What Is the Risk?

In the United States, drug use and dependence is widespread. It is estimated that there are approximately one million active injection drug users in the general population. It is widely recognized that the reuse and "sharing" of contaminated injection equipment and blood-contaminated dissolved drugs is a substantial risk factor for transmission of the HIV virus, hepatitis B and C and other blood-borne pathogens. Since the beginning of the HIV epidemic, the Centers for Disease Control (CDC) estimates that injection drug use (IDU) has directly and indirectly accounted for approximately one-third of the HIV/AIDS cases in the United States.1 Each year more than 8,000 people are newly infected with HIV through sharing contaminated syringes and works. These infections are preventable.

Although race and ethnicity are not, by themselves, risk factors for HIV infection, racial and ethnic minority populations in the United States are disproportionately affected by IDU-associated HIV/ AIDS.1 Results of the 2005 National Survey on Drug Use and Health revealed that the rate of current illicit drug use was higher for Native American and Alaska Natives (12.8%) than among persons of other races and ethnicities.4 In both male and female Native Americans and Alaska Natives, a larger percentage of HIV/AIDS cases were associated with only injection drug use.4 Also, the percentage was higher for NA/AN men who have sex with men (MSM) and inject drugs.4 Furthermore, IDU-associated HIV/ AIDS accounts for a larger percentage of cases among adolescents and adult women than men.

How Can Transmission Be Prevented?

Comprehensive Harm Reduction education on injection drug use to prevent HIV must provide education on how to prevent transmission through drug-related behavior and sexual activity whichposes significant risk not only to them selves, but to their sexual partners as well.

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  1. For the highest level or prevention, effective substance abuse treatment that helps people stop using drugs not only eliminates the risk of infection from sharing contaminated equipment, but, for many, reduces the risks of engaging in risky behaviors that might result in sexual transmission.

  2. For an injection drug user who cannot or will not stop injecting drugs, using sterile needles and syringes only once along with clean works remains the safest, most effective approach for limiting HIV transmission.

  3. An injection drug user who has never shared syringes will not get HIV from sharing syringe, however needs to be aware that they can still get HIV from sharing pipes, straws when snorting drugs, and from sharing works.

  4. If possible, do not share syringes or other injection supplies, such as water, cotton or the cooker/spoon because they may be contaminated with HIV or other blood-borne pathogens.

    1. To obtain sterile syringes, injection drug users should be encouraged to take advantage of syringe exchange programs: also called Harm or Risk Reduction Programs if they exist in the area.
    2. The North American Syringe Exchange Network maintains a list of some of the syringe exchange sites and referrals and can be accessed at www.nasen.org.
    3. In many parts of the United States, sterile syringes may be purchased at local pharmacies without a prescription.
  5. People who share syringes and works, even with close friends and family, are at risk of being infected with HIV and other blood born pathogens. Sharing syringes allows a direct exchange of blood from one person's body into the bloodstream of another and is an efficient way to spread HIV and other blood-borne pathogens, such as Hepatitis B and C which are much easier to transmit than HIV due to their ability to survive outside the human body.

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    If you share syringes, remember that bleaching is not risk free! However, it is an important element for reducing the risk of becoming infected and should be done immediately before and after each use. The following are recommended procedures.

    1. After each use and before using bleach, flush the syringe with cool water to rinse fresh or dried blood that may remain in the barrel.
    2. Fill the syringe all the way up with undiluted bleach and shake in the syringe for a full two minutes. (Bleach will kill HIV after 30 seconds, but it takes up to two minutes to kill Hepatitis B.)
    3. Discard the bleach and repeat.
    4. Rinse the syringe two more times, shaking with water when you are finished to remove all of the bleach which can damage the veins.
    5. Rinse out your cooker with cool water then bleach for 2 minutes and throw water away. Remember not to ever share cotton, as it can not be cleaned.
  7. Other strategies for reducing personal risk while sharing needles, are to always use the clean needle first and to repeat the bleach procedure in between use by other partners.

Drugs, Sex and HIV Transmission

If you share syringes, "works" or have unprotected sex with people other than your main partner, you may be putting yourself and your sexual partners at risk for HIV transmission through sexual activity.

Therefore, it is essential to ascertain the risk associated with various sexual activities and use safer sex techniques to reduce the risk to yourself and others.


  1. CDC, HIV/AIDS Surveillance Report, 2005. Vol. 17
  2. San Francisco AIDS Foundation, Reducing the Risk of Getting HIV From Injection Drug Use
  3. CDC, Drug-Associated HIV Transmission Continues in the United States, May 2002
  4. CDC, HIV/AIDS among American Indians and Alaska Natives, March 2007
  5. AIDS Health Project, Building Quality HIV Prevention Counseling Skills, September 2006
  6. CDC, HIV/AIDS among Men Who Have Sex with Men, May 2007

Online Resources

Continuum of Risk [IDU]