HIV/AIDS Program
Using bleach to prevent HIV and hepatitis
Update on the use of bleach to prevent transmission of HIV and hepatitis among injection drug users (Sept. 1999)
Background:
Transmission of HIV through blood to blood contact by the sharing of injection equipment among Injection Drug Users (IDUs) was identified early in the HIV epidemic as one of the main routes of transmission. Early prevention strategies included informing IDUs to use sterile syringes and needles for injection and to not share any "works", including syringes, needles, cottons, cookers, and water. Laboratory studies in the mid-1980s showed that household bleach could kill HIV. At a time when there were few needle exchange programs, bleach soon became a standard harm reduction intervention for use as a syringe and needle disinfectant for IDUs. Distribution of bleach became an important part of outreach to IDUs and helped outreach workers provide HIV/AIDS education and information about drug treatment options.
Research on the effectiveness of bleach:
Studies in the late 1980s and early 1990s evaluated the effectiveness of bleach to kill HIV in syringes. These studies did not include investigation of the effect of bleach on hepatitis. Research identified certain conditions that may reduce the ability of bleach to kill HIV. These include the amount of fresh, dried or clotted blood left in the syringe, the length of time bleach is in contact with the syringe, and the "freshness" of the bleach. Continued research shows that IDUs frequently share their "works" and, if infected blood is present in this equipment, those who share can become infected with or transmit HIV. Research also shows that many IDUs who use bleach to disinfect their works do not use the bleach properly, therefore reducing its effectiveness.
Current bleach policy:
"Bleach kits" are available at all Seattle Needle Exchange sites and some drug treatment and social services agencies. These kits contain small bottles of full strength bleach, cookers, cottons, alcohol wipes, tourniquets and directions on how to properly bleach injection equipment. The kits are funded and distributed by the HIV/AIDS Program.
Directions for the use of bleach are as follows:
| 1. |
Fill the syringe with water. Tap it with your finger to loosen blood drops. Shake the syringe. Shoot out the bloody water. Repeat these steps until you can't see any blood. |
| 2. |
Completely fill the syringe with bleach. Make sure the bleach touches all the inside area of the syringe for at least 30 seconds. Shoot it out. |
| 3. |
Rinse out the bleach with new clean water. Shoot it out. |
To kill HIV, it is important that these directions be followed exactly!
Hepatitis B and C:
Current studies show that 85% of IDUs in King County are actively infected with Hepatitis C (HCV) and can infect others. About 60% of IDUs have been infected with Hepatitis B (HBV). Some of these remain actively infected and can infect others. We know that hepatitis viruses are much harder to kill than HIV. Unfortunately, there are few studies that have looked at the effect of bleach on HBV or HCV. Although bleach kills hepatitis viruses under certain laboratory conditions, evidence suggests that these viruses may survive the 30-second bleach method currently used for HIV disinfection. In addition, since we know that HBV and HCV are more infectious than HIV, traces of blood in cookers, cottons, syringes, water and shared drug doses may pose a risk of transmitting HBV and HCV when these items are shared among IDUs.
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