Portland's HIV/AIDS Resource Webpages

HIV by Injection

Reducing the Risk of Getting HIV From Injection Drug Use

Below we describe the risks of getting HIV from injection drug use, and ways to reduce those risks. Follow a link from the alphabetical list, then click the up arrow to bring you back to this point if you want to look at another link. Or, you can read straight through the entire document.

Behavior Change	Crack & HIV Transmission	Needle Exchange
Risk: What is it?	Risk Reduction: Cleaning	Risk Reduction: Sharing
Sex & Injection Drug Use	Social Issues

What Is The Risk?

It is well documented that injection needle users who share unclean needles are at great risk of being infected with HIV. Sharing unclean needles allows a direct exchange of blood from one person's body into the bloodstream of another. When a person puts a needle into the vein, s/he will pull back the plunger to make sure that they are in a vein, and if they are, blood will enter the syringe. Some of this blood may still be in the syringe when it's given to a second person.

An injection drug user who has never shared needles will not get HIV from needles regardless of his or her habit. It's the exchange of blood that causes transmission.

How Can Transmission Be Prevented?

If possible, don't share needles ...

Anyone who uses needles should avoid sharing and take advantage of needle exchange programs. Using your own works is the best protection against HIV exposure from needles. For needle exchange referrals, see the list of links to exchange web sites maintained by Safe Works. Call the CDC National AIDS Hotline toll free at 800/342-AIDS.

If you do share needles, keep in mind that bleach cleaning is not risk free, but is an important tool for risk reduction. For it to be effective you must be consistent and careful in following needle cleaning procedures.

..... or clean needles immediately after and immediately before use

This is to reduce sterilization problems caused by clotted blood. Before using bleach, flush the syringe with water to rinse fresh or dried blood that may remain in the barrel. Then follow the long-standing guidelines: "bleach, bleach, water, water." Flush the barrel of the syringe at least twice with bleach (that is, fill and then empty the barrel with bleach twice). Bleach works best after 30 seconds. Hold the bleach in the barrel for that long.

Note:

Bleach should not be diluted.
While it is important to rinse the needle and barrel in clean water, a small amount of bleach entering the body is not likely to cause any harm.
Alcohol also kills HIV and can thus be used for needle-cleaning. Rubbing alcohol and hard liquor can be used; but beer and wine do not contain enough alcohol and should not be used for needle-cleaning.
Hydrogen peroxide is most likely as effective as bleach, using the 30-second guidelines. Even though it is less likely to cause harm to the needle than bleach (bleach dulls the point and breaks down the rubber plunger), it is more expensive. Also, the reason it comes in a dark bottle is because it degenerates over time. Probably peroxide that is older than six months should not be used.

You might not think of yourself as having "shared" a needle if you shared it with a close friend or acquaintance, but sharing unclean needles with friends can be as dangerous as sharing with strangers.

Social Issues

A person using clean needles may continue to shoot up and live a long life. A person sharing dirty needles may become infected with HIV and possibly develop AIDS. That is the reason we emphasize the need for clean needles. Studies indicate that injection drug users "have in fact responded to the threat of AIDS through a reduction in needle sharing."

From a health standpoint, it is probably best not to use injected drugs at all. We can offer referrals to substance abuse programs.
If people do use injected drugs, it is best not to share their syringes.
If people do share syringes, it is critical to always clean them thoroughly between uses.

Sex And Injection Drug Use

Keep in mind that if you share dirty needles, you may also be putting your sexual partner or partners at risk through sexual activity. If you are having sex with anyone, you can find out about risks of infection through various sexual activities, and ways to reduce those risks, in the safer sex section of this guide. A significant percentage of women with AIDS in this country have been infected from sexual contact with an injection needle user.

Crack And HIV Transmission

Some studies have shown a connection between crack and HIV transmission. Crack is smoked. The risk from HIV is not from injection but from sex. People who smoke crack are more likely to practice unsafe sex because the drug increases sexual desire. Also, it is not uncommon for female crack smokers to exchange sexual favors for crack, and this usually means unsafe sex. A study reported in the VIII International AIDS Conference in Amsterdam found that crack smoking may also be a co-factor in oral sex transmission because it may cause severe burns in the mouth.

Needle Exchange Programs

Needle exchange sites exist around the state and around the country, but needle exchange remains controversial. Issues and exchange sites change frequently. For needle exchange referrals, see the lis of links to needle exchange web sites maintained by Safe Works, or call the CDC National AIDS Hotline toll free at 800/342-AIDS.

Injection Drugs And Behavior Change

Even if you have a long history of injection drug use, you should clean your needles in the future for three reasons. First, it is possible that you have not yet been infected. Second, even if you have been infected, you should avoid reinfection, which may speed the development of AIDS. Third, other diseases like hepatitis are also transmitted by sharing dirty needles. Diseases like hepatitis greatly damage your immune system's ability to fight off disease, and may also speed the development of full-blown AIDS.