Parenteral Transmission of HIV Among Injection Drug Users: Assessing the Frequency of Multiperson Use of Needles, Syringes, Cookers, Cotton, and Water

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Abstract
To describe and estimate the frequency of different types of drug preparation and injection practices that could result in the transfer of blood and bloodborne infections among injection drug users (IDUs). We analyzed data from interviews administered to 12,323 active IDUs recruited from 19 sites in the United States. The interviews ascertained drug-related behaviors during the previous 30 days. 31.9% of IDUs reported that they engaged in the use of both needle/syringes and cookers/cotton/water previously used by another IDU; 8.6% engaged only in the use of needle/syringes previously used by another IDU; 17.5% engaged only in the use of cookers/cotton/water previously used by another IDU; and 42.0% reported using neither needle/syringes nor cookers/cotton/water previously used by another IDU. Only 12.6% reported use of new (never-used) needle/syringes. The 3935 IDUs who used both needle/syringes and cookers/cotton/water that had been previously used by another IDU had more than 311,000 potential exposures to blood-borne infections from these high-risk practices in 30 days; about 64% of these exposures were from multiperson use of cookers/cotton/water. Programs to limit parenteral transmission of HIV and other bloodborne infections among IDUs must consider all drug preparation and injection practices that could allow transfer of blood and blood-borne infections among IDUs.