A study suggests encouraging drug abusers to use thin syringes, which retain less fluid and the virus it may contain.
Distributing “low-dead-space syringes” to addicts could substantially lessen H.I.V. transmission among them, a new study has estimated.
Syringes have widely varying amounts of “dead space” — the amount of fluid retained even when the plunger is fully depressed, said William A. Zule, a researcher at RTI International and the lead author of the paper in The International Journal of Drug Policy.
Fat ones with interchangeable needles may have 40 times as much dead space as thin ones like those used by diabetics. And simulations of the way addicts draw in blood and rinse with water showed that the biggest syringes can retain 1,000 times as much virus as thinner ones.
Many foreign governments that distribute syringes ignore dead space and buy whatever is cheapest, Dr. Zule said.
Recipients of clean syringes are not supposed to share them, but some do. Users of heroin, cocaine or methamphetamine usually accept thin syringes, the study said. Users of poppy straw extract, homemade stimulants or crushed tablets may not.
The best way to get addicts to demand low-dead-space syringes, Dr. Zule suggested, may be to point out that they get more drug.
“That may not be politically correct, but you need messages that speak to the group you have to work with,” he said.
No human clinical trials have proved that such syringes save lives, but the idea is plausible and switching now would be affordable and safe, Dr. Zule argued.
By DONALD G. McNEIL Jr.
NOTE: This is a very serious and important topic, so I retrieved the journal article the NYTimes piece refers to and put it in the archive here: William A. Zule, Harry E. Cross, John Stover, Carel Pretorius. "Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries." International Journal of Drug Policy. 24 (1): 1-7
Circumstantial evidence from laboratory studies, mathematical models, ecological studies and bio behavioural surveys, suggests that injection-related HIV epidemics may be averted or reversed if people who inject drugs (PWID) switch from using high dead-space to using low dead-space syringes. In laboratory experiments that simulated the injection process and rinsing with water, low dead space syringes retained 1000 times less blood than high dead space syringes. In mathematical models, switching PWID from high dead space to low dead space syringes prevents or reverses injection-related HIV epidemics. No one knows if such an intervention is feasible or what effect it would have on HIV transmission among PWID. Feasibility studies and randomized controlled trials (RCTs) will be needed to answer these questions definitively, but these studies will be very expensive and take years to complete. Rather than waiting for them to be completed, we argue for an approach similar to that used with needle and syringe programs (NSP), which were promoted and implemented before being tested more rigorously. Before implementation, rapid assessments that involve PWID will need to be conducted to ensure buy-in from PWID and other local stakeholders. This commentary summarizes the existing evidence regarding the protective effects of low dead space syringes and estimates potential impacts on HIV transmission; it describes potential barriers to transitioning PWID from high dead space to low dead space needles and syringes; and it presents strategies for overcoming these barriers.
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