of HIV present on blood-contaminated surfaces is provided by the example of the disinfection of hemodialysis machines. Patients infected with HIV who are undergoing hemodialysis do not require isolation from other dialysis patients. Although the dialyzer itself is disposable, the recommendations for disinfecting the dialysis fluid pathways of the hemodialysis machine (exposure to 500 to 750 milligrams per liter of sodium hypochlorite for 30 to 40 minutes)—originally intended for controlling bacterial contamination—are also effective in inactivating HIV (Centers for Disease Control, 1986; Conte, 1986).
In sum, when used appropriately, there is no doubt that bleach can effectively disinfect surfaces contaminated by HIV-infected blood.
In the mid-1980s, the recognition of an impending epidemic in the spread of HIV infection in injection drug users led to discussion among health care professionals and providers concerning potential intervention strategies to limit virus transmission. Although HIV infection had entered the injection drug user population in San Francisco by 1985, it had not yet assumed the high level of prevalence that was seen among injection drug users in the New York metropolitan area. A San Francisco group of community health outreach workers that came to be known as the Mid-City Consortium to Combat AIDS proposed that the types of education and behavior change efforts that had been successfully conducted among homosexual and bisexual men in the area (Becker and Joseph, 1988) might also attenuate the transmission of HIV among injection drug users (Newmeyer, 1988). However, the opportunities for public health interventions were limited.
California's paraphernalia and prescription laws made the prospects for legally authorized needle exchange remote. The most effective risk reduction behavior, cessation of drug use, was not a realistic option for many injection drug users because of the nature of the addictive process and limited treatment resources (Murphy, 1987). Social norms for sharing injection equipment among injection drug users, as well as legal and economic constraints, all placed restrictions on an individual's ability and motivation to keep a needle and syringe set for personal use only (Des Jarlais et al., 1986; Hopkins, 1988; Feldman and Biernacki, 1988). Therefore, the option of disinfecting needles and syringes seemed to hold the greatest promise for realistic interventions to limit HIV transmission among injection drug users.
Ethnographic studies were conducted in San Francisco to determine characteristics that would make a disinfection strategy acceptable to injection drug users (Newmeyer, 1988). Newmeyer listed five essential features