studies indicate that injection drug users may use variable, and often clearly inadequate, disinfection strategies. Furthermore, adherence to recommended disinfection protocols after training may decrease with time. Increasingly complex disinfection strategies may be less likely to be retained or adopted by injection drug users.

Additional research is needed to identify approaches that most effectively transmit to injection drug users the importance of disinfection of contaminated injection equipment and that ensure maximal compliance with recommended procedures. In the interim, promotion of a clear, consistent method of disinfection procedures, such as those recommended in the recent CDC/NIDA/CSAT publication, is essential to help decrease the risk of HIV infection for injection drug users who continue to share needles and syringes.

Bleach can be an effective and potentially life-saving intervention for injection drug users who share needles and syringes. Bleach distribution programs have been a popular and effective component of community health outreach efforts to decrease HIV risk behaviors among injection drug users. Continued advocacy of bleach disinfection will be necessary even if sterile needles and syringes become more widely available through exchange programs or the relaxation of prescription laws.

Research efforts to better model the efficacy of disinfection strategies for blood-contaminated needles and syringes should be actively encouraged. Emphasis should be placed on models that are relevant to the typical practices and circumstances of injection drug use behaviors. Additional field research studies are needed to further evaluate the effectiveness of bleach disinfection in decreasing the risk of HIV infection among injection drug users. A better understanding of the reasons for the limited protective impact of needle and syringe disinfection practices documented to date is essential. Research to identify effective education strategies to maximize injection drug user familiarity with and practice of effective bleach disinfection methods is needed.

Conclusions

The panel concludes that:

  • Bleach, if used according to the recommendations of the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the Center for Substance Abuse Treatment, is likely to be an effective HIV prevention strategy for injection drug users who share needles and syringes.

  • Concerted efforts are essential to increase the awareness of injection



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