Reducing the Risk of Getting HIV From Injection Drug Use

What Is the Risk?

It is well documented that people who share syringes are at risk of being infected with HIV. Sharing syringes allows a direct exchange of blood from one person's body into the bloodstream of another and is one of the most efficient ways to spread blood-borne diseases -- such as HIV and Hepatitis -- from one person to another.

When a person puts a syringe into the vein, s/he will pull back the plunger to make sure that they are in a vein, and if they are, blood will enter the syringe. Some of this blood may still be in the syringe if it is used by a second person.

An injection drug user who has never shared syringes will not get HIV from syringes regardless of his or her drug use. It's the exchange of blood from the sharing of syringes that causes transmission, not the drug use itself. That being said, stopping injection drug use altogether can reduce your risk of becoming infected with HIV because it eliminates the chance that you might share needles with someone else. If you live in San Francisco, our HIV Prevention Project can offer you referrals to drug treatment programs to help you stop using.

How Can Transmission Be Prevented?

If possible, don't share syringes or any other injection supplies (such as water or cotton)

Anyone who uses needles should avoid sharing them. Sharing needles with anyone -- even close friends -- can put you at risk for HIV and other blood-borne diseases. Using your own 'works' is the best protection against potential exposure to HIV if you choose to inject drugs. When people use a sterile syringe each time they inject, they are significantly reducing their risk of contracting HIV and hepatitis.

In order to obtain sterile syringes, we encourage you to take advantage of syringe exchange programs like the San Francisco AIDS Foundation's HIV Prevention Project. For syringe exchange referrals, see the list of links to exchange web sites maintained by the North American Syringe Exchange Network; if you live in California, call the San Francisco AIDS Foundation's California AIDS Hotline toll free at 800-367-AIDS; if you live outside California, call the CDC National AIDS Hotline toll free at 800-342-AIDS.

In many parts of the United States (including some localities in California), you can purchase sterile syringes without a prescription from a local pharmacy.

If you do share syringes, keep in mind that bleach cleaning is not risk free - for example, bleach does not kill the Hepatitis C virus - but is an important tool for reducing the risk of becoming infected. For it to be effective you must be consistent and careful in following syringe cleaning procedures.

If you must share, clean your syringes with bleach immediately before and after each use and follow these procedures:

  • Before using bleach, flush the syringe with water to rinse fresh or dried blood that may remain in the barrel.
  • Fill the syringe all the way up with bleach and leave it in the syringe for a full two minutes.
  • Discard the bleach and repeat.
  • Rinse the syringe twice with water when you are finished.

Injection Drugs and Hepatitis

Injection drug users are also at a high risk for contracting Hepatitis B and C, both of which are blood-borne diseases. These viruses are much easier to contract than HIV due to the high concentration of hepatitis in the blood stream and its ability to survive outside the human body.

Hepatitis B is caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is spread when blood from an infected person enters the body of a person who is not infected. For example, HBV is spread through having sex with an infected person without using a condom or by sharing drugs, needles, or "works" when "shooting" drugs.

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person. Although it is rarely transmitted sexually, it is very easily transmitted through the sharing of needles and other injection supplies, such as cookers and cotton. HCV infection is highly prevalent among injection drug users -- studies have found that 50-90% of injection drug users are infected with HCV. The CDC estimates that 60% of all new cases of hepatitis C are among injection drug users.

To learn more about Hepatitis, visit or

In order to avoid hepatitis B or C, injection drug users should not share any part of their safer injection supplies. This includes the syringe, cotton, water, cooker and tourniquet.

Needle Exchange Programs

Under California law, cities and counties in the state can choose to legalize needle exchange programs through the passage of a declaration of a public health emergency. San Francisco has authorized local needle exchange programs since 1993. Localities in California can also choose to allow local pharmacies to sell syringes without requiring a prescription. Many localities have taken these important steps to expand access to sterile syringes, but others have not.

The San Francisco AIDS Foundation HIV Prevention Project (HPP) operates one of the largest needle exchange programs in the United States. There are 10 exchange sites per week in different locations throughout the city. HPP exchanges over 2.3 million syringes a year.

Other needle exchange sites exist around the state and around the country, but needle exchange remains controversial and is not universally available. Despite significant scientific research documenting the effect needle exchange programs have had in reducing the spread of HIV, the U.S. government continues to prohibit the spending of federal dollars on needle exchange programs.

For syringe exchange referrals, see the list of links to needle exchange web sites maintained by the North American Syringe Exchange Network; if you live in California, call the San Francisco AIDS Foundation's California AIDS Hotline toll free at 800-367-AIDS; or if you live outside California, call the CDC National AIDS Hotline toll free at 800-342-AIDS. For additional information on legal and policy related issues related to syringe access efforts go to SFAF's Syringe Access page or visit the Drug Policy Alliance web site.

Drugs, Sex and HIV Transmission

Keep in mind that if you share syringes, you may also be putting your sexual partners at risk through sexual activity. If you are having sex with anyone, you can find out about the risks of infection through various sexual activities, and ways to reduce those risks, in the safer sex section of this site.

In addition, studies have found a connection between drug use and HIV transmission. Drugs such as crack, crystal meth, alcohol and others can increase sexual desire and/or impact a person's sexual behavior in ways that can lead to unsafe sex. Unprotected sex may also occur when sexual favors are exchanged for money to buy drugs like crack or crystal meth.

Smoking crack or crystal meth may also be a co-factor in transmission of HIV because it can cause severe burns or cuts on the mouth and lips. These cuts or burns can serve as a transmission site for HIV or other blood-borne infections during oral sex or when sharing pipes used for smoking crack.