The Journal of International Drug Policy is reporting that circumstantial evidence from a variety of models show that using a newly developed syringe that reduces dead space by a thousand percent from current syringes has high probablity that HIV, Hepatitis C and other blood borne diseases could be reduced to zero within 8 years. William A. Zule and several other researchers contend that changing the current syringe design could almost completely eliminate HIV transmission to the user and their family and/or sexual partners caused by needle sharing.
A low-dead-space syringe (left) retains a small fraction of the fluid that a high-dead-space syringe retains. (William A. Zule et al./International Journal of Drug Policy)
Every needle-syringe, when the plunger is fully depressed, retains some fluid or blood in what is termed "dead-space". Some syringe designs have more of this "dead space" than others - especially those with detachable needles. Depending on the design, some syringes can retain 84 microlitres of fluid. This is a very, very small amount - but other syringe designs can retain as little as 2 microlitres.
So the hypothesis is simple: if you share a syringe with higher "dead-space", then there will be more blood retained in the syringe and you will be more likely to become infected with blood-borne viruses. If you share a low "dead space" syringe, you are still putting yourself at risk - but perhaps less so, as there is less blood retained when the plunger is fully down.
In experiments that mimicked drug injections, the high-dead-space syringes retained 1,000 times as many microliters of blood, even after rinsing. For people carrying HIV with viral loads between one million copies and 2,000 copies per milliliter, the capacious syringes could carry multiple copies of HIV, "whereas," William A. Zule and his coauthors write, "low-dead-space syringes would retain even a single copy only a fraction of the time."Worldwide estimates of IV drug users is 1.9 million people.
In an 18-year-period, the total number of injections spared could top 500,000, the authors claim, a reduction that would have spillover effects into the greater population at large, as those uninfected people would not transmit the disease to non-drug-users as well.
Sounds great and could be easily implemented right? Perhaps it will in some countries with high IV/HIV infection rates that are not as pious and prejudicial as ours. We have a lot of issues for so many to wrap their minds around and all of them scare the beejeebus out of many people in this country. Let's name a few.
Despite similar rates of IV use among whites, Black Americans who inject drugs are 10 times more likely to get infected by HIV than their white counterparts, Latino injectors are five times more likely and I would contend that poverty and access to quality healthcare, insurance that pays for syringes etc. exacerbate the problem for minorities.
Incarceration plays an important role as well. Human Rights Watch and others have documented that blacks and Latinos are imprisoned at grossly disproportionate rates for drug related crimes' Incarceration of drug users has been linked to increased HIV risk, as incarceration disrupts stable networks that limit needle-sharing. Police practices and fear of arrest have been shown to alter the behavior of injection drug users, from avoiding syringe exchange sites to hurried, less hygienic injection to disruption of stable user networks that reduce sharing of needles.
The CDC lists the following major hurdles to ending blood borne disease from the population. The most important one that I see are local and state drug paraphernalia laws. We can't even get to decriminalization or legalizing marijuana in this country let alone distributing sterile needles to at risk populations.
1) Drug paraphernalia laws. These laws establish criminal penalties for the manufacture, sale, distribution, possession, or advertisement of any item used to produce and consume illegal drugs, including syringes. In 2002, 47 states, the District of Columbia, and the Virgin Islands had drug paraphernalia laws.
2) Syringe prescription laws. These laws prohibit dispensing or possessing syringes without a valid medical prescription. In 2002, eight states and one territory had syringe prescription laws. In 2000, an analysis of state laws showed that physician prescription of sterile syringes to IDUs is legal in 46 states; in two other states physicians have a "reasonable claim to legality."
3) Pharmacy regulations and practice guidelines. As part of their oversight responsibilities, state boards of pharmacy develop and enforce regulations and guidelines that cover many aspects of syringe sales, including display, advertising, record keeping, log books, customer identification, and assessments of customers’ probable use. Twenty-three states have such regulations and guidelines.
4) Restrictions on syringe exchange programs. In some states, syringe prescription laws and drug paraphernalia laws effectively restrict the ability of syringe exchange programs (SEPs) to operate unless they are specifically exempted from the laws.
We need a national strategy that implements free to low cost distribution of these dead space needles. If we can reduce transmission from the estimated 16% of new HIV cases that is caused by injecting drugs then we should do it quickly by eliminating the barriers that the CDC has identified. We have no time to lose.
The Human Rights Watch harm reduction coalition has more on this strategy to eliminate HIV infections in IV users here