Injection Drug Users' Reactions to Guidelines for Bleach Disinfection of Needles and Syringes: Implications for HIV Prevention

Abstract

The objective was to determine injection drug users' (IDUs) reactions to and willingness to adopt new National Institute on Drug Abuse, Center for Substance Abuse Treatment, and Centers for Disease Control provisional guidelines for bleach disinfection of needles and syringes (NS). In 1993, 154 IDUs participated in 17 focus groups in 8 U.S. cities. Process evaluations of transcriptions were completed utilizing qualitative techniques. Active IDUs expressed willingness to adopt most new recommendations. Syringe agitation and use of full strength bleach were acceptable. Pre-bleach water rinse, complete filling of the NS, post-bleach rinsing with fresh water, and longer bleach contact times were possible under favorable injection conditions. Cleaning both before and after injection and disassembling the NS for cleaning were unlikely to be adopted. Multiple barriers to consistent bleach use were identified. IDUs were willing to attempt new guidelines, but many circumstances interfere with adequate bleach disinfection. To avoid HIV exposure, increased access to sterile NS is necessary. Implications for HIV prevention are discussed.