Archival Content: 1999-2005
If IDUs who continue to inject use a new sterile syringe for every drug injection, it can substantially reduce their risks of acquiring and transmitting blood-borne viral infections.
More than 20 years into the AIDS epidemic, roughly one million Americans (estimated range between 1,039,000 and 1,185,000) are now living with HIV and about 40,000 new infections occur every year. Approximately 1.25 million Americans are chronically infected with hepatitis B; 2.7 million Americans are chronically infected with hepatitis C.(1,2,3)
As of 2004, injection drug use accounted for about one-fifth of all HIV infections and most hepatitis C infections in the United States.(1,3) Injection drug users (IDUs) become infected and transmit the viruses to others through sharing contaminated syringes and other drug injection equipment and through high-risk sexual behaviors. Women who become infected with HIV through sharing needles or having sex with an infected IDU can also transmit the virus to their babies before or during birth or through breastfeeding.
To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. Such an approach includes a range of pragmatic strategies that address both drug use and sexual risk behaviors. One of the most important of these strategies is ensuring that IDUs who cannot or will not stop injecting drugs have access to sterile syringes. The U.S. Public Health Service and several institutions and governmental bodies have recommended use of sterile syringes as an important risk reduction strategy.(4) In supporting this position, the Institute of Medicine of the National Academy of Sciences has said:
"For injection drug users who cannot or will not stop injecting drugs, the once-only use of sterile needles and syringes remains the safest, most effective approach for limiting HIV transmission."(5)
Why Are Sterile Syringes Necessary for Injection Drug Users?
The process of preparing and injecting drugs provides many opportunities for transmitting HIV and viral hepatitis. Before injecting intravenously, an IDU determines whether the needle is in a vein by pulling back on the syringe plunger. If blood enters the syringe, the needle is in a vein and the IDU will inject the drug. After injecting, the IDU rinses the syringe with water. This water is often used to later prepare drugs for injection. If the IDU has HIV or viral hepatitis, his or her blood will contaminate the entire syringe and the preparation equipment with the virus, which can remain viable for several weeks.(5)
Transmission can occur directly, when an infected IDU shares a syringe with others, or indirectly, when an infected injector shares injection paraphernalia such as water, cookers, cottons, and spoons, or when he or she jointly prepares and shares drugs with other IDUs. Given the efficiency with which HIV and other blood-borne viruses can be transmitted through injection practices, ensuring that IDUs who continue to inject have access to sterile syringes is a vitally important strategy to prevent disease transmission. Ensuring access to sterile syringes does not increase the number of persons who inject drugs or the number of drug injections.(5,6,7) It does reduce the sharing and reuse of syringes.(8,9)
How Do IDUs Obtain Syringes?
IDUs get their syringes in several ways:(10)
Why Is Access to Sterile Syringes a Critical Issue?
It is estimated that an individual IDU injects about 1,000 times a year.(11) This adds up to millions of injections, requiring millions of syringes every year. Most IDUs who continue to inject are currently unable to obtain a sufficient number of sterile syringes to effectively reduce their risks of acquiring and transmitting blood-borne viral infections.(12)
What Factors Limit IDUs' Access to Sterile Syringes?
What Have States and Communities Done to Increase Access to Sterile Syringes?
Three types of interventions are now being carried out in the U.S. to increase IDUs’ access to sterile syringes:
Safe Disposal of Used Syringes: An Integral Element of the Access Issue
Ensuring that IDUs who continue to inject can obtain a sufficient number of sterile syringes is only part of the equation; counseling, health education, and access to substance abuse treatment are equally important. Safe disposal of used syringes is another important consideration, both to reduce the chances that an IDU will reuse a blood-contaminated syringe and to respond to community and pharmacist fears about the risks of discarded syringes in neighborhoods. (See the related fact sheet Syringe Disposal.)
For More Information
Read A Comprehensive Approach: Preventing Blood-Borne Infections Among Injection Drug Users, which provides extensive background information on HIV and viral hepatitis infection in IDUs and on the legal, social, and policy environment. It also describes strategies and principles for addressing these issues.
1. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. 2005 National HIV Prevention Conference; June 12–15, 2005. Atlanta, GA. Abstract 595.
2. Centers for Disease Control and Prevention (CDC). Hepatitis B fact sheet. Accessed December 22, 2005 from http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm.
3. Centers for Disease Control and Prevention (CDC). Hepatitis C fact sheet. Accessed December 22, 2005 from http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm.
4. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Drug Abuse and Substance Abuse and Mental Health Services Administration. HIV prevention bulletin: Medical advice for persons who inject illicit drugs. May 9, 1997.
5. Normand J, Vlahov D, Moses LE, eds. Preventing HIV transmission: the role of sterile needles and bleach. Washington (DC): National Academy Press, 1995. Accessed December 23, 2005 from http://www.nap.edu/books/0309052963/html/
6. Guydish J, Bucardo, J, Young M, Woods W, Grinstead O, Clark W. Evaluating needle exchange: are there negative effects? AIDS 1993;7:871-876.
7. Needle RH, Coyle SL, Normand J, Lambert E, Cesari H. HIV prevention with drug-using populations - current status and future prospects: introduction and overview. Public Health Reports 1998;113(Suppl 1):4-18.
8. Gleghorn AA, Wright-De Agüero L, Flynn C. Feasibility of one-time use of sterile syringes: a study of active injection drug users in seven United States metropolitan areas. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S30-S36.
9. Heimer R, Khoshnood K, Bigg D, Guydish J, Junge B. Syringe use and reuse: effects of syringe exchange programs in four cities. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S37-S44.
10. Gleghorn AA, Jones TS, Doherty MC, Celentano DD, Vlahov D. Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995;10:97-103.
11. Lurie P, Jones TS, Foley J. A sterile syringe for every drug user injection: how many injections take place annually, and how might pharmacists contribute to syringe distribution? Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S45-S51.
12. Gostin LO, Lazzarini Z, Flaherty K, Jones TS. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users: A national survey on the regulation of syringes and needles. JAMA 1997;277(1):53-62.
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