Table of Contents
- Sharing Needles and HIV Infection
- Drug Treatment Programs
- New Needles
- Needle Exchange Programs
- Cleaning Needles
- Taking Care of Yourself and Others
Injection drug use (IDU) accounts for a large number of HIV infections. Sharing needles, syringes, and drug injection equipment or "works" (including cookers and cotton) allows HIV to be spread from one person to another. The World Health Organization (WHO) reports that about 16 million people inject drugs worldwide, and that three million of those are people living with HIV (HIV+). Globally, one out of every ten new HIV infections is caused by injection drug use on average. However, there are some areas of Central Asia and Eastern Europe where as many as eight out of every ten new HIV infections are the result of injection drug use.
Blood from a person living with HIV can remain in or on a needle or syringe and then be transferred directly to the next person who uses it. HIV-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") to filter out particles that could block the needle
Injection drugs users can reduce the risk of HIV infection in the following ways:
- Using drug treatment programs to get help with quitting
- Using a new, sterile needle and syringe every time and not sharing needles, syringes, cookers, or cotton with others
- Using needle exchange programs to get new unused needles and syringes, etc.
- If new, unused needles and syringes are not available, cleaning the ones that have been used thoroughly before using them again with another person (for instructions, see below). There are also videos about how to clean syringes in the Additional Resources section at the bottom of this article.
Stopping injection drug use altogether is probably the best thing you can do for your health. This may be an incredibly hard thing to do and it may not work for everyone. However, it will get rid of all the risk of HIV infection that comes from sharing contaminated needles, syringes, cookers, and cottons.
Drug treatment programs are available in many countries to help you in stopping injection drug use. 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 Additional Resources section below for help in finding a program. Also see our article on Substance Abuse and Addiction  for more information on the link between substance use and HIV and what you can do if you struggle with substance abuse.
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. Do not 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 US 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 can give new syringes and needles to people who inject drugs 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 spread of HIV, some people oppose them. The WHO (World Health Organization) strongly supports the use of evidence-based needle and syringe programs as part of HIV prevention methods. There are needle exchange programs in some countries, but they are not available everywhere. In the US, some states have needle exchange or syringe access programs, while others do not.
Needle exchange programs offer a good way for people who inject drugs 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 programs. To find a needle exchange program in the US, see the list in the resource section of this article.
If you must share needles and syringes because new, unused ones are not available, 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 cleaning with bleach does not make re-using the equipment risk-free. However, it is an important tool to reduce the risk of infection. 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 (full-strength, no water added) 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).
- 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
People who inject drugs are also at a high risk for getting hepatitis B (HBV)  and C (HCV) , both of which are diseases spread through blood that damage the liver. HCV infection is common in people who inject drugs – a study from 2011 showed that six to eight out of ten people who inject drugs in 25 countries were infected with HCV. HBV infection is less common, with up to one in ten people who inject drugs infected with HBV in 21 countries.
Hepatitis is easily spread through sharing 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.
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 at risk through injecting drugs either now or in the past, get tested for HIV  and hepatitis. You can also put your sexual partners at risk if you have unprotected sex, so it is important to use condoms and practice safer sex .
The original version of this article (2006) was adapted from materials from the San Francisco AIDS Foundation and the University of Albany.
Illustrations from Heart of Richmond AIDS Society (http://heartofrichmond.com/ )