Alice Gleghorn

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

&NA; 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.

HIV testing behaviors in a population of inner-city women at high risk for HIV infection

The relationship between HIV testing history. HIV serostatus, and risk behaviors was examined to investigate factors associated with obtaining an HIV test, returning for results, or receiving multiple tests. Seven hundred and five volunteers for an HIV study were questioned about prior HIV testing, drug and sexual practices, and sociodemographic characteristics. Women who reported a prior HIV test were compared with those without a previous test, women who returned for test results were compared with those not returning; and women who reported multiple tests were compared with those having only one test. Seventy-five percent of the women reported a prior test; 12% had not returned for test results; 46% reported multiple tests. Women reporting higher levels of HIV risk behaviors were more likely to have been tested and to return for results. Injection drug use and having four or more sex partners were significantly associated with repeated HIV testing. Over one third of the women with substantial HIV risk practices had not been HIV tested or failed to obtain test results. Women who obtained multiple HIV tests were more likely to report high-risk practices in spite of having received risk counseling with repeated testing.

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.