HIV transmission: guidelines for assessing risk - Canadian AIDS ...

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HIV TRANSMISSION: Guidelines for Assessing Riskincreased potential for HIV transmission because of theincreased likelihood of an exchange of blood, semen orvaginal fluid between partners.disease and complicateor reduce treatmentoptions.Evidence of TransmissionAlthough there are no documented cases of HIV that canbe directly attributed to these cultural practices, there havebeen studies which have shown that the rates of HIV arehigher in those regions which practice these activities 19 .Assessment of Risk of HIV TransmissionAccording to our model, the lack of documented cases inrelation to the high potential of risk would lead this activityto be categorized as Negligible Risk. In this case though,the potential for risk associated with the activity and thelack of mention in research literature precludes making arisk assignment.Part 2. Drug UseDrugs can be consumed many different ways. For thepurposes of HIV transmission the methods of consumptionthat we will examine include snorting, smoking and injection.Injection Drug Use“Shooting up, hitting up, jacking up, mainlining, cranking”Injection drug use may involve either street drugs (e.g.cocaine, heroin), prescription drugs (e.g. insulin, anabolicsteroids), hormones or vitamin supplements (e.g. intramuscularvitamin B12).Potential for TransmissionSharing needles or syringes has a very high potential fortransmission of HIV due to the presence of blood in theshaft of the used needle and in the tube of the used syringe.Whether it is visible or not, blood will almost certainly bepresent in a used needle or syringe in sufficient quantitiesfor transmission to occur. Infective HIV may remain presentin the blood in a used needle or syringe for up to 24 to 72hours 20 . Sharing needles and syringes can also transmit otherblood-borne viruses, such as hepatitis B and hepatitis C.These are of particular concern to people living with HIV(and vice-versa), as they can hasten the progression of theTo reduce the risk,a new needle andsyringe should beused every time. Ifsharing a needle orsyringe is absolutelyunavoidable, it isessential that they arecleaned using bleachand water to reducethe risk of contractingHIV. Any brand ofhousehold bleach willdo, although the mostconcentrated bleach(5% or more) is best.If undiluted bleach is not available, then diluted bleach isa less but still somewhat effective cleaning agent. Liquiddishwashing detergent can also help eliminate HIV. If nothingelse is available, hydrogen peroxide, rubbing alcoholor strong drinking alcohol might be tried, although theseagents are considered less effective and are no guaranteeof killing any virus present. Tunnel wash—a mix of soap,diluted bleach, vinegar and water—is widely used in prisonswhere undiluted bleach is not readily available. Sterile water(available from some needle exchanges) is preferable for rinsing,but water which has been recently boiled can be used ifsterile water is not available.Even when injection drug use does not involve sharedneedles or syringes, a number of infections other than HIVmay be acquired by injecting drugs. Avoiding these illnessesis particularly important for people living with HIV/AIDS.These illnesses include skin abscesses and infections at thesite of injection, blood clots, heart infections and bacterialpneumonia.Evidence of TransmissionIt is well established that sharing needles and syringes posesa high risk of transmission of HIV.19. Baleta, A. Concern voiced over “dry sex” practices in South Africa, The Lancet: 352:1292. 1998.20. Masters, B. et al. Recovery of HIV from syringes. 12th World AIDS Conference Abstract 23222, 1998.30 HIV Transmission
HIV TRANSMISSION: Guidelines for Assessing RiskAssessment of Risk of HIV TransmissionInjection using shared and/or uncleaned needle, syringeand/or mixing equipment . . . . . . . . . . . . . . . . . High RiskInjection using shared and cleaned needle, syringe and/ormixing equipment . . . . . . . . . . . . . . . . . . . . . . .Low risk*Injection using new and/or unshared needle, syringe andmixing equipment . . . . . . . . . . . . . . . . . . . . . . . .No Risk*There is evidence of transmission due to improperly cleanedneedles and/or syringes.Non-Injection Drug UseSharing straws, crack pipesPotential for TransmissionThere is a potential of transmission of HIV through thesharing of straws or pipes for snorting or smoking drugs.This is because of the likelihood of blood being present onthe straw or pipe due to a disruption of nasal membranes orcuts and sores on the lips.The likelihood of transmission of HIV is lessened by theamount of time that the pipe or straw is exposed to the airbefore being used by a second person. HIV does not survivewell outside of the body.Evidence of TransmissionThere is no published evidence of HIV transmission specificallythrough the sharing of crack pipes. There are severalstudies indicating HIV transmission through crack usersperforming oral sex. In these cases transmission the cuts,sores and burns on the lips of the crack user are thought tohave served as the route of entry for the disease 21 .There are no published cases of transmission of HIVthrough the sharing of straws or other devices for snorting.Assessment of Risk of HIV TransmissionSnorting or smoking drugs using new and/or unsharedstraws or pipes . . . . . . . . . . . . . . . . . . . . . . . . . . .No RiskSnorting or smoking drugs using shared straws orpipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . Negligible Risk**Risk is associated with the potential presence of blood on thesematerials due to the rupture of nasal membranes and/or thepresence of sores or cuts on the lips.Part 3. Other Activities InvolvingNeedlesTattooing, Piercing, Electrolysis and AcupuntureOther than for injection drug use, needles can be used fortattooing, piercing, electrolysis and acupuncture.Potential for TransmissionAll tattooing, piercing, electrolysis and acupuncture practitionersshould follow universal precautions similar to thoseused in hospitals 22 . It is required by law that all needles usedin such procedures be used only once and disposed of afteruse. However, situations occur where these precautionsmay not be adhered to or strictly enforced. In such cases,individuals will have to negotiate their own level of acceptablerisk. Appropriate queries should be made about theprecautions observed in any particular clinic or studio priorto such procedures being performed. (See Section 2, HIVand Prisons).There is also an opportunity for genital piercing potentiallyto puncture a condom. An extra-large condom or condomwith a larger resevoir may provide added protection forpiercings on the head of the penis.Evidence of transmissionThere is a potential for blood to be present on tools usedfor piercing, tattooing and electrolysis, however there havebeen no reported cases of transmission through this method.Ensuring that the tattoo, piercing or electrolysis is carriedout using sterilized equipment (using universal precautions)and new needles will eliminate the risk of exposure.Evidence of transmission using non-professional, handmade equipment (for example, the equipment used by peo-21. Faruque S, Edlin BR, McCoy CB, Word CO, Larsen SA, Schmid DS, Von Bargen JC, Serrano Y. Crack cocaine smoking and oral soresin three inner-city neighborhoods. J Acquir Immune Defic Syndr Hum Retrovirol., 13(1): 87-92.22. 1996 Sept. Masters, B. et al. Recovery ofHIV from syringes. 12th World AIDS Conference Abstract 23222, 1998.22. Health Canada. Infection Control Guidelines: Preventing the transmission of bloodborne pathogens in health care and publicservices settings, Health Canada. May 1997.HIV Transmission31
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