought to classify a sample of HIV-positive African-American crack cocaine smokers into homogenous HIV drug use and sexual risk groups using a two-step multivariate cluster analysis.

The subjects of the study were 258 crack smokers. Cluster analysis revealed three distinct HIV risk groups:

• The largest group, which was also the highest risk group, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use.
• The second-largest group was characterized by inconsistent condom use.
• The smallest group was characterized by consistent condom use.

Comparisons among the three groups revealed that the highest risk group had a higher proportion of illegal sources of income; higher proportion of binge crack use; frequent, daily alcohol use; same gender sex partners; and higher scores for depressive symptoms.

Persons in the inconsistent condom group were more likely to have a main sex partner; to be married; to be on public assistance; to know the HIV status of their casual partners; and were less likely to conceal their HIV status.

Those in the consistent condom use were more likely to have been diagnosed with HIV for a shorter time; to have HIV serodiscordant casual sex partners; to have higher psychological motivation for condom use; and a lower frequency of vaginal sex.

"An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners," the authors concluded. "Interventions aiming to prevent the secondary spread of HIV infection in African-American crack cocaine smokers should take this variability into account and focus on the differences."

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