Desperately seeking skeezers: Downward Comparison Theory and the implications for STD/HIV prevention among African-American crack users

HIV infection rates among African-Americans have increased disproportionately when compared to other at-risk groups in the United States. Crack smoking also has been found to increase the risk of infections with HIV, syphilis, and other sexually transmitted diseases. Despite the scientific and citizenly dissemination of this information, infection rates continue to increase among African-American drug users, as traditionally-used prevention curricula apparently have lacked influence among this population. This manuscript demonstrates the utility of Downward Comparison Theory (DCT) to explain how many African-American crack smokers erroneously assess their risks for STD/HIV transmission. More than 200 African-American crack smokers were interviewed in Washington, DC, and Miami, FL using a qualitative interview guide. Briefly stated, African-American crack smokers believe that women who trade sex for crack are the lowest-ranking members of the social hierarchy. Many members of this group also believe that people who rank lower on the social hierarchy cannot transmit disease to higher-ranking members. Examples of this and other DCT principles are provided as well as implications and suggestions for interventions and future research. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: KEYWORDS. African-American, crack, condom use, sex-trading, sexually transmitted diseases (STDs), HIV risk, Downward Comparison Theory