sodium-hypochlorite and HIV-Infections

The Revised National Tuberculosis Control Programme (RNTCP) aims to improve case detection rates of tuberculosis to facilitate prompt recognition and treatment. The low case detection rates in the programme can be directly attributed to failure to screen patients with suspected tuberculosis and the low sensitivity of the direct smear microscopy method to detect cases among the fraction of patients that are screened. Apart from low sensitivity, this method also has other disadvantages including the increased risk of infection transmission to technicians. There are several methods that can be used to improve sensitivity, but their applicability in a national programme and in resource limited settings are limited. Bleach processing of sputum smears prior to microscopy may be a cheap and effective way to improve on the sensitivity of the direct smear. Four distinctive techniques of sputum smear processing using bleach are described in the review, with the variations in each technique, along with the sensitivity. An analysis of reports published earlier on the bleach method is also presented including a discussion on when and why the bleach method works.

Topics: Bacteriological Techniques; Disinfectants; HIV Infections; Humans; Microscopy; Sodium Hypochlorite; Sputum; Tuberculosis, Pulmonary

The social dynamics of prostitution render prostitutes unable at times to meet basic human needs, vulnerable to violence, and at risk for sexually transmitted disease. Since April 1989 a mobile van from a private foundation has been contacting prostitutes throughout the five boroughs of New York City to provide HIV testing and counseling and to distribute condoms, bleach kits for cleaning needles, and HIV prevention information. Data collected from 1,963 female prostitutes are discussed in this article. Information is provided on demographics, family and living arrangements, sex and drug practices, HIV status and risk reduction practices, and health history. Methods are discussed for social workers to develop creative ways to provide outreach and develop relationships with a vulnerable population that invests much effort in remaining concealed.

Topics: Adult; AIDS Serodiagnosis; Community-Institutional Relations; Condoms; Counseling; Disinfection; Family Characteristics; Female; HIV Infections; Humans; Needles; New York City; Risk Assessment; Risk Factors; Sex Work; Sexual Behavior; Sexually Transmitted Diseases; Social Environment; Social Work; Sodium Hypochlorite; Substance-Related Disorders; Violence

In the United States, a major federally-funded approach to HIV-1 prevention for injecting drug users (IDUs) includes teaching them to always rinse their needles/syringes with household bleach and water before use. This report describes interdisciplinary studies of the extent to which HIV-1 can be found in injection equipment and the efficacy of bleach as a disinfectant, under simulated field conditions. Bloody needle/syringe units collected from Miami, Florida, shooting galleries or from community outreach prevention participants were selected for these studies. Groups of needle/syringe units were cleansed with bleach using a standard technique taught to IDUs in community outreach programs. Cleansed and uncleansed groups of needles/syringe units were then tested for the presence of HIV-1. The data demonstrate the efficacy of bleach rinses in reducing the risks of HIV-1 infection from needle/syringe units and indicate that the teaching of a bleach cleansing method to IDUs should be part of a total AIDS prevention protocol.

Topics: Disinfection; HIV Infections; HIV-1; Humans; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

Human immunodeficiency virus (HIV) infection among injecting drug users remains a major health problem. Traditional approaches to prevent parenteral transmission of HIV infection in this population include abstinence facilitated through treatment for drug abuse, HIV testing with education and counseling, disinfection of needles with bleach between uses, and needle exchange programs. While each of these strategies are important and contribute to risk reduction, high-risk behavior and transmission of HIV infection continues. The development and distribution of safe and effective HIV vaccines in this population is urgently needed.

Topics: AIDS Vaccines; Disinfection; HIV Infections; Humans; Needle-Exchange Programs; Needles; Risk-Taking; Sodium Hypochlorite; Substance Abuse, Intravenous

Topics: Disinfection; HIV Infections; Humans; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

In 1986, community outreach workers began distributing small bleach bottles to injection drug users (IDUs) in San Francisco as a simple means for them to reduce their risk of infection with HIV and other pathogens by quickly flushing their syringes with bleach. At inception, the intervention was based on four assumptions: (a) sole reliance on expanded drug treatment capacity could not achieve HIV prevention goals, (b) legal barriers made syringe distribution or exchange schemes unfeasible, (c) IDUs would act in their own interest if the measures offered were acceptable to them, and (d) using bleach would diminish the risk of HIV transmission from reusing injection equipment. Following successful implementation of this program in San Francisco, similar programs were developed in many locations. These programs serve as the principal means of preventing needle-borne HIV infection among IDUs not enrolled in drug abuse treatment in the United States. Needed are definitive laboratory studies to determine the effectiveness of bleach decontamination as presently used by IDUs.

Topics: Disinfection; HIV Infections; Humans; Needles; San Francisco; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; United States

At the heart of the recommendations to prevent HIV transmission in workers who perform high-risk tasks are the universal blood and body fluid precautions. These precautions are meant to be followed by all health-care workers in the care of all patients and by public safety workers (e.g., firefighters, police officers, and correctional facility personnel) whenever they perform specific tasks that expose them to blood, body fluids, or tissues. Universal precautions apply to blood, semen, vaginal secretions, body tissues, cerebrospinal fluid, synovial fluid, pleural fluids, peritoneal fluid, pericardial fluid, and amniotic fluid. These fluids have either been implicated in HIV transmission or their risk of transmission is unknown. Other fluids or excretions are excluded from universal precautions because epidemiologic studies have failed to implicate them in HIV transmission. These include feces, nasal secretions, sputum, sweat, tears, urine, vomitus, breast milk, and saliva, unless they contain visible blood. However, routine precautions (handwashing, gloves, etc.) to prevent exposure to other diseases transmitted by these media should be followed. Other precautions are directed at health-care workers who perform specialized at-risk procedures, e.g., surgeons, dentists, laboratory workers, etc. In general, recommendations for these workers include the universal precautions plus additional emphasis on the use of barrier measures. Although the risk of environmentally mediated HIV transmission is negligible, it is theoretically possible, and recommendations to kill or inactivate HIV on environmental surfaces should be followed. Fortunately, HIV is easily inactivated in the environment. The cheapest and most convenient method is a 1:10 or 1:100 dilution of household bleach.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allied Health Personnel; Centers for Disease Control and Prevention, U.S.; Decontamination; Disinfection; Health Workforce; HIV Infections; Humans; Maintenance; Occupational Diseases; Protective Clothing; Risk Factors; Sodium Hypochlorite; Sterilization; United States

Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were 5.21 dollars/episode averted, 0.62 dollars/diarrhea-day averted, and 1,252 dollars/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been 11 dollars/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.

Topics: Cost-Benefit Analysis; Diarrhea; Family Characteristics; HIV Infections; Humans; Patient Education as Topic; Quality-Adjusted Life Years; Rural Health Services; Sodium Hypochlorite; Treatment Outcome; Uganda; Water Purification

Diarrhea is frequent among persons infected with human immunodeficiency virus (HIV) but few interventions are available for people in Africa. We conducted a randomized controlled trial of a home-based, safe water intervention on the incidence and severity of diarrhea among persons with HIV living in rural Uganda. Between April 2001 and November 2002, households of 509 persons with HIV and 1,521 HIV-negative household members received a closed-mouth plastic container, a dilute chlorine solution, and hygiene education (safe water system [SWS]) or simply hygiene education alone. After five months, HIV-positive participants received daily cotrimoxazole prophylaxis (160 mg of trimethoprim and 800 mg of sulfamethoxazole) and were followed for an additional 1.5 years. Persons with HIV using SWS had 25% fewer diarrhea episodes (adjusted incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI] = 0.59-0.94, P = 0.015), 33% fewer days with diarrhea (IRR = 0.67, 95% CI = 0.48-0.94, P = 0.021), and less visible blood or mucus in stools (28% versus 39%; P < 0.0001). The SWS was equally effective with or without cotrimoxazole prophylaxis (P = 0.73 for interaction), and together they reduced diarrhea episodes by 67% (IRR = 0.33, 95% CI = 0.24-0.46, P < 0.0001), days with diarrhea by 54% (IRR = 0.46, 95% CI = 0.32-0.66, P < 0.0001), and days of work or school lost due to diarrhea by 47% (IRR = 0.53, 95% CI = 0.34-0.83, P < 0.0056). A home-based safe water system reduced diarrhea frequency and severity among persons with HIV living in Africa and large scale implementation should be considered.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Child; Child, Preschool; Diarrhea; Disinfectants; Female; HIV; HIV Infections; Housing; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Rural Population; Severity of Illness Index; Sodium Hypochlorite; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda; Water Purification; Water Supply

A U.S. study of WF10, a mixture of Hydrogen Peroxide and bleach, suggested that WF10 improves the function of macrophages, damages HIV once WF10 is released by an infected cell, enhances resistance to infections, and does not interfere with AZT or ddI activity. WF10 does not show any toxicity in the liver, bone marrow, or kidneys; side effects were mild and temporary. WF10 is available from Canada through Health Canada's Special Access Programme and costs approximately $1,200 to $1,600 per cycle.

Topics: AIDS-Related Opportunistic Infections; Female; HIV; HIV Infections; Humans; Hydrogen Peroxide; Macrophage Activation; Macrophages; Male; Placebos; Sodium Hypochlorite; Virus Replication

Laos has a high prevalence of tuberculosis (TB) and a slowly increasing prevalence of human immunodeficiency virus/acquired immunedeficiency syndrome (HIV/AIDS). Sputum smear microscopy is the only method currently available for routine screening of pulmonary TB, although it only detects one in three cases among persons living with HIV (PLWH). Bleach treatment of sputum samples (bleach method) has been shown to significantly improve the sensitivity of the test; however, its effectiveness in PLWH remains to be determined in Laos.. To determine the performance of the bleach method as a diagnostic tool for pulmonary TB in PLWH and to assess its cost-effectiveness in Laos.. Of 174 sputum samples collected from 92 patients, 29 were culture-positive for Mycobacterium tuberculosis in 17 patients. The sensitivity of the direct method and the bleach method was respectively 59% and 93%, and specificity was 100% for both methods. The incremental cost-effectiveness ratio for screening an additional case was US$17.40.. The bleach method is simple, cheap, easy to perform and cost-effective in PLWH. Its implementation in laboratories involved in routine screening of pulmonary TB among PLWH would allow practitioners to start the treatment of this life-threatening co-infection earlier.

Topics: Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections; Bacteriological Techniques; Bleaching Agents; Child; Coinfection; Cost-Benefit Analysis; Female; Health Care Costs; HIV Infections; Humans; Laos; Male; Microscopy; Middle Aged; Mycobacterium tuberculosis; Predictive Value of Tests; Prevalence; Prospective Studies; Sensitivity and Specificity; Sodium Hypochlorite; Specimen Handling; Sputum; Tuberculosis, Pulmonary; Young Adult

The purpose of the study was to evaluate the performance and feasibility of tuberculosis diagnosis by sputum microscopy after bleach sedimentation, compared with by conventional direct smear microscopy, in a setting of high prevalence of HIV.. In a community-based study in Kenya (a population in which 50% of individuals with tuberculosis are infected with HIV), individuals with suspected pulmonary tuberculosis submitted 3 sputum specimens during 2 consecutive days, which were examined by blind evaluation. Ziehl-Neelsen-stained smears were made of fresh specimens and of specimens that were processed with 3.5% household bleach followed by overnight sedimentation. Two different cutoffs for acid-fast bacilli (AFB) per 100 high-power fields (HPF) were used to define a positive smear: >10 AFB/100 HPF and 1 AFB/100 HPF. Four smear-positive case definitions, based on 1 or 2 positive smears with the 1 AFB or 10 AFB cutoff, were used.. Of 1879 specimens from 644 patients, 363 (19.3%) and 460 (24.5%) were positive by bleach sedimentation microscopy, compared with 301 (16.0%) and 374 (19.9%) by direct smear microscopy, with use of the 10 AFB/100 HPF (P < .001) and 1 AFB/100 HPF (P < .001) cutoffs, respectively. Regardless of the case definition used, bleach sedimentation microscopy detected significantly more positive cases than did direct smear microscopy: 26.7% (172 of 644) versus 21.7% (140 of 644), respectively, with the case definition of 1 positive smear and the 1 AFB/100 HPF cutoff (P < .001), and 21.4% (138 of 644) versus 18.6% (120 of 644), respectively, with the case definition of 1 positive smear and the 10 AFB/100 HPF cutoff (P < .001). Inter- and intrareader reproducibility were favorable, with kappa coefficients of 0.83 and 0.91, respectively. Bleach sedimentation was relatively inexpensive and was not time consuming.. Bleach sedimentation microscopy is an effective, simple method to improve the yield of smear microscopy in a setting of high prevalence of HIV. Further evaluation of this method, under operational conditions, is urgently needed to determine its potential as a tool for tuberculosis control.

Topics: Bacteriological Techniques; Centrifugation; HIV Infections; Humans; Microscopy; Prevalence; Sodium Hypochlorite; Specimen Handling; Sputum; Tuberculosis, Pulmonary

Bleach sputum concentration and fluorescence microscopy (FM) are reportedly more sensitive than direct Ziehl-Neelsen (ZN) sputum smears for tuberculosis detection, and might be particularly valuable for human immunodeficiency virus (HIV)-positive patients excreting fewer bacilli. This study, implemented in Yaoundé, Cameroon, determined the yield from both direct and bleach-concentrated FM and ZN duplicate smears against culture on Löwenstein-Jensen medium, with HIV testing from the sputa. From 418 HIV-positive and 518 HIV-negative tuberculosis suspects, 185 (44.3%) and 243 (46.9%) cultures, respectively, grew Mycobacterium tuberculosis. Direct ZN was positive for, respectively, 87 (47.0%) and 202 (83.1%) of the culture-positive cases. Proportional incremental yield over direct ZN from ZN and FM bleach smears was 14.9% (P < 10(-3)) and 17.2% (P < 10(-4)) for HIV-positive versus 4.9% (P < 10(-2)) and 2.0% (non-significant) for HIV-negative cases. There was no gain from direct FM. Bleach FM showed 2% excess false positives. The bleach concentration, therefore, increases the yield of ZN and FM, particularly from HIV-positive patients, but with a higher risk for false positives with bleach FM. With excellent baseline direct ZN, the gain remains modest. Field studies under real-life conditions are needed to determine whether it is worth the risks and operational challenges in HIV high-prevalence populations. FM was not more sensitive than ZN in this study, probably because of sub-optimal objective power and background staining. Culture on solid media with sparing laurylsulfate decontamination was clearly superior for HIV-positives, but it remains to be seen if culture also leads to more cases started on treatment routinely.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Centrifugation; Chi-Square Distribution; Child; Child, Preschool; Enzyme-Linked Immunosorbent Assay; Female; HIV Infections; Humans; Male; Microscopy; Middle Aged; Mycobacterium tuberculosis; Rosaniline Dyes; Sensitivity and Specificity; Sodium Hypochlorite; Sputum; Tuberculosis; Young Adult

We describe the performance of bleach-digested Zeihl-Neelsen (ZN) smears in TB suspects with/without HIV. In total, 51 (26%) and 62 (31%) out of the first 198 spot and digested smears were positive. Seven of the 30 HIV-positive patients had TB and their ZN smears were negative, scanty or 1 +. Six of seven digested smears were scanty. Forty-two of 115 HIV-negative patients had TB. Eleven (26%) of their digested smears were negative, 12 (29%) scanty and 19 (45%) positive. Despite the lower bacilli numbers of HIV-positive patients, the technique had sensitivity and specificity similar to that in HIV-negative patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections; Cytological Techniques; Female; HIV Infections; Humans; Male; Microscopy; Middle Aged; Mycobacterium tuberculosis; Predictive Value of Tests; Sensitivity and Specificity; Sodium Hypochlorite; Specimen Handling; Sputum; Tuberculosis, Pulmonary

The bleach digestion of sputum may improve the yield of smear microscopy but has not been validated in patients with HIV. Therefore we assessed the performance of bleach-digested smear microscopy among patients with HIV. One thousand three hundred and twenty one patients with chronic cough submitted three sputum samples for direct smear microscopy and were offered HIV tests. One sample was selected for a bleach-digested smear and another one was cultured. Patients were classified as having 'definite' (>or=2 positive smears), 'very likely' (smear-negative, culture- positive), 'less likely' (one smear-positive, culture-negative) and 'unlikely' (smear and culture negative) tuberculosis (TB). In all, 566/1045 (54%) patients were HIV positive and 731/1186 (62%) were culture positive. The digested smears were positive in 123/125 (98%) 'definite', 4/118 (3%) 'very likely' and 1/174 'unlikely' TB patients with HIV and in 125/127 (98%) 'definite', 2/74 (3%) 'very likely', 4/4 'less likely' and 2/127 'unlikely' TB without HIV. Three direct smears identified 252 (57%) and one digested smear 254 (57%) of the 444 patients with 'definite' or 'very likely' TB. One bleach-digested smear performed similarly to three direct smears. Both methods were less sensitive in HIV-positive patients. Further studies are needed to compare the performance of the two methods under operational conditions.

Topics: Cross-Sectional Studies; Disinfectants; HIV Infections; Humans; Mycobacterium tuberculosis; Prospective Studies; Sensitivity and Specificity; Sodium Hypochlorite; Sputum; Tuberculosis, Pulmonary

Topics: Communicable Disease Control; Disinfectants; HIV Infections; HIV-1; Humans; Needle Sharing; Sodium Hypochlorite

Bleaching of syringes has been advocated to prevent HIV-1 transmission among injection drug users (IDUs). Bleach is frequently distributed by needle exchange, outreach, and educational programs targeting IDUs. We applied a sensitive HIV-1 microculture assay to determine the effectiveness of bleach in disinfecting syringes contaminated with HIV-1. This study demonstrates that in a laboratory environment designed to replicate injection behaviors, undiluted bleach is highly effective in reducing the viability of HIV-1 even after minimal contact time. However, it did not reduce the HIV-1 recovery to zero. Furthermore, three washes with water were nearly as effective as a single rinse with undiluted bleach in reducing the likelihood that contaminated syringes harbored viable HIV-1. Given the reality that IDUs share syringes and may not have access to a new, sterile syringe for each injection, the results suggest that they should be encouraged through harm reduction interventions to clean their syringes, preferably with undiluted bleach.

Topics: Disinfectants; Equipment Contamination; HIV Infections; HIV-1; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; Time Factors

The use of bleach (hypochlorite) as a disinfectant for drug injection equipment in the intravenous-drug-using population was recommended early in the HIV-1/AIDS epidemic. Epidemiological studies have challenged the use of bleach as an effective measure to prevent HIV-1 transmission. However, in vitro HIV-1 coculture studies have shown that a high concentration of bleach is an effective cytotoxic and potentially virucidal agent. In this study, we demonstrate that HIV-1 peripheral blood mononuclear cell cocultures containing low concentrations of hypochlorite in the media showed earlier conversion to HIV-1 positivity, as measured by the presence of p24 antigen. HIV-1 cocultures with high concentrations of hypochlorite in the culture media, which appeared to be highly cytotoxic, and HIV-1 cocultures without bleach in the media did not exhibit this early p24 antigen positivity. Hypochlorite chemically disinfects by releasing free chlorine that is a potent oxidant. In injection drug equipment, a low residual concentration of bleach is likely to remain in cleaned equipment despite rinsing with water. Low concentrations of oxidants have been shown to enhance tissue inflammation, in vivo, as well as HIV-1 replication in vitro. Previous studies have shown that despite vigorous cleaning of blood-contaminated injection syringes with bleach followed by water, microaggregates of residual blood remained in bleach-cleaned blood-contaminated syringes. Hypothetically, oxidant effects of the residual bleach in the bleach-cleaned syringes could enhance the possibility of infection by remaining HIV-1 contained in a contaminated syringe. We suggest that the likelihood of an injection drug user contracting HIV-1 through the sharing of a bleach-cleaned blood-contaminated syringe may be increased by the cotransmission of residual bleach and its localized tissue-inflammatory effects; however, this has not been statistically proven in epidemiological studies.

Topics: Cell Survival; Coculture Techniques; Disinfectants; Disinfection; Dose-Response Relationship, Drug; Equipment Contamination; HIV Core Protein p24; HIV Infections; HIV-1; Humans; Leukocytes, Mononuclear; Needles; Oxidants; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; Virus Replication

In this study, we examined the relationship between depressive symptoms and needle-sharing behavior in a community sample of intravenous drug users (N = 499) in Baltimore, Maryland. Based on the polytomous logistic regression, higher depressive symptoms were positively associated both with needle sharing after cleaning with bleach and with needle sharing without first cleaning with bleach at the bivariate analyses. This relationship remained significant (OR = 1.66) even after adjusting for demographic characteristics, life events, drug use patterns, and social and drug networks. A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed. More depressed intravenous drug users who also had a larger drug network were found to be at higher risk of needle sharing after cleaning with bleach, as well as needle sharing without cleaning (OR = 2.59). Depression status is discussed as a predisposing factor and drug network size as a precipitating factor for needle-sharing behavior. Implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed.

Topics: Adult; Comorbidity; Depressive Disorder; Disinfection; Female; HIV Infections; Humans; Logistic Models; Male; Maryland; Needle Sharing; Needles; Risk Factors; Risk-Taking; Social Support; Sodium Hypochlorite; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

This study examines an intervention designed to improve needle-cleaning practices among injection drug users (IDUs) in Dayton and Columbus, Ohio, to meet the recommended bleach exposure time of at least 30 seconds. Simulated needle-cleaning practices were observed in offices at baseline and after an intervention at 2 to 4 week and 6-month follow-ups. Descriptive statistics, t-tests, logistic, and multiple regressions were used to examine behavior change and the correlates of safer cleaning practices. At baseline (n = 541), the mean bleach exposure time was 13.8 seconds. At first follow-up (n = 410), the mean bleach contact time (23.4 s) increased significantly (t = 8.59; p < .05). At 6-month follow-up (n = 83), the mean bleach exposure time (21.1 s) also increased significantly (t = 2.98; p < .05). Longer bleach contact time was associated with higher injection frequency and needle transfer at 6-month follow-up. Although mean bleach exposure time increased significantly at both follow-ups, only 30.3% of the IDUs kept bleach in the syringe for at least 30 seconds at 6-month follow-up. Improved interventions are needed.

Topics: Adult; Disinfectants; Disinfection; Evaluation Studies as Topic; Female; Follow-Up Studies; HIV Infections; HIV-1; Humans; Logistic Models; Male; Needles; Ohio; Sodium Hypochlorite; Substance Abuse, Intravenous; Time Factors

Syringe cleaning guidelines for injecting drug users (IDUs) were revised in 1993. This paper examines efforts by IDUs in NSW prisons to adopt the revised guidelines in 1994. Consecutive inmates (229) nearing release were visited and asked to call a toll free number for an interview once released. Respondents (102) did not differ from non-respondents (127). Many respondents (64%) reported ever injecting and many of these reported injecting (58%), sharing (48%) and syringe cleaning (46%) when last in prison. Some (23%) respondents reported adopting the revised syringe cleaning guidelines. Tattooing (38%) was reported more often than sexual activity in prison (4%). A new methodology for prison research was found to be feasible in this study. The potential for HIV to spread in prison still poses major public health challenges.

Topics: Adult; Disinfection; Female; HIV Infections; Humans; Male; Needle Sharing; New South Wales; Prisons; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

Topics: Disinfectants; HIV Infections; Humans; Needles; Risk Factors; Sodium Hypochlorite; Syringes

To evaluate the impact of an HIV risk-reduction program among injecting drug users (IDU) in Denver, Colorado.. A targeted, community-level intervention study with multiple, time-phased, cross-sectional measurements assessing HIV high-risk behaviors among IDU in intervention and comparison sites.. Neighborhoods with high IDU prevalence in Denver, Colorado (intervention site) and Long Beach, California (non-intervention comparison site).. Street-recruited IDU who had injected drugs in the previous 30 days and shared injection equipment in the previous 60 days to evaluate the use of bleach to clean injection equipment; or had sexual intercourse in the previous 30 days, to evaluate condom use.. A prevention program in which peer volunteers were recruited and trained to distribute and discuss intervention kits that included condoms, bleach bottles and role model stories.. Multiple cross-sectional surveys were conducted in the intervention and comparison sites to assess the impact of the intervention on the consistent use of bleach before sharing injection equipment and the consistent use of condoms for vaginal intercourse with steady and occasional partners.. Between February 1991 and December 1993, 1997 IDU were interviewed, 890 at the intervention site and 1107 at the comparison site. In contrast to the comparison site, subjects from the intervention site reported significant increases in consistent use of bleach [odds ratio (OR), 2.6; 95% confidence interval (CI), 1.3-5.1; P < 0.001], and consistent use of condoms with occasional partners (OR, 13.6; 95% CI, 3.2-58.0; P < 0.001).. This targeted, peer-based intervention was associated with significant HIV risk reduction among IDU in Denver and may be useful in other communities at risk for HIV infection.

Topics: Adult; Colorado; Community Health Services; Contraceptive Devices, Male; Disinfection; Female; HIV Infections; Humans; Male; Needles; Outcome Assessment, Health Care; Prevalence; Risk Factors; Sodium Hypochlorite; Substance Abuse, Intravenous

Topics: Adolescent; Adult; Centers for Disease Control and Prevention, U.S.; Contraceptive Devices, Male; Disinfection; Evaluation Studies as Topic; Health Education; HIV Infections; Humans; Needles; Sexual Behavior; Sodium Hypochlorite; United States

Sharing of contaminated needles constitutes one of the primary modes of HIV transmission in the U.S. This study examined social and environmental factors as possible correlates of needle sharing in a sample of inner-city drug users in Baltimore, Maryland. Drug users' social context was assessed through an analysis of personal networks, and the environmental context of drug use was assessed through a delineation of injection settings. The 330 respondents participating in an HIV prevention study were administered two surveys an average of 5.2 months apart. An examination of the association of network characteristics at baseline and needle sharing at followup revealed that the factors of higher total network density, larger drug network size, and injecting at friends' residences were positively associated with reports of sharing needles that had been cleaned with bleach. Sharing of needles that had not been disinfected with bleach was positively associated with reports of injecting in semipublic areas (streets, rooftops, parks, cars, public bathrooms, and abandoned buildings). These data support ecological and resource models of needle sharing and suggest the potential utility of network-oriented strategies for reducing needle sharing among injecting drug users.

Topics: Adult; Disinfection; Female; HIV Infections; Humans; Life Style; Male; Middle Aged; Needle Sharing; Needles; Risk-Taking; Social Behavior; Social Environment; Sodium Hypochlorite; Substance Abuse, Intravenous; Surveys and Questionnaires

Viable and potentially infectious HIV-1 has been recovered from the peritoneal dialysis effluent (PDE) of patients with end-stage renal disease (ESRD) who are infected with the human immunodeficiency virus (HIV). No information had previously been available as to how long HIV-1 could survive in this environment, and no data were available as to how long HIV-1 could survive on peritoneal dialysis exchange tubing (PDET). Therefore, this study was designed to answer these questions. HIV-1 Mn was added to PDE and allowed to incubate at room temperature for 0 to 14 days. Following centrifugation, the cellular component of the PDE mixture was placed in co-culture with peripheral blood mononuclear cells (PBMC) from HIV negative donors. Aliquots from the co-cultures were removed after 14 days and assayed for the HIV-1-P24 antigen. High levels of HIV P24 antigen were recovered up to and including seven days of room temperature incubation. HIV could not be recovered from PDE that had been incubated at room temperature for 10 to 14 days. Ten milliters of HIV-PDE mixture was placed within PDET and incubated at room temperature for 10 minutes. The solution was then removed by gravity drainage. After drying times of 0 to 168 hours, the tubing was flushed with HIV culture medium and placed in co-culture with PBMCs from HIV negative donors. The culture supernatant was assayed for the HIV-1 P24 antigen as a marker of viral replication. High levels of HIV-1 P24 antigen were recovered from the PDET wash for up to and including 48 hours of drying time. No viable virus could be detected for drying times of between 72 and 168 hours. To determine if common disinfectants found in the dialysis unit could inactivate HIV, dilutions of Amukin 50% and household bleach were prepared at final concentrations ranging from 1:32 to 1:2048. These disinfectant solutions were incubated with PDE containing HIV for 10 minutes. The cellular fraction of the PDE was isolated by centrifugation, washed, and placed in co-cultures with peripheral blood mononuclear cells. HIV P24 antigen levels were assayed every three days for 28 days. Amukin 50% and a 10% household bleach solution were effective in killing HIV in PDE at dilutions up to and including 1:512. These results indicate that HIV can survive in PDE at room temperature for up to seven days. HIV can survive on peritoneal dialysis exchange tubing for up to 48 hours. Final dilutions of 1:512 Amukin 50% and 10% household bleach, after 10 minutes o

Topics: Culture Media; Dialysis Solutions; Disinfectants; HIV Infections; HIV-1; Humans; Kidney Failure, Chronic; Kinetics; Peritoneal Dialysis; Sodium Hypochlorite; Time Factors

This study investigates factors influencing needle-bleaching intentions and behavior among IDUs who share injection equipment. Analysis of 443 interviews conducted with IDUs who share revealed that intention to bleach and frequency of bleaching were positively associated with attitudes, social norms, perceived behavioral control, and perceived risk of unsafe sharing. Intention was related (positively) to exposure to AIDS-prevention information, whereas frequency of bleaching was associated (negatively) with frequency of intoxication. Exposure to AIDS information may be more effective in creating intention to bleach needles than in stimulating behavior, and noninjection drug use may inhibit bleaching behavior.

Topics: Adult; Aged; Cross-Sectional Studies; Disinfectants; Disinfection; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Male; Middle Aged; Needle Sharing; Needles; Regression Analysis; Risk-Taking; Social Behavior; Sodium Hypochlorite; Substance Abuse, Intravenous

Topics: Disinfection; HIV Infections; Humans; Needles; Sodium Hypochlorite

To examine the HIV seroconversion rate, risk factors for seroconversion, and changes in risk behavior over time in intravenous drug users (IVDU) in San Francisco, 1985-1990.. Observational study.. All methadone maintenance and 21-day methadone detoxification programs in San Francisco.. A total of 2351 heterosexual IVDU, of whom 681 were seronegative at first visit and seen at least twice ('repeaters').. HIV seroconversion rates, risk factors for seroconversion, and changes in behavior.. The HIV seroconversion rate in repeaters was 1.9% per person-year (ppy) of follow-up [2.1% in women versus 1.7% in men (not significant); 4% in African Americans versus 1% in whites (P = 0.006); 3.9% ppy in the first third of the study, 1.2% in the second (P = 0.007), and 1.9% in the last (not significant)]. Risk factors for seroconversion were five or more sexual partners per year [hazard ratio (HR) = 2.6; P = 0.02], use of shooting gallery ever (HR = 2.9; P = 0.02), and less than 1 year (lifetime) in methadone maintenance (HR = 2.7; P = 0.02). Self-reported intravenous cocaine use fell from 33 to 15% over 5 years, shooting gallery use fell from 19 to 6%, and the proportion with five or more sexual partners fell from 25 to 10%. Bleach use rose to 75% of needle-sharers.. The 1985-1990 HIV seroconversion rate in IVDU (1.9% ppy) was comparable to that in San Francisco cohorts of homosexual men (1.4% ppy). A decline in HIV seroconversion coincided with changes in risk behavior. Stable attendance of methadone maintenance was highly protective: the seroconversion rate in subjects with 1 year or more in methadone was 12% ppy.

Topics: Adult; Amphetamines; Bias; Cocaine; Cohort Studies; Comorbidity; Disinfection; Equipment Contamination; Ethnicity; Female; Heroin Dependence; HIV Infections; HIV Seropositivity; HIV Seroprevalence; Humans; Injections, Intravenous; Male; Needle Sharing; Risk Factors; San Francisco; Sexual Behavior; Sexual Partners; Sodium Hypochlorite; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Substance-Related Disorders; Urban Population

Sodium hypochlorite (NaOCl) is widely used to inactivate retroviruses topically and on environmental surfaces. This proposal establishes the thesis that sodium hypochlorite and its related oxygen free radicals can be administered in minute quantities in vivo to achieve a reduction in retroviral titer within the infected individual. Published reports of animal studies and accidental sodium hypochlorite infusion in much greater concentrations have indicated that the protein depletion and oxidation of sulfhydryl compounds is reversible and possibly preventable by administration of disulfide reducing agents. Various methods of infusion can include the ex vivo retroviral inactivation of plasma utilizing extracorporeal circulation through a continuous centrifugal plasma separator. The utilization of infusion of low-concentration sodium hypochlorite dialysate for retroviral inactivation merits immediate experimental study. Chlorinated tap-water and table salt ingestion must also be among the environmental factors studied for correlation to HIV infection.

Topics: Animals; Disinfectants; HIV Infections; Humans; Infusions, Parenteral; Models, Biological; Proteins; Reactive Oxygen Species; Retroviridae Infections; Sodium Hypochlorite

We employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of needles and syringes among injecting drug users (IDUs) as a means of preventing human immunodeficiency virus (HIV) infection. Sixteen HIV-seroconverters who responded to bleach use questions and who reported injecting with shared or used equipment in the 6 months prior to their first positive visit were compared with 89 controls. Controls had remained HIV-seronegative at two or more visits, reported injecting with shared or used equipment, responded to bleach-cleaning questions, and were seen at recall visits +/- 6 months from the date of seroconversion of the index case. Risk factors associated with HIV seroconversion in univariate analyses were a history of sexual intercourse with an HIV-infected partner and the frequency of speedball (mixed heroin and cocaine) injections. After adjusting for confounders, we found no evidence that bleach use protected against HIV infection.

Topics: Adult; Case-Control Studies; Cocaine; Cohort Studies; Disinfection; Female; Heroin; HIV Infections; Humans; Male; Needles; New York City; Odds Ratio; Regression Analysis; Risk Factors; Sexual Partners; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

This report describes experiments assessing the effectiveness against HIV of potential disinfecting agents that are commonly available to IDU when they are sharing syringes. We exposed cell-free HIV, HIV-infected cells, and HIV-infected blood containing known quantities of HIV to household cleaning agents, alcohols, peroxide, and highly acidic materials for 1 min, in order to examine the effects of these materials on the infectivity of the HIV. Undiluted liquid laundry bleach and dilute liquid dish detergent reduced the number of culturable HIV to an undetectable level under the experimental conditions used. Diluted bleach was not completely effective. Other potential disinfecting agents, including ethanol, isopropyl alcohol, and hydrogen peroxide, were unable to disinfect high numbers of HIV-infected cells or infected blood. Liquid dish detergent warrants further study as a possible acceptable alternative to bleach. Our data provide support for recommendations to IDU that they disinfect shared syringes every time between users with full-strength liquid laundry bleach to reduce their risk of acquiring or transmitting HIV. When bleach is not available, liquid dish detergent or other available disinfecting agents such as rubbing alcohol, hydrogen peroxide, or high alcohol content beverages are more effective than water at disinfecting HIV, recognizing that these materials are less effective than bleach. Although these materials are effective, they should not be viewed as a substitute for decreased sharing of injection equipment by IDU, or increased availability of sterile needles and syringes.

Topics: 1-Propanol; Acetates; Acetic Acid; Alcoholic Beverages; Beverages; Cell Line; Detergents; Disinfection; Ethanol; HIV Infections; HIV-1; Humans; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

To evaluate the effectiveness of bleach disinfection of injection equipment, we tested HIV-1 inactivation by household bleach in needles and syringes. We obtained blood from HIV-1 infected injecting drug users (IDUs), placed small aliquots in needles and syringes. Blood with and without anticoagulant was incubated at room temperature for 3, 6, 18, and 24 h, and some needles and syringes from each condition were exposed to undiluted bleach for 15 and 30 s. The needles and syringes were then rinsed and the rinses were used to inoculate peripheral blood mononuclear cells (PBMNCs). HIV-1 replication was monitored using p24 enzyme linked immunosorbent assay (ELISA). We describe results that HIV-1 is inactivated in clotted and unclotted blood allowed to stand at room temperature for 3, 6, 18, and 24 h in needles and syringes using undiluted household bleach at 30 s of exposure time. These results are consistent with earlier findings that micropellets of HIV-1 were inactivated by bleach under similar conditions of exposure to bleach; 10% bleach was not effective at an exposure time of 30 s and undiluted bleach was not effective at an exposure time of 15 s to inactivate HIV-1 in clotted blood. Bleach concentration and exposure time are critical and HIV disinfection may not occur with inadequate exposure to bleach HIV.

Topics: Disinfection; HIV Infections; HIV-1; Humans; Leukocytes, Mononuclear; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; Temperature

To examine the putative protective effect of disinfectant use on HIV seroconversion among injecting drug users, we conducted a nested case-control study of black heterosexuals comparing 34 HIV seroconverters with 154 persistent seronegatives matched on gender, cocaine injection (yes/no), date of study entry, and duration of follow-up. Injecting drug users who reported using disinfectant all the time had an odds ratio of seroconversion of 0.87, as compared with those who reported no use of disinfectants; the corresponding odds ratio was 1.00 for those who used disinfectants less than all the time. We examined the effect of drug use and sex practice variables, and responses to a socially desirable responding scale as possible confounders for the effect of needle disinfection on HIV seroconversion; the adjusted odds ratios for disinfectant use and HIV seroconversion were unchanged in this analysis. Despite limited statistical power and the potential for residual confounding, these data suggest that disinfection of injection equipment is not a substitute for abstinence from drugs or use of sterile injection equipment.

Topics: 1-Propanol; Adult; Case-Control Studies; Cocaine; Cohort Studies; Disinfection; Female; Follow-Up Studies; HIV Antibodies; HIV Infections; HIV-1; Humans; Male; Needle Sharing; Needles; Odds Ratio; Sexual Behavior; Sodium Hypochlorite; Substance Abuse, Intravenous

Objectives were to measure syringe cleaning strategies used by injection drug users (IDUs) and to assess syringe contact with bleach during cleaning demonstrations. IDUs were interviewed about cleaning activities during their most recent injection episode; they demonstrated these activities on videotape. Coders reviewed the videotapes, categorized activities, and used stop watches to record bleach exposure. Of 161, 146 subjects reported cleaning at last injection, 85 (58%) of 146 used full strength bleach. Of bleach users, 20% had total contact time (duration of bleach inside syringe) of > or = 30 s; combining draw (time taken to fill syringe) and contact times, 54% of bleach users had total "flush" times of > or = 30 s. Median observed time per bleach flush was 16 s. Median reported cleaning times were twice as long as observed. Recent reports indicate 30 s of exposure to undiluted bleach is necessary to inactivate HIV in the laboratory; here, 80% of IDUs using bleach had contact of < 30 s. Judgment of contact time was inaccurate. On average, instructions advocating two bleach flushes may reach 30 s; here, half the subjects had insufficient time with two flushes. The majority showed inadequate techniques, therefore, alternate cleaning strategies should be developed.

Topics: Adult; Disinfection; Female; HIV Infections; Humans; Interviews as Topic; Male; Middle Aged; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; Time Factors; Videotape Recording

Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall and performance of the most commonly recommended bleach cleansing procedure of two complete fillings of the syringe with bleach, followed by two complete fillings with rinse water, and not putting used bleach and water back into source containers. IDUs were taught this procedure on enrollment in an HIV prevention demonstration project in Dade County, Florida. During follow-up session 6-12 months after initial training, the knowledge and ability of IDUs to perform bleach cleansing were assessed by trained observers using a standardized method. In 1988-90, we assessed the knowledge and ability of 450 IDUs to perform the bleach cleansing procedure taught at enrollment. More than 90% of IDUs assessed performed the basic steps. However, only 43.1% completely filled the syringe with bleach and only 35.8% completely filled the syringe with bleach at least twice. Substantial proportions of IDUs did not perform all the steps of the previously taught bleach cleansing procedure. Compliance decreased as the number of steps required was increased. This limited compliance may make bleach cleansing less effective and suggests that some IDUs may fail to adequately disinfect injection equipment and therefore sterile needles and syringes are safer than bleach-cleansed ones. Compliance testing can help assess the effectiveness of HIV prevention programs.

Topics: Disinfection; Florida; Follow-Up Studies; HIV Infections; Humans; Needles; Patient Compliance; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

Topics: Disinfection; HIV Infections; Humans; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous

Topics: Disinfection; HIV Infections; Humans; Needle Sharing; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

Topics: Disinfection; HIV Infections; Humans; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

Based on a 1988-91 sample of 422 drug-using arrestees in Los Angeles, this study compares the drug-related risk behavior of users whose preferred injection drug is cocaine and users with a preference for heroin or no preference between the two drugs. Cocaine preference is unrelated to the likelihood of needle sharing overall, needle sharing with strangers, needle sharing at shooting galleries, and failure to use bleach as a needle disinfectant. In analyses restricted to users who reported needle sharing, the frequency of sharing is no more closely related to heroin injection frequency than to cocaine injection frequency. These results suggest that local preventive education programs do not need to address distinctive patterns of drug-related risk behavior among injection cocaine users and injection heroin users in Los Angeles.

Topics: Adult; Choice Behavior; Cocaine; Crime; Disinfection; Female; Health Behavior; Health Education; Heroin Dependence; HIV Infections; Humans; Los Angeles; Male; Needle Sharing; Needles; Risk Factors; Risk-Taking; Sampling Studies; Sodium Hypochlorite; Substance Abuse, Intravenous

In 1988, the Institute for Epidemiological Research on Drug Dependence conducted an ethnographic study designed to assess the results of liberalization of the sale of syringes. In that study, drug addicts were found to have gradually altered their customary practices by limiting the sharing of syringes. Two years later, a second study was conducted to further assess the behavioural changes under way. The whole survey covered 359 subjects--165 in Paris, 110 at Marseille and 93 at Metz. Almost all the subjects stated that they knew about the risks of transmission of the human immunodeficiency virus (HIV) by needle and during unprotected sexual intercourse. Almost all of them (98 per cent) knew that syringes were freely sold at pharmacies. Most of them (84 per cent) felt that they were generally well informed on the subject of AIDS and the ways in which the virus was transmitted. Prostitutes accounted for 17 per cent of the sample, with more women (32 per cent) than men (13 per cent) included in that category. The overwhelming majority of the subjects bought their syringes at pharmacies, and the trend towards the non-sharing of syringes was confirmed, a change in behaviour that has emerged mainly since 1987. Among the "new generation" of drug addicts, namely those who began to inject after 1987, the changes are reflected in a much lower rate of infection--2 per cent instead of 28 per cent of the total. About a third of the subjects, however, continued to engage in practices involving a certain level of risk. In a global context, including subjects who do not know how to properly clean a syringe, a variety of usually ineffective practices are followed, for example rinsing with water, lemon juice, or scent. The use of bleach remained limited, and few people considered cleaning with it. Liberalization of the sale of syringes seems to be essential to the prevention of AIDS among drug addicts. But this measure is not enough in itself. Apart from the overall problems of looking after the health of drug addicts and ensuring access to medical care, certain specific measures remain highly desirable. Of particular importance is the dissemination of information clearly describing effective methods of sterilizing syringes (including the use of bleach).

Topics: Adolescent; Adult; Disinfection; Female; Follow-Up Studies; France; Health Knowledge, Attitudes, Practice; HIV Infections; HIV Seroprevalence; Humans; Male; Middle Aged; Needle Sharing; Needles; Risk Factors; Sex Work; Sexual Behavior; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes; Urban Population

Topics: Disinfection; HIV Infections; Humans; Needles; Sodium Hypochlorite

As new issues and areas of concern arise in the health care industry, such as the potential transmission of HIV and HBV, adaptive measures will continue to be developed to assist health care professionals in their mission to provide expert medical care for patients and safe environments in which to practice. Health care institutions must commit to exploration of the advances in infection control that employ improved measures to manage the cleaning and disinfecting of spill incidents involving blood and/or body fluids and the disinfecting of contaminated surfaces. Together, product manufacturers and health care workers will discover new ways to save time, money, and resources. The goal for health care administrators should be to focus on products that stress simplicity, efficiency, cost containment, and, most important, the safety of staff and patients.

Topics: Blood; Body Fluids; Centers for Disease Control and Prevention, U.S.; Costs and Cost Analysis; Disinfectants; Equipment and Supplies, Hospital; Hepatitis B; HIV Infections; Housekeeping, Hospital; Humans; Infection Control; Sodium Hypochlorite; United States

Time trends in needle sharing and bleach use were examined among needle users enrolled at drug abuse treatment and nontreatment sites in greater Worcester, MA, from 1987 through 1989. Substantial declines in high-risk behavior were found, with different trends at drug treatment versus nontreatment sites. The percentage of individuals sharing needles declined at treatment facilities but not at nontreatment sites. Among those sharing, the proportion using bleach increased at both drug treatment and nontreatment sites. The bleach distribution program in Worcester appears to be associated with increased bleach use among residents. Bleach use was associated with residence in Worcester, after controlling for age, gender, race, enrollment site, time period, and frequency of sharing. Risk reduction in the subpopulation of needle users entering treatment was greater than that among those not in treatment. As avoidance of sharing is likely to be more effective than bleaching for the prevention of human immunodeficiency virus (HIV) transmission, the subpopulation not in treatment should be targeted for prevention programs.

Topics: Adolescent; Adult; Cross-Sectional Studies; Disinfection; Female; HIV Infections; Humans; Male; Massachusetts; Needle Sharing; Needles; Residence Characteristics; Risk-Taking; Sodium Hypochlorite; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Time Factors

Topics: Disinfectants; HIV Infections; Humans; Injections, Intravenous; Needles; Sodium Hypochlorite; Substance Abuse, Intravenous; Syringes

We interviewed a group of 145 injecting drug users (IDUs) in Amsterdam about their drug use, participation in a needle-exchange programme and needle sharing. Approximately 1 year later 60 IDUs were followed up. IDUs who exchange regularly ('exchangers') are older, inject longer and are more often in contact with methadone programmes. Exchanging is associated neither with an increase in injecting nor with lending needles to other IDUs. The risk level of injecting of the exchangers is much lower than that of the non-exchangers. From this it can be concluded that a needle exchange is an effective prevention programme against the spread of HIV infection. However, efforts have to be made to reach the group of younger short-term injectors and those IDUs who are not in contact with methadone-maintenance programmes. Since there are indications that regular injectors in particular exchange, and since young male injectors are more at risk of borrowing independent of exchanging, it is argued that an exchange programme should be complemented with other prevention approaches, i.e. intensive counselling and the spread of leaflets with information on cleaning used needles with bleach.

Topics: Adult; Age Factors; Communicable Disease Control; Disinfection; Evaluation Studies as Topic; Female; Follow-Up Studies; HIV Infections; Humans; Male; Methadone; Needles; Netherlands; Odds Ratio; Risk Factors; Sodium Hypochlorite; Substance Abuse, Intravenous; Surveys and Questionnaires; Syringes; Time Factors