Do you happen to inject
drugs? Or care about those who do? If so, there is some good news for you.
Certain syringes, those with the low dead space, may help prevent HIV infection, says
recent article by Dr. William Zule and
colleagues.
What is dead space and why it matters? The point is that after the plunger is fully squeezed, a tiny
amount of fluid still remains in the syringe in the space behind the needle (or dead space, see the
picture).
 |
| Source: Eurasian Harm Reduction Network |
In some syringes, usually the ones with detachable needles, this dead space is larger (they are called high dead space syringes). Some others, like a 1-ml insulin-type syringe with a non-detachable needle, have much smaller dead space. According to the article, the smaller the dead space, the less fluid stays there after the injection. If injection involves drawing blood from the vein, some of it stays there too. And if the person who injected with that syringe had HIV, some of the viruses may also be in that blood. So the larger the dead space, the more viruses remain in the syringe and can be passed to someone else using that syringe.
This is how Dr. Zule and the
team figured it out. First they tested both types of syringes in the lab by simulating the process
of injecting drugs and counting how much blood and HIV viruses remain in the syringe. It turned out that the number of HIV viruses in the low dead space syringes after injection is about one thousand times
lower than in the high dead space ones, meaning there are one
thousand times less chances for the virus to get into the body.
Then the scientists ran a special
program in the computer to see what would happen if 95% of people who inject
drugs in an area would switch to the low dead space syringes. The computer said that in
this case the HIV epidemic will not happen or, if HIV is already there, the epidemis will
eventually fade away, even if syringe sharing continues. To confirm the results they looked at HIV
levels in 67 cities around the world and found that in places where low dead space syringes
are more popular HIV level as a rule is lower as compared to the areas where high dead space
ones are mostly used.
Thus chances are high that using the low dead space syringes would help prevent or curb down HIV
epidemic among people who inject drugs. Some
more research is still needed to be 100% sure, but that will take time and money while
people will continue getting infected. So Dr.
Zule points out that we need not to wait
and should start promoting these low dead space syringes right now. As another
expert, James Bridge from the Global Fund to Fight AIDS, TB and Malaria wrote: “if
we could reduce HIV transmission simply by providing one kind of syringe over
another, then this is something that must be rolled out as soon as possible”.
However, there are some issues with the low dead space syringes. First of all, some people who inject
drugs do not want to use these syringes - one of the reasons is that the needle cannot be replaced. This requires improvements in the syringe design (some manufacturers are already working on this). Another problem is that buying and
distributing these syringes will cost money that is not available in many cases. Finally, using these syringes does not guarantee complete safety if syringe sharing happens.
Regardless of these unresolved issues, action by people like you is still important. You can pass the word about these syringes
around. If you inject drugs and cannot stop, try to use the low dead space syringes. If there is a clean syringe distribution program in your area, ask them if they
have those syringes; or, if you manage such a program, add the low dead space syringes into your product assortment. You may also contact your local health board, legislature or a Congress representative about supporting low dead space syringe promotion.
Umed Ibragimov is a public health PhD student at Emory University. He
is a native of Tajikistan, a small Central Asian country lying on one of the
major Afghan heroin trafficking route. Umed’s research interests include drugs
and sex.
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, Available online 9 August 2012, ISSN 0955-3959,
10.1016/j.drugpo.2012.07.002.
Really wonderful job keeping the posting non-judgemental and lay-relevant.
ReplyDeleteThis is really interesting research that has big implications for needle syringe distribution programs! It sounds like making low dead space syringes available could really help curb the HIV epidemic among injection drug users. You do a great job highlighting how complicated the issue is though (particularly given costs, acceptibility of syringes with and without detachable needles, etc.) Are there any current efforts underway to enhance the design so that the needles on low dead space syringes can be detached?
Great job on this blog post, Umed. You were really successful at translating complex information into an easy to understand format. I also though that you did a great job of addressing your audience - I immediately knew from your tone and recommendations that you were primarily speaking to injection drug users or their friends/loved ones.
DeleteOne idea for the post might be to include another call to action that's oriented towards other people - not just messages around considering using these syringes, but messages around telling friends about them to create buzz... something like that. I would also be interested to hear why you chose to focus on this audience as opposed to public health practitioners, activist groups, policy makers who might be more inclined to make population-based recommendations and how your recommendations in the post might change accordingly.
Overall, I thought you did a really great job!
thanks for the useful comments, Danielle and Rebecca, I will definitely address them. Indeed, there are efforts to develop a detachable low dead space needle, the problem with them is that their dead space is slightly higher, around 14 mkl, however it is still way lower than in the high dead space ones.
DeleteAs for expanding the audience for the action messages, it also can be done, though I will still focus on those who either inject drugs or have significant ones who do - there are many activists, advocates and even program managers among them.
Hey Umed, nice job. This is a great discovery that I hadn't heard about before reading your blog. Is that a high-impact journal? I was sort of expecting to see JAMA or NEJM as I read the blog, as it seems like a potentially huge finding.
ReplyDeleteI found the intro a bit eerie, but other than that, nice blog.
Umed, It was interesting to read this informative work. I liked the way you had introduced the topic and the way you toned down the findings so as to avoid interpreting it as 'the' solution to HIV transmission among those who inject drugs.
ReplyDeleteUmed, your post was very interesting and accessible. It is always exciting to learn that there might be relatively simple changes that could have a major impact on the spread of HIV. The graphic really helped to illustrate the difference between the two types of syringe and why the dead space is important.
ReplyDeleteUmed, You've written a very interesting post. I feel like it's not often that you hear about such a seemingly simple way to reduce risk of HIV infection, especially among injection drug users. The whole post was very accessible and neutral -- which is not always easy to do when making this sort of information public. Good job.
ReplyDeleteAdam
Hi Umed,
ReplyDeleteThis is an interesting topic to cover and also an interesting audience to address it to. I think one of the challenges you have is in the framing of the message. For example, I think this is a great context to introduce the concept of "harm reduction." I think that would really help you talk about the fact that using IV drugs still isn't good, but that if you use a different kind of needle, you may be able to avoid some of the other non-drug related complications you can have when using drugs.
Overall, I had a hard time following what you were talking about because it was very technical and focused too much on the methods of the study. Consider your "average" drug user on the street. If you were going to try to get them to use a different kind of syringe, would you talk to them about the methods of the study? How would you explain this to them in a way that is really clear and simple and not at all technical?
Also, even if they did get it, how do you talk about the logistics of where they should get a different kind of syringe? You have something in there about asking for them, but is that realistic? In a sense -- what might the ethical issues be about pitching this kind of information to someone who probably can't do much about it? Instead, I would think about pitching this to a wider audience who may be able to have more impact on the solution.
This is a challenging and important topic, and I'm interested to talk with you more about how to make this accessible and actionable to people.
Ariela
I thought the content of the blog was good, but perhaps the syntax could be cleaned up a bit? Some of the statements I had to real a couple of times as it seemed to be a bit awkwardly worded.
ReplyDeleteI also feel (and of course this is entirely dependent on the intended audience) that some of the discussion about the type of syringes used is a bit mechanical; perhaps there is a way to simplify the language (by using an analogy) to make it accessible to an audience who might not know the "inner working" of a syringe.
Hi Umed,
ReplyDeleteI really want to commend you for addressing such a unique problem to a unique audience. And the paper you chose is very challenging considering how controversial the topic is and how technical the methods are, but the way in which you interpret it is very clear and easy to follow.
As a researcher in this field, what I want to point out is the "helplessness" of individual in a system where politics trumps science and rationality. Almost every drug addict knows that if they share needles they're going to transmit HIV, but they're still sharing because they simply don't want to go to jail. You mentioned "buying and distributing these syringes will cost money that is not available in many cases"; while funding is definitely an issue, one cannot overlook the tension between public health and criminal justice system, and the moral controversies behind. The philosophy of harm reduction (built on J.S. Mill's "harm principle") seems only popular in academia, even only in certain disciplines such as economics. Instead of taking the easy way out, I would like you to discuss how the idea of low dead space needle would confront these issues.
I'm so happy to find someone sharing the common research interest, and I'm really looking forward to talking to you more if we have a chance.
Hefei