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AIDS and Intravenous Drug Use - Sharing Equipment

hiv blood infected sex

Drug use can lead to HIV infection, then to AIDS, then to death because drug users share equipment contaminated with infected blood. The equipment involved is the syringe, the needle, the "cooker," cotton, and rinse water used to prevent blood from clotting in the needle and syringe.

The syringe and the needle can become contaminated when infected blood is left behind between uses. This can occur when users draw back their own blood into a syringe and then inject the blood again several times in an attempt to capture and inject all of the drug held in the syringe. This practice, known as "booting," does not occur when users practice intramuscular or subcutaneous injection, known as "skin popping."

Tests have shown that bleach, hydrogen peroxide, and alcohol can kill HIV in a test tube (in vitro). These substances can be effective for cleaning a syringe and needle if the solution fills the syringe completely, but using disinfected syringes and needles is still not as safe as using new, sterile equipment.

The "cooker" is any small container, usually a spoon or a bottle cap, used to dissolve the injectable drug, most often a powder. Contamination may occur when infected blood is pushed out of the needle or syringe into the cooker while a new shot of the drug is being drawn up. If the needle and syringe are effectively sterilized, the cooker will not be contaminated. In the event of cooker contamination, heating the cooker between shots can kill the virus.

Drug users sometimes employ a piece of cotton as a strainer to trap any impurities from the cooker solution. They strain the solution through the cotton as they draw solution into the syringe. Instead of disposing of each piece of cotton immediately after use, a user will sometimes "beat the cotton" with a little

TABLE 9.1
Reported AIDS cases, by sex, age, and transmission category, through 2003
SOURCE: "Table 17. Reported AIDS Cases, by Age Category, Transmission Category, and Sex, Cumulative through 2003—United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention, December 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed March 31, 2005)

Males Females Total
2003 Cumulative through 2003a 2003 Cumulative through 2003a 2003 Cumulative through 2003a
Transmission category No. % No. % No. % No. % No. % No. %
Adult or adolescent
Male-to-male sexual contact 15,859 48 401,392 55 15,859 35 401,392 45
Injection drug use 4,866 15 156,575 21 2,262 20 61,621 38 7,128 16 218,196 24
Male-to-male sexual contact and injection drug use 1,695 5 57,998 8 1,695 4 57,998 6
Hemophilia/coagulation disorder 74 0 5,130 1 11 0 318 0 85 0 5,448 1
Heterosexual contact 3,371 10 40,947 6 5,234 45 70,200 43 8,605 19 111,147 12
Sex with injection drug user 477 1 10,930 1 985 9 24,148 15 1,462 3 35,078 4
Sex with bisexual male 0 0 0 0 223 2 4,402 3 223 0 4,402 0
Sex with person with hemophilia 7 0 80 0 16 0 465 0 23 0 545 0
Sex with HIV-infected transfusion recipient 24 0 505 0 37 0 705 0 61 0 1,210 0
Sex with HIV-infected person,
risk factor not specified 2,863 9 29,432 4 3,973 34 40,480 25 6,836 15 69,912 8
Receipt of blood transfusion, blood
components, or tissueb 111 0 5,219 1 108 1 4,076 2 219 0 9,295 1
Other/risk factor not reported or identifiedc 7,274 22 62,217 9 3,946 34 27,181 17 11,220 25 89,399 10
Subtotal 33,250 100 729,478 100 11,561 100 163,396 100 44,811 100 892,875 100
Child ( < 13 yrs at diagnosis)
Hemophilia/coagulation disorder 0 0 227 5 0 0 7 0 0 0 234 3
Mother with the following risk factor for,
or documented, HIV infection: 61 87 4,232 88 70 85 4,317 95 131 86 8,549 91
Injection drug use 6 9 1,643 34 11 13 1,645 36 17 11 3,288 35
Sex with injection drug user 8 11 784 16 6 7 741 16 14 9 1,525 16
Sex with bisexual male 0 0 95 2 2 2 102 2 2 1 197 2
Sex with person with hemophilia 1 1 21 0 0 0 15 0 1 1 36 0
Sex with HIV-infected transfusion recipient 0 0 11 0 0 0 16 0 0 0 27 0
Sex with HIV-infected person,
risk factor not specified 18 26 705 15 18 22 737 16 36 24 1,442 15
Receipt of blood transfusion, blood
components, or tissue 0 0 73 2 0 0 83 2 0 0 156 2
Has HIV infection, risk factor not specified 28 40 900 19 33 40 978 21 61 40 1,878 20
Receipt of blood transfusion, blood
components, or tissueb 1 1 244 5 1 1 143 3 2 1 387 4
Other/risk factor not reported or identifiedd 8 11 80 2 11 13 98 2 19 13 178 2
Subtotal 70 100 4,783 100 82 100 4,565 100 152 100 9,348 100
Total 33,320 100 734,261 100 11,643 100 167,961 100 44,963 100 902,223 100
a Includes persons with a diagnosis of AIDS, reported from the beginning of the epidemic through 2003. Cumulative total includes 1 person of unknown sex.
b AIDS developed in 46 adults/adolescents and 3 children after they received blood that had tested negative for HIV antibodies. AIDS developed in 14 additional adults after they received
tissue, organs, or artificial insemination from HIV-infected donors. Four of the 14 received tissue or organs from a donor who was negative for HIV antibody at the time of donation.
c Includes 36 adults/adolescents who were exposed to HIV-infected blood, body fluids, or concentrated virus in health care, laboratory, or household settings, as supported by
seroconversion, epidemiologic, and/or laboratory evidence. One person was infected after intentional inoculation with HIV-infected blood. For an additional 361 persons who acquired
HIV infection perinatally, AIDS was diagnosed after age 13. These 361 persons are tabulated under the adult/adolescent, not the pediatric, transmission category.
d Includes 5 children who were exposed to HIV-infected blood as supported by seroconversion, epidemiologic, and/or laboratory evidence: 1 child was infected after intentional
inoculation with HIV-infected blood and 4 children were exposed to HIV-infected blood in a household setting. Of the 178 children, 23 had sexual contact with an adult with or at high
risk for HIV infection.

water in an attempt to extract the tiniest bit of the drug that may be left in it. The cotton can become infected if the syringe and needle have not been properly sterilized.

Syringes and needles are usually rinsed out before reuse, not necessarily to decontaminate them but to prevent clotting blood from blocking the equipment. If the rinse water does not contain bleach to disinfect the instruments, use and reuse of the same rinse water can also be a source of contamination.

When two drug users share equipment, one positive for HIV, one not, and the equipment is not properly sterilized between uses, the infection can pass from the carrier of HIV to the healthy person. Other blood-borne diseases can follow the same pathway, including Hepatitis B and Hepatitis C viruses, which cause liver disease.

HIV infection caused by sharing drug paraphernalia can pass to others through sexual contact, and it can also pass to newborn children through childbirth and breastfeeding.

TABLE 9.2
Estimated number of deaths from AIDS, by selected characteristics, 1999-2003
SOURCE: "Table 7. Estimated Numbers of Deaths of Persons with AIDS, by Year of Death and Selected Characteristics, 1999-2003—United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention, December 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed March 31, 2005)

Year of death
1999 2000 2001 2002 2003 Cumulative through 2003a
Age at death (years)
< 13 97 51 48 35 29 5,103
13-14 18 8 4 11 8 252
15-24 232 216 270 199 229 9,789
25-34 3,258 2,823 2,512 2,143 1,928 142,761
35-44 7,706 7,138 7,525 6,896 6,970 216,093
45-54 4,994 5,203 5,548 5,737 5,964 104,064
55-64 1,556 1,631 1,873 1,840 2,146 33,717
≥ 65 630 670 743 696 741 12,282
Race/ethnicity
White, not Hispanic 5,834 5,559 5,524 5,128 4,767 230,289
Black, not Hispanic 9,106 8,832 9,345 8,923 9,048 195,891
Hispanic 3,341 3,162 3,435 3,274 3,915 92,370
Asian/Pacific Islander 113 103 108 94 85 3,340
American Indian/Alaska Native 79 67 83 79 78 1,529
Transmission category
    Male adult or adolescent
    Male-to-male sexual contact 6,703 6,316 6,479 6,012 6,015 257,898
Injection drug use 4,425 4,182 4,298 4,126 4,166 107,797
    Male-to-male sexual contact and injection drug use 1,335 1,334 1,396 1,285 1,233 38,083
    Heterosexual contact 1,403 1,417 1,585 1,526 1,644 23,080
    Otherb 194 204 174 166 140 9,846
Subtotal 14,061 13,454 13,932 13,116 13,198 436,704
    Female adult or adolescent
Injection drug use 2,051 1,925 1,985 1,956 2,056 39,848
    Heterosexual contact 2,157 2,192 2,444 2,335 2,584 37,901
    Otherb 97 92 92 89 95 4,115
Subtotal 4,305 4,209 4,521 4,379 4,736 81,864
    Child ( < 13 yrs at diagnosis)
Perinatal 117 72 67 58 78 4,961
    Otherc 8 5 4 4 5 531
Subtotal 124 78 71 62 83 5,492
Region of residence
Northeast 5,698 5,294 5,344 5,015 6,140 168,213
Midwest 1,712 1,685 1,839 1,550 1,343 50,258
South 7,406 7,352 7,624 7,526 7,068 178,447
West 2,952 2,681 2,817 2,520 2,588 107,767
U.S. dependencies, possessions, and associated nations 723 729 900 947 877 19,375
    Totald 18,491 17,741 18,524 17,557 18,017 524,060
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting.
aIncludes persons who died with AIDS, from the beginning of the epidemic through 2003.
bIncludes hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified.
cIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
dIncludes persons of unknown race or multiple races and persons of unknown sex. Cumulative total includes 640 persons of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

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