Abstract: The effectiveness of bleach in inactivating HIV in drug users’ injection equipment is in question. In a letter to the editor published in the American Journal of Public Health, Harvey Siegal et al respond to the report by Shapshak and his colleagues that a minimum of 30 seconds in bleach is needed for sufficient cleaning of the equipment. Through their own observations of 77 intravenous drug users, Siegal et al noted a great disparity in the amount of bleaching time–from 1 to 75 seconds–as well as in the methods of cleaning of the equipment. Despite the fact that the study was conducted in project offices, the results provide some evidence of how drug users really use bleach when cleaning. It is important to clearly state disinfection techniques in prevention messages that target drug users, because a few seconds’ difference can make all the difference between becoming infected with HIV or remaining uninfected.

Abstract: OBJECTIVES. The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS. Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS. Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS. These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing.

Abstract: BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are the two blood-borne pathogens most commonly transmitted among injection drug users via multi-person use of syringes and other injection equipment. However, important differences exist in the epidemiology of HIV and HCV within different populations of intravenous drug users. METHOD: A literature review was carried out to summarize publications describing the epidemiology and natural history of HIV and HCV in injection drug users. RESULTS: Among injection drug users worldwide, HIV prevalence varies from <5% to >80%, with annual HIV incidence between <1% and 50%. More consistency is shown in HCV prevalence (50–90%) and incidence (10–30% per year). Host, environmental and viral factors that favor rapid spread of HCV among IDUs suggest that HCV infection in a population of injection drug users may become endemic over a relatively short period of time. Lower transmission efficiency for HIV also indicates that its spread among injection drug users may be somewhat slower. CONCLUSIONS: Successful efforts to prevent transmission of blood-borne viruses among IDUs typically result in risk reduction; however, no intervention has resulted in elimination of risk behavior. To reduce HIV transmission, risk reduction may be sufficient, whereas control of HCV may necessitate the use of injection practices that guarantee elimination of exposure to equipment contaminated with even small amounts of blood.

Abstract: The 1999 Stanton Peele Addiction Lecture (at Deakin University in Melbourne) was delivered by John Fitzgerald, of the University of Melbourne. John examines perspectives on drug use from the standpoint of narratives, or cognitive frameworks in terms of which we — particularly Westerners — interpret our worlds. Without changing these narratives, efforts to change policies for drug regulation face almost impossible odds, and may be doomed. Fitzgerald presents a consumer narrative of heroin use, and the consequences of this narrative for public health, law enforcement, users themselves, et al. Fitzgerald’s work represents a brilliant conceptual shift for approaching drug use and addiction.

Abstract: Most injecting drug users have never been in drug treatment yet much research is done on samples with high treatment rates drawn from agency and peer recruited populations. This study accessed drug injectors with little or no prior drug treatment, described their characteristics, BBVI risk behaviours and feedback on services. Its results challenge some stereotypes about citizens who inject drugs. A sample of 511 ’hidden’ drug injectors, of whom only 28.7% had any specialist drug treatment agency contact, completed a questionnaire which was distributed with ’Fitpack’ needle packs sold through community pharmacies in WA. The mean age of respondents was 26.2 years, 43.4% were women, 44.3% were living with their sexual partner, 41.7% were parents, and 46.4% were employed, mostly in full time work. In the previous month 61.2% had injected less frequently than daily. The study accessed a diverse group of drug injectors not typically seen in agency and peer recruited research. They provided useful feedback about how harm reduction strategies among injectors can be improved. However, they also reported higher rates of injecting and sharing than found previously in traditionally recruited samples of injectors, which suggests there is no room for complacency regarding the potential for blood-borne viral infection (BBVI) transmission in this group.