(Wiebel, 1990, 1993a) initiated an active program of education, intervention, and research, employing a field staff with extensive knowledge of and familiarity with the local community of injection drug users. In an evaluation of this approach (Wiebel et al., 1990), active injecting drug users were queried about their use of bleach disinfection at baseline and at 6 months following the initiation of the educational program. Bleach use as a disinfection strategy was adopted by many injection drug users. Two-thirds of the study participants who initially used bleach "less than always" reported an increase in bleach use, with one-third of the follow-up sample reporting "always" using bleach.

Similarly, researchers in New York (Friedman et al., 1990) helped form an organization of injection drug users in an effort to decrease HIV risk behaviors. Injection drug users in recovery provided HIV risk-reduction education for active users. These groups encouraged the adoption of safe sexual and drug-related behaviors and offered AIDS education, individual counseling, and HIV testing. In an evaluation of this program, follow-up comparisons were made between injection drug users who participated in the education and organizing effort and those who did not. Although use of new needles and condoms increased in both groups, only the organized injection drug users showed an increase in consistent bleach use.

Additional studies sponsored by the National Institute on Drug Abuse (NIDA) evaluated AIDS risk behaviors and trends in HIV infection in injection drug users in methadone treatment programs (Battjes and Pickens, 1992, 1993). Reported trends over the five-year period included increased use of bleach and alcohol by injection drug users to clean injection equipment in four of the seven cities studied: New York; Asbury Park, N.J.; Trenton, N.J.; Baltimore, Md.; Chicago, Ill.; San Antonio, Tex.; and Los Angeles. Additional studies conducted in Indianapolis and Los Angeles County have reported increased rates of bleach use (McKee et al., 1992; Longshore et al., 1993). These changes appear to reflect the increasing awareness and acceptance of bleach as an HIV prevention strategy.

In a survey of nearly 3,000 injection drug users in Baltimore conducted in 1988 and 1989, Latkin and colleagues (1992) reported that a variety of substances, including water, bleach, and alcohol, were used by injection drug users to clean contaminated needles and syringes. In addition to the use of various agents, the methods reportedly used by injection drug users for syringe disinfection were often imprecise and variable. Gleghorn and colleagues (Gleghorn et al., 1994; Gleghorn, 1994) studied cleaning practices used by injection drug users via videotaping mock needle and syringe cleaning sessions. They found that more than 80 percent of the 161 subjects studied used bleach for less than 30 seconds, although they reported cleaning for longer periods of time.

McCoy and colleagues (1992, 1994) studied injection drug users in Miami



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