of a disinfection technique as follows: ''(1) it should be quick, preferably taking less than 60 seconds; (2) it should be inexpensive; (3) it should use materials conveniently available; (4) it should be safe to the user and his/her injection equipment; and (5) it should be effective at neutralizing viruses" (Newmeyer, 1988:160). In determining an appropriate disinfectant, published studies available at the time—particularly those of Martin et al. (1985) and Resnick and colleagues (1986)—were the primary sources of information regarding the efficacy of various disinfectants for inactivation of HIV under laboratory conditions.

Based on these studies, several disinfectants were considered, including bleach, hydrogen peroxide, and isopropyl alcohol. According to Newmeyer (1988), hydrogen peroxide was rejected due to its limited shelf life and sensitivity to light exposure; the potential for isopropyl alcohol to be confused with other readily available sources of alcohol in beer, wine, and hard liquors eliminated it from consideration. Boiling syringes in water for 15 minutes was another strategy considered; however, this strategy was deemed impractical due to the length of time required, the facilities needed, and the fact that boiling melted the syringe (Murphy, 1987). As a result of these considerations, household bleach (approximately 5 percent sodium hypochlorite) was determined to be the most feasible. Bleach met the criteria for cost and availability, and reviews of the available literature (Becker et al., 1974; Froner et al., 1987) suggested that accidental injection of bleach would not produce great harm to injection drug users. Aside from fading the numbers inscribed on the syringe barrel (Newmeyer, 1988) and corrosion of the rubber stopper of the plunger of the syringe, bleach did not seem to have excessive deleterious effects on the injection equipment.

Following the selection of bleach as the disinfectant of choice, community health outreach workers in San Francisco began a campaign of bleach distribution and provided simple, graphic instructions for its use in disinfecting needles and syringes (Watters, 1987). The initial bleach distribution efforts were part of a broader education program to decrease the risk of HIV infection among injection drug users that included condom distribution and voluntary HIV counseling and testing. The educational message delivered was: "The best protection is to stop using drugs; if you can't stop using, don't inject; if you can't stop injecting, at least keep your own outfit and don't share it with anyone; if you do share, use bleach to reduce your risk." The recommended protocol for bleach disinfection was to fill needles and syringes twice with bleach, followed by two water rinses (Newmeyer, 1988; Froner et al., 1987; Watters, 1987). These initial disinfection guidelines recommended the use of full-strength bleach, which was believed by the San Francisco community health outreach workers to provide a more potent and convenient disinfectant than the diluted bleach preparations used in the early laboratory studies.



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