Changes in Needle Sharing and Syringe Cleaning among San Francisco Drug Abusers

Studies conducted from 1985-1987 indicated that most intravenous drug users in San Francisco were attempting to reduce their risks of infection with HIV by cleaning their syringes with bleach but these studies found only small changes in the reported frequency of needle sharing. Recent analyses of patient reports in our San Francisco drug- abuse clinic reveal considerable decreases in needle sharing as well. All clients entering the outpatients heroin detoxification clinic of San Francisco General Hospital from 1986-1988 answered questions about the number of times they had shared needles in the previous month and the number of people who had shared each needle. To assess the change in such statistics over time we selected all clinical admission (n=313) in June of each of the 3 years. The results are shown in Figure 1. The proportion of patients sharing needles decreased from 55% to 28% (p<0.001). However the decrease is accounted for by patients reporting 1 needle-sharing partner which decreased from 37% to 15%. The proportion of patients who reported sharing a needle with 2 or more partners decreased only 5%--from 18% in 1986 to 13% in 1988. In a multiple logistic regression analysis controlling for age sex race and previous treatment cocaine use was significantly (p<0.05) associated with needle sharing with multiple partners in the month before admission. In addition patients have reported using condoms in the syringe-cleaning process. The rubber plunger becomes stiff when the syringe is repeatedly sterilized with bleach. Several patients have reported lubricating the plunger by inserting it into the packet of a lubricated condom thus restoring its smooth action. The use of condoms to lubricate syringes may have some value if the lubricant contains sufficient nonoxynol 9 and provided it does not contribute to irritation or infection. This practice also provides drug users with a reason to carry condoms eliminating 1 reason for not using them during sexual activity. (full text)