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A Community Reinforcement Approach: Treating Cocaine Addiction

Exhibit 20: Recommendations to Prevent HIV Transmission Through Shared Drug Injection Equipment

All drug abusers should be aware of the potential for acquiring HIV infection and AIDS from sequentially using (sharing) injection equipment and paraphernalia and through sexual activity.
  • Persons with a negative HTV antibody test should be counseled to reduce their risk of acquiring HIV infection through sharing injection equipment by the following means:
    • Abstain from any further use of drugs by injection. This eliminates any new risk of bloodborne infections. Drug abuse treatment should be sought to aid in stopping drug use.
    • Do not share injection equipment with anyone. This further protects the drug user from contracting HIV infection. Care should be taken not only with needles and syringes but also with cotton balls, cookers, wash bottles, or any other materials possibly containing blood.
    • If you continue to share injection equipment, disinfect between uses. While it is not foolproof, boiling needles and syringes for 15 minutes is one way to sterilize equipment between uses; however, boiling plastic equipment may alter the shape and utility of the syringes. Cleaning injection equipment with disinfectants, such as bleach, does not guarantee that HIV is inactivated. DISINFECTANTS DO NOT STERILIZE EQUIPMENT. However, consistent and thorough cleaning of injection equipment with disinfectants such as bleach should REDUCE transmission of HIV if equipment is reused or shared.
    • To maximize the effectiveness of cleaning, needles and syringes should be flushed with water, preferably soon after use, before blood has time to clot in the needle and syringe. Continue flushing until the equipment is at least visibly clear of blood and debris. The use of soapy water and agitating (tapping, shaking, or "plucking") the equipment while cleaning may be helpful in removing blood and debris. The equipment should then be FILLED with fuil-strength household bleach for at least 30 seconds of contact before again rinsing with water. Even apparently clean equipment should be bleached before use unless it is known to be sterile. Bleach, which is highly corrosive, may alter the usefulness of the equipment.
  • Infected persons should be counseled to prevent further transmission of HIV by the following means:
    • Inform prospective drug-using partners and sexual partners of their infection so they can take appropriate precautions. Clearly, abstaining from drug injection and sexual activity with another person is one option that would eliminate any risk of HIV transmission by those routes.
    • Protect a partner during any drug use by taking precautions, as suggested above.
    • Since reinfection and/or infection with another strain of HIV may contribute to disease progression, HIV-infected drug users should refrain from reusing or sharing injection equipment to protect their own-health as well as that of others.

Source: Adapted from Centers for Disease Control and Prevention 1986.


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