Can HIV-1-contaminated syringes be disinfected? Implications for transmission among injection drug users

Bleaching of syringes has been advocated to prevent HIV-1 transmission among injection drug users (IDUs). Bleach is frequently distributed by needle exchange, outreach, and educational programs targeting IDUs. We applied a sensitive HIV-1 microculture assay to determine the effectiveness of bleach in disinfecting syringes contaminated with HIV-1. This study demonstrates that in a laboratory environment designed to replicate injection behaviors, undiluted bleach is highly effective in reducing the viability of HIV-1 even after minimal contact time. However, it did not reduce the HIV-1 recovery to zero. Furthermore, three washes with water were nearly as effective as a single rinse with undiluted bleach in reducing the likelihood that contaminated syringes harbored viable HIV-1. Given the reality that IDUs share syringes and may not have access to a new, sterile syringe for each injection, the results suggest that they should be encouraged through harm reduction interventions to clean their syringes, preferably with undiluted bleach.

Association between drug use patterns and HIV risks among homeless, runaway, and street youth in northern California

We examined relationships between drug use patterns and HIV risk behaviors among 1121 street-recruited homeless, runaway, and 'street youth' in Northern California. Comparisons demonstrated that youth using any heroin, methamphetamine, or cocaine exhibited more sexual risks than non-users, while primary stimulant and combined heroin/stimulant users showed greatest sexual risk. Combined heroin/stimulant injectors showed higher risk injection practices than primary heroin or primary stimulant injectors, including frequent injections and backloading syringes. Interventions for street youth should be tailored to current drug use patterns since those using combinations of heroin and stimulants may require more comprehensive prevention, support and treatment services.

Feasibility of one-time use of sterile syringes: a study of active injection drug users in seven United States metropolitan areas

OBJECTIVES

To assess the feasibility of advice to injection drug users (IDUs) to use a sterile syringe for each injection, we examined sources of syringes, syringe use and reuse, and barriers to and facilitators of compliance with the one-time use of syringes by active IDUs in seven U.S. metropolitan areas.

METHODS

Brief, interviewer-administered surveys were completed by 593 active IDUs, defined as injection reported within the past 90 days, in seven U.S. metropolitan areas characterized by various restrictions on syringe acquisition and possession.

RESULTS

Most of the IDUs interviewed were male (69%) and African American (74%). Overall, only 23% obtained the most recently used syringe from a reliable source of sterile syringes (i.e., pharmacy or syringe exchange program [SEP]). The median number of injections per most recently used syringe was 3 (mean=5.2); 21% used the syringe only once. IDUs were more likely to have used a reliable source for obtaining their most recent syringe in cities with a SEP (odds ratio [OR]=5.3; 95% confidence interval [CI] 3.3-8.5) or without restrictive paraphernalia laws (OR=0.1; 95% CI 0.1-0.3). To facilitate one-time use of sterile syringes, IDUs recommended the provision of free syringes (50.3%), access to a SEP (38.1%), and access to pharmacy purchase of syringes (24.0%).

CONCLUSIONS

Restrictions on syringe availability and the beliefs and practices of IDUs are barriers to the public health recommendation of one-time use of sterile syringes for IDUs who cannot stop injecting. Increased access to legal, inexpensive sterile syringes and education about the merits of one-time use are needed.

Pharmacists' attitudes about pharmacy sale of needles/syringes and needle exchange programs in a city without needle/syringe prescription laws

We assessed pharmacists' practices for needle and syringe (NS) sales and their attitudes toward a needle exchange program through a telephone survey of 75 randomly selected pharmacies in Baltimore, Maryland, where possession of drug paraphernalia is illegal but where NS can be purchased without a prescription. Pharmacists' (n=46) procedures for NS sales included asking for picture identification (54%), requiring a prescription (34%), or requiring a diabetic identification (DID, 34%) for NS purchase; multiple responses were allowed. The median number of prescription and nonprescription NS sold per month was 950. Most (86.6%) pharmacists reported selling NS without prescriptions at their discretion. Pharmacists sold a median of 16 nonprescription NS per month. Pharmacists who required prescriptions or DID (56.5%) sold nonprescription NS significantly less often than those who did not require prescriptions or DID (p=.007). Most pharmacists (87%) were aware of the needle exchange program, 78.3% supported the program, and 67.4% supported selling nonprescription NS in pharmacies. Although there was no difference in anticipated effects of needle exchange or in support for needle exchange between pharmacists who did or did not require prescriptions, DID, or both, pharmacists who did require these items were significantly less likely to support pharmacy sales of nonprescription NS than pharmacists with less restrictive sales policies (p=.04). Although most pharmacists surveyed supported access to sterile NS by injection drug users through a needle exchange program, there was a diversity of approaches to nonprescription NS sales among pharmacists in a city that does not require prescriptions for access to sterile NS. Most supported nonpharmacy needle exchange programs, and more than one half limited injection drug users' access to NS through restrictive sales practices. To reduce injection drug users' exposure to HIV, pharmacists should be educated about HIV prevention and injection drug use and be included in development of HIV prevention programs, including legal pharmacy NS sales.

Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland

Our objective was to determine how injection drug users (IDUs) in Baltimore, Maryland obtain and use needles and syringes (NS) for drug injection, before the opening of a needle exchange program (NEP). The method of this study was a cross-sectional structured interview survey in 1992 of active IDUs in a longitudinal study of human immunodeficiency virus (HIV) infection. For 466 IDUs (94.6% black, 83% male), usual sources of NS were "street" dealers (49.6%), pharmacies (29.8%), diabetics (16.3%), friends/neighbors (2.2%), and "shooting galleries" (1.9%). Half (53.5%) reported pharmacy purchase of NS, and 55.6% had diabetic friends/relatives. Twenty-three percent traded drugs, and 5% traded sex for NS. Eighty-eight and two-tenths percent would use a needle exchange program; 24.6% currently own no NS (median owned = 2.2). NS reuse was common (median = three times). Concern about (55.2%) or history of (33.9%) hassle/arrest for NS possession was typical; 81% kept NS at home, and 67% do not carry NS when purchasing drugs. Pharmacy purchasers (versus "street") were less likely to have been jailed, shared NS, or used shooting galleries during the preceding 6 months. In Maryland, although IDUs can legally purchase NS at pharmacist discretion, possession remains illegal; fewer than one-third of IDUs use pharmacies, and most obtain NS from illegal sources. Most IDUs reuse NS, but discard them after several uses. Current patterns of NS acquisition and use in Baltimore are likely to increase HIV transmission. Increased availability and decriminalization of NS possession could decrease the risk of injection-related HIV transmission.

Inadequate bleach contact times during syringe cleaning among injection drug users

Objectives were to measure syringe cleaning strategies used by injection drug users (IDUs) and to assess syringe contact with bleach during cleaning demonstrations. IDUs were interviewed about cleaning activities during their most recent injection episode; they demonstrated these activities on videotape. Coders reviewed the videotapes, categorized activities, and used stop watches to record bleach exposure. Of 161, 146 subjects reported cleaning at last injection, 85 (58%) of 146 used full strength bleach. Of bleach users, 20% had total contact time (duration of bleach inside syringe) of > or = 30 s; combining draw (time taken to fill syringe) and contact times, 54% of bleach users had total "flush" times of > or = 30 s. Median observed time per bleach flush was 16 s. Median reported cleaning times were twice as long as observed. Recent reports indicate 30 s of exposure to undiluted bleach is necessary to inactivate HIV in the laboratory; here, 80% of IDUs using bleach had contact of < 30 s. Judgment of contact time was inaccurate. On average, instructions advocating two bleach flushes may reach 30 s; here, half the subjects had insufficient time with two flushes. The majority showed inadequate techniques, therefore, alternate cleaning strategies should be developed.

Perceptual and cognitive abnormalities in bulimia

The authors compared 55 bulimic subjects and 55 normal control subjects using the Beck Depression Inventory, a new scale designed to detect cognitive distortions (the Bulimia Cognitive Distortion Scale), and several perceptual and attitudinal measures of body image. There were significant differences between the bulimic and control groups on all measures except estimates of face width. These findings are discussed in terms of a multifactorial theory of the psychopathogenesis of bulimia.