Infected Needles and HIV

Sharing drug-injection needles is extremely risky, even between people who show no signs of having AIDS, because HIV infection is often asymptomatic for the first 5 to 10 years. In some areas of the United States, reused contaminated needles are the primary cause for HIV transmission.

According to the Centers for Disease Control, not only can injections needle be contaminated, but drug solutions can be contaminated during preparation by

  • using blood-contaminated syringes to prepare the drugs;
  • reusing and sharing water;
  • reusing bottle caps, spoons, and other "cookers" for dissolving and heating the drugs; and
  • reusing cotton balls or other "cottons" to filter out particles that can block the needle.

For this reason, needle exchange programs and adequate cleaning techniques are the most effective ways to reduce the risk for needle transmission of HIV and other blood borne diseases for people who are unable to stop using injectable drugs.

Needle Exchange Programs

Obtaining sterile needles from a pharmacy requires a prescription. Needle exchange programs allow drug users to exchange used needles for sterile ones, no questions asked. This is the best way to ensure the use of clean needles and the proper disposal of used ones. Many researchers and AIDS activists believe that easy access to clean needles reduces the rate of HIV transmission. Other people believe that needle exchange programs encourage illicit drug use and increase the spread of HIV.

Research has shown that needle exchange programs reduce the spread of HIV without increasing the use of illegal injection drugs among participants or increasing the number of injection-drug users. Many national and regional organizations recommend needle exchange programs based on the weight of this evidence. These organizations include the United States Centers for Disease Control and Prevention (CDC), American Medical Association (AMA), National Institutes of Health (NIH), United States Preventative Services Task Force, National Institute of Drug Abuse, and most state and local departments of health.

In addition, needle exchange programs often provide life-saving services to high risk drug users, who may be otherwise hard to reach. Services may include free latex condoms, HIV counseling and testing, tuberculin skin testing, and primary health care including care for HIV, hepatitis C, and other illnesses associated with injection drug use.

In the United States, over 50 percent of all new AIDS diagnoses among African Americans and Latinos are related to injection drug use. African Americans and Latinos who inject drugs are nearly 5 times more likely to develop AIDS than Caucasians who inject drugs. Some experts believe that this discrepancy is due to the fact that Caucasians generally have easier access to sterile needles.

The North American Syringe Exchange Network provides information about regional needle exchange programs.

Cleaning and Reusing Needles

It is widely recommended that people who inject drugs use a new, sterile syringe and needle for each injection. For those who cannot obtain new sterile injection equipment, sterilization with undiluted bleach is recommended. Bleach is commonly used to disinfect drug injection equipment, but only careful cleaning techniques effectively kill HIV. The following guidelines can minimize the risk for disease transmission when a new needle is unavailable:

  • Rinse syringe and plunge with clean, cold water several times.
  • Fill to the top with fresh, undiluted bleach and leave for 30 seconds; plunge it out and repeat at least 3 times.
  • Fill to the top with clean, cold water; squirt it out and repeat at least 3 times.
  • Shake the equipment while cleaning and rinsing it.

Many people think that because hot water kills germs, it is best for killing blood borne pathogens. But hot water may cause blood left in the needle or works to clot, making it harder to remove. Equipment should always be rinsed after use, even if cleaning with bleach is delayed. It is necessary to use full-strength, undiluted bleach, which must remain in the syringe for 30 seconds. Also, the syringe should be shaken to loosen any remaining blood before the bleach is pushed out. Some evidence suggests that the bleach must remain in the syringe for 2 minutes to kill hepatitis B, and it is not known whether bleach kills hepatitis C in the syringe.

Detachable needles and custom equipment should be disassembled for cleaning. Spoons and other cookers also should be cleaned in this manner. Cotton ball filters and other "cotton" should never be shared, because they cannot be cleaned thoroughly.

Some studies have shown that tiny amounts of blood remain in bleach-cleaned syringes, even after vigorous washing and rinsing. In fact, some researchers believe that sharing bleach-cleaned, blood-contaminated syringes may increase the rate of HIV transmission if traces of bleach are left in the syringe. The oxidant effects of bleach and the local inflammation that occurs when a needle with traces of bleach enters the skin may enhance transmission. Equipment should always be rinsed thoroughly after cleaning with bleach.

Minimizing Risk: Needles and HIV

People who inject drugs can minimize the risk for contracting or transmitting HIV in the following ways:

  • Seek drug treatment and stop injecting drugs. Consult the Yellow Pages of the phone book under "Drug Abuse" for local treatment or support centers. They provide information about needle exchange programs, counseling services, and support groups. Contact the Center for Substance Abuse Treatment at 1.800.662.4357.
  • Obtain syringes from reputable sources; syringes are sometimes repackaged and sold as new.
  • Always avoid used or shared needles and syringes.
  • Use clean, fresh water, cookers, and filters.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Nov 2000

Last Modified: 23 Jul 2015