Population Research and Policy Review 18: 71–87, 1999.
© 1999 Kluwer Academic Publishers. Printed in the Netherlands.
A gender comparison of HIV and drug use across the rural-urban
CLYDE B. McCOY, LISA R. METSCH, H. VIRGINIA McCOY &
Comprehensive Drug Research Center, Department of Epidemiology and Public Health,
University of Miami School of Medicine, Miami, Florida, USA
Abstract. Despite the central role of women drug users in escalating AIDS statistics, there
is still a limited number of studies that examine the roles of gender and drug use type in HIV
seroprevalence. This lacuna in the research literature has led to signiﬁcant gaps in researchers’
understanding of how and to what extent women may differ in their drug-using and HIV
risk behaviors compared to their better-studied male counterparts. This study, derived from a
sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural
communities, attempts to compare the drug usage and needle and sexual risk behaviors of
male and female drug users that put them at risk for HIV infection. The overall seropositivity
rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results
of multivariate analyses indicate that females compared to males were 1.4 times more likely
to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include
living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs.
Furthermore, there was a strong linear relationship between drug use type and HIV seropreva-
lence among women drug users. Compared to those who were neither crack smokers nor
injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be
HIV seropositive, while those who were both crack smokers and injectors were 5 times more
likely to be HIV seropositive, and those who were injectors only were 6 times more likely to
be HIV seropositive. These ﬁndings indicate that among women, drug abuse and its associated
risk behaviors, increase the vulnerability of this population for HIV and thus render them an
extremely important priority population on which to focus HIV prevention and public health
efforts and programs.
Keywords: Chronic drug users, HIV, Rural drug use, Sexually Transmitted Diseases (STDs),
According to the 1997 World Health Report of the World Health Organiza-
tion (WHO 1997), HIV/AIDS was the ninth leading cause of death world-
wide and approximately 5.2 million adults were newly infected with HIV in
1997, of whom 2.1 million (40%) were women. Within the United States,
AIDS is now the second leading cause of death among adults aged 25–44