Globally, HIV prevention efforts have focussed on injecting drug users, one of the highest risk populations for HIV. While injecting drug use is not widespread throughout the Caribbean, some researchers have found that HIV prevalence in crack cocaine smoking populations is almost as high as those found in injecting drug users. Crack’s short-lived high and addictiveness creates a compulsive cycle where the user is constantly looking to repeat the first “hit” of crack. Caught in this cycle, users quickly deplete their finances and find fast ways to maintain their use, often exchanging sex for money or drugs. Crack cocaine also increases sexual desire and can increase unsafe sexual practices that put users at risk for sexually transmitted infections including HIV. Once a drug user is HIV positive, crack cocaine use accelerates disease progression.