Detachable Needles and HIV - Research and Program Implications

Recently published literature indicates a likely link between using syringes with detachable needles and transmission of HIV and HCV. (See: William Zule, High dead-space syringes and the risk of HIV and HCV infection among injecting drug users, Drug & Alcohol Dependence, 2009.)

Syringes with detachable needles have larger “dead space” in them, able to hold 40 (or more) times the amount of blood compared to non-detachable syringe/needles. This greater “dead space” leads to greater amounts of blood left over in the syringe, which (presumably) leads to greater HIV/HCV infection rates. The evidence is still not strong enough to prove causation, but is strong enough that researchers are calling for programs to make some practical adjustments.

I’m recommending that you consider 2 simple additions to your IDU program:
1. RESEARCH:

Add some simple questions to our IDU TRaC questionnaires to:

Ask IDUs what they are using the inject: detachable or not

On those TRaCs where we also track HIV/HCV, see if there’s an association between using detachable s and higher rates of disease

I have asked Gary Mundy (Reg’l Researcher, Asia) to work on the questions.

2. PROGRAM:

IDU programs should:-

Inform clients of the potential greater risk of using detachables-
Consider procuring non-detachables, or, at least, actively promoting non-detachables

At the very least, ask your IDU clients what kinds of syringes and needles they are using. If detachable are common, then share with them this new evidence indicating that detachables may be more risky to use. This is a new area of harm reduction, and the evidence is still coming in. But it’s possible that we could help reduce transmission by paying more attention to the types of injecting equipment we are providing/promoting, as in this case.