1. Lisa R. Norman, PhD Ponce School of Medicine and Health Sciences, Ponce, PR Harm Reduction International July 26, 2012

2.  The use of Crack cocaine among women who live in the Caribbean is fueled by cultural and economic factors associated with living in the Caribbean.

3.  Intense cravings are a main feature of crack dependency. Most regular users will keep right on using until they run out of money or run out of the drug.  Women are especially vulnerable to the effects of crack cocaine use.

4.  The size of crack rocks can vary, but generally ranges from 1/10 to ½ gram. Rocks can sell for as low as $3 to as much as $50, but prices generally range from $10 to $20.

5.  Crack-cocaine costs much less in the Caribbean, costing about $5 or less for a rock. However, due to the economic situation of most Caribbean countries (e.g., Jamaica), this cost is extremely high and women engage in unsafe sexual behaviors in order to gain money or drugs. For example, in Jamaica, a woman may exchange sex for money or drugs for $200 Jamaican dollars which equals approximately $2 US.

6.  Only two studies were identified that have current data on HIV risk behaviors among current crack cocaine users, one in Saint Lucia and one in Puerto Rico.*  In both of these studies, rates of condom use were very low (less than 15%) and multiple sex partners was high (more than 50%). *Another study was identified that collected data from current crack users in Trinidad and Tobago, Saint Lucia, and Jamaica (See Day and Norman, 2007).

7.  In PR, self-reported HIV seropositivity among the sample of current crack cocaine users was 27.8%.  In Saint Lucia, 7.1% tested positive for HIV.  In Saint Lucia, 77% tested positive for syphilis.

8.  76.5% of female crack-cocaine users in Saint Lucia reported having exchanged sex for crack or money.  50% of these women reported not using a condom during this sexual exchange.  In PR, 100% of current female crack cocaine users were unemployed.  In Saint Lucia, almost 100% of current female crack cocaine users were unemployed.

9.  Impoverished crack users are more likely to engage in risky sexual behaviors to get money or drugs. This is what makes women in the Caribbean so vulnerable to the risks associated with crack-cocaine use. 1  It is also important to note that this population has been basically excluded from research (international funders as well as international conferences) targeting female crack cocaine users who may be at increased risk of HIV.  It is important to include the affected population in order to develop and implement targeted and more appropriate interventions to decrease their risk of HIV. Interventions that have included members of the targeted population have shown to be more effective in reaching those persons who continue to engage in HIV high risk behaviors.

10. We know this population has a disproportionately high percentage of heavy crack-cocaine users, who may engage in risky sexual behaviors which brings with it the risk of contracting HIV and other STIs. It is a difficult population to access due to the stigma attached to women who use drugs in the Caribbean. 2

11.  Women have to be made feel comfortable so they will come forward and seek treatment, either for drug use or HIV or both, in a non- threatening environment. Until the current climate changes, this population will continue to engage in high-risk behaviors, putting themselves and others at risk for HIV as well as other STIs.

12.  1 Hoffman et al. (2008). “HIV and Sexually Transmitted Infection Risk Behaviors and Beliefs Among Black West Indian Immigrants and US- Born Blacks.” American Journal of Public Health, Vol 98, No. 11, pp. 2041-50.  2 Norman LR. (2012). “Drug-using and sexual stigma and sympathy toward persons living with HIV/AIDS in Puerto Rico.” Oral presentation given at Ponce School of Medicine and Health Sciences Scientific Conference, June.