African-Americans have experienced a disproportionately high rate of HIV infection when compared to other at-risk groups. Studies have linked this increase in HIV infection to crack smoking and other risky behaviors involving trading sex for drugs. The authors outline the social hierarchy of the African-American drug trade culture and show how the use of Downward Comparison Theory (DCT) helps explain how many African-American crack users incorrectly assess their risk for HIV infection. The authors interviewed 201 African-American drug users during 1996 and 2001 in the District of Columbia and Miami. The in-depth, semi-structured interviews included questions about sociodemographics and life history. The interviews illustrate how African-American crack users view women who trade sex for drugs as the lowest ranking members on the social hierarchy. Many also believe that HIV cannot be transmitted from a lower ranking member to a higher ranking member; thus increasing their chances of HIV infection. The authors show how downward comparisons both facilitate and impede the use of condoms among the drug users who engage in sex for drugs exchanges. The application of the principles of DCT to the problem of the increased risk of HIV infection among African-American crack users has implications for the content and design of health campaigns. By focusing the campaign on issues that are real to this population, their condom use habits may be changed for the better. References