Injection drug use (IDU) accounts for a large number of HIV infections. Sharing of needles, syringes, and drug injection equipment or "works" (including cookers and cotton) allows HIV to be transmitted or passed from one person to another.

HIV is not transmitted through the drugs, it is transmitted through blood. This happens when an HIV+ person uses a needle to inject drugs. Blood from the infected person can remain in or on a needle or syringe and then be transferred directly to the next person who uses it. Infected blood can also find its way into drug solutions through:

• Using blood-contaminated syringes to prepare drugs
• Reusing water
• Reusing bottle caps, spoons, or other containers ("cookers") used to dissolve drugs in water and to heat drug solutions
• Reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle

Injection drugs users can avoid or reduce the risk of HIV infection in the following ways:

• Going to a drug treatment program
• Using a new, sterile needle and syringe every time and not sharing needles, syringes, cookers, or cotton with others
• Using needle exchange programs

If needles and syringes have been shared, cleaning them thoroughly between uses

Stopping injection drug use altogether is probably the best thing you can do for your health. This may also be the hardest and may not work for everyone, but it will completely eliminate the risk of HIV infection from sharing contaminated needles, syringes, cookers, and cottons.

Drug treatment programs are available throughout the country to assist you in reaching recovery. Some programs have waiting lists and women with children may need to make special arrangements. To find out if this a good option for you, look for a substance use treatment program in your area. See the resource section of this info sheet for help in finding a program.

If you do inject drugs, it is best to use a new, sterile needle and syringe every time you inject and not share needles and syringes with others. You might not think of yourself as having "shared" a needle and syringe if you shared it with a close friend or acquaintance. But sharing needles and syringes with friends can be as dangerous as sharing with strangers.

"Street sellers" of needles and syringes may repackage used needles and syringes and sell them as sterile when they are not. Don’t assume a needle and syringe are new, even if they seem to be packaged as new.

Obtain needles and syringes from reliable sources of sterile needles and syringes, such as pharmacies. In many parts of the U.S. you can purchase sterile needles and syringes without a prescription from a local pharmacy.

If you cannot buy new needles and syringes from a pharmacy, look for a needle exchange program (also called a syringe exchange program). Needle exchange programs have been authorized to give new syringes and needles to injection drug users without a prescription in order to prevent the spread of HIV and other blood-borne diseases.

Although scientific evidence shows that needle exchange programs do not increase drug use and do reduce the transmission of HIV, some politicians oppose them. There are needle exchange programs in many parts of the country, but they are not available everywhere.

Needle exchange programs offer a good way for injection drug users to reduce the risk of HIV transmission. In addition, these programs may be able to help you get benefits, medical care, and access to drug treatment. To find a needle exchange program, see list in the resource section of this info sheet.

If you do share needles and syringes, the risk of infection can be reduced by always cleaning them in bleach and water immediately after use and just before reuse. Keep in mind that bleach cleaning is not risk free, but is an important tool for risk reduction. For it to be effective you must be consistent and careful in following the cleaning procedures listed below.

Pour clean water into a cup, cap or something that only you will use.

Fill the syringe by drawing the water up through the needle to the top of the syringe.

Shake it around and tap it to loosen the blood.

Squirt out the water and repeat at least three times (do not reuse water).

Pour some undiluted bleach into a cup, cap or something that only you will use.

Fill the syringe by drawing the bleach up through the needle to the top of the syringe.

Shake it around and tap it. Leave the bleach in the syringe for at least 30 seconds.

Squirt out the bleach and repeat at least three times (do not reuse bleach).

Pour new clean water into a cup, cap or something that only you will use. Don't use the water from part one.

Fill the syringe with water, to rinse out the bleach. Fill the syringe by drawing the water up through the needle to the top of the syringe.

Shake it around and tap it for at least 30 seconds.

Squirt out the water and repeat three times (do not reuse water).

Some tips:

• You can substitute hydrogen peroxide or rubbing alcohol if you do not have any bleach. Use hard alcohol, not beer or wine, if that's all you've got.
• You can improve cleaning effectiveness by taking the set apart, removing the plunger from the barrel and soaking them in bleach for at least 30 seconds.
• Never shoot or drink the bleach.
• If the cooker (spoon) must be reused, soak it in bleach for at least 30 seconds and then rinse it with clean water.
• Since bleach loses its effectiveness with exposure to light, store all bleach for cleaning needles and works in a container that does not let light pass through.

Injection drug users are also at a high risk for contracting hepatitis B (HBV) and C (HCV), both of which are blood-borne diseases that attack the liver. HCV infection is common in injection drug users – studies have found that 50-90% of injection drugs users are infected with HCV.

Hepatitis is easily transmitted through the sharing of needles and other injection supplies, such as cookers, cotton, and ties. Cleaning your skin prior to injecting is important. Also make sure you throw away alcohol pads and cotton wipes so that no one else touches them. Wipe down surfaces when possible before injecting. Cleaning your injection drug equipment with bleach according to the directions listed above can kill HBV; it is unclear if it can kill HCV.

The best way to prevent hepatitis is to use a new needle and syringe each time, and never share any part of your works. Get vaccinated against hepatitis A and B to prevent infection with these two types of the virus; there is no vaccine to prevent hepatitis C.

Sharing a needle, syringe, or any related equipment for any use, including skin popping, injecting steroids, tattooing, and body piercing, can put you at risk for HIV and other blood-borne infections. If you plan to have body piercing or get a tattoo, make sure you go to a qualified technician who uses sterile equipment.

If you use needles for any reason, think about ways to eliminate or reduce the risk of transmitting diseases. The safest thing to do is to stop injecting drugs altogether. If this is not possible right now, get new, sterile needles each time you shoot up or find a needle exchange program. If you have to share, thoroughly clean your needles and works with bleach and water after each use and before reusing.

If you are or have put yourself at risk through injecting drugs, get an HIV and hepatitis test. You can also put your sex partners at risk if you have unsafe sex, so remember to use condoms.

This info sheet was adapted from materials from the San Francisco AIDS Foundation http://www.sfaf.org/aids101/injection.html and the University of Albany http://www.albany.edu/AIDS/prevention_3.html

Illustrations from Heart of Richmond AIDS Society http://www.heartofrichmond.com/PDF/needles.pdf

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Centers for Disease Control and Prevention Syringe Disinfection for Injection Drug Users http://thebody.com/cdc/idu_safety.html