Never in Care: Characteristics of HIV-Infected Crack Cocaine Users in 2 US Cities Who Have Never Been to Outpatient HIV Care

Background: There are very limited data available of the correlates of HIV-infected crack users who have never been to HIV care. Methods: Interviews were conducted at bedside with HIV-infected crack cocaine users who were recruited from the inpatient wards at Jackson Memorial Hospital in Miami, FL, and Grady Memorial Hospital in Atlanta, GA, between August 2006 and July 2009. Participants were asked about their sociodemographic characteristics, drug use, drug/alcohol treatment history, use of HIV care, perceived social support, and mental health status. Multiple logistic regression was performed to identify factors associated with never having been to HIV care. Results: Among 355 study participants, 21% reported never having been to a doctor or clinic for HIV care. Higher adjusted odds of never having been in care were associated with an annual income of less than $5000 [ adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI) = 3.35 to 19.94], residence in Atlanta compared with Miami (AOR = 2.57, 95% CI = 1.36 to 4.83), no history of drug treatment (AOR = 4.13, 95% CI = 2.24 to 7.62), and not being helped into care at the time of HIV diagnosis (AOR = 2.83, 95% CI = 1.56 to 5.15). Conclusions: Our data show that a significant proportion of HIV-infected crack cocaine users in 2 city hospitals have never been to HIV care. Interventions at the time of HIV diagnosis and drug treatment participation may facilitate linkage to care.