|image: Yale School of Medicine|
It may be out of the daily headlines, but Americas war on AIDS continues. The Centers for Disease Control and Prevention (CDC) estimates that the number of Americans who have died from AIDS has reached more than 430,000 and as many as 900,000 Americans are living with HIV infection.
One of the reasons AIDS affects so many people is that intravenous drug use is on the rise, especially among young people. But researchers are now looking at heat as a way to kill the killer virus. The heat is on
Its a known fact that one of the ways HIV is transmitted is through the sharing of infected needles. Since the epidemic began in 1981, injection drug use has accounted for more than one-third of AIDS cases in the U.S. This prompted Yale University epidemiologist Robert Heimer to study how long the virus can last in syringes and under what conditions.
Before studying HIV in syringes, Heimer and his team spent several years developing a test that could detect HIV in the minute amounts of blood that would normally be left over in syringes after injection. Then they tested more than 1,500 syringes that had contained HIV-tainted blood.
|A researcher at Yale works with syringes.|
image: Yale Medical School
The researchers found that temperature made a big difference as to how long the virus survived. "Syringes stored at higher temperatures have HIV decay and become inactive more quickly than syringes stored at lower temperatures," says Heimer.
Heimers lab research simulated conditions that are found among intravenous drug users on the street. "We work very closely with medical anthropologists to mimic real life," he says. "We do not use laboratory strains of HIV. We draw blood from uninfected individuals and use that to target white blood cells to infect with HIV."
In practical terms, Heimers research shows that at 39 degrees Fahrenheit (4 degrees centigrade), which is a typical early winter temperature in a city like Chicago, the virus can live up to six weeks in syringes. But during a New York summer, for example, the virus lives for only a week. As Heimer puts it, "Stashing syringes behind the radiator in Chicago in winter or keeping them in the glove compartment in Tucson, Arizona, for example, would take care of the problem."
|Dr. Robert Heimer|
In another study funded by the National Institute on Drug Abuse (NIDA) and published last year in the Journal of Acquired Immune Deficiency Syndrome, Heimer studied the paraphernalia associated with injection drug use. He looked at HIV in "cookers"usually spoons or bottle caps in which drugs are mixed with water and then heated with a flame before injectionwhich are another possible source of infection for drug users when the cookers are shared and/or reused. In these, the HIV inactivated once the temperature reached 149 degrees Fahrenheit (65 degrees centigrade). It only takes about 15 seconds to reach this temperature, and Heimer found that thin bottle cap cookers worked the fastest.
Only part of the solution
But Heimer cautions that storing syringes in hot places or heating drugs in cookers for at least 15 seconds wont eliminate the risk of AIDS, and using the same needle twice is not recommended under any circumstances. He thinks that federally funded needle exchange programs could save lives, as well as taxpayers money, in the long run. Indeed, a study published in 1997 in The Lancet found that the U.S. governments ban on federal funding for needle exchange programs may have caused as many as 10,000 needless HIV infections between 1987 and 1995 and cost the health care system over $500 million in treatment expenses that could have been avoided.
|Folks at a needle exchange program.|
Opponents of such programs say giving needles to drug addicts merely encourages drug use, but several studies show the opposite to be true. In addition, a study by the Substance Abuse Policy Research Program found that, contrary to popular belief, it is legal in most states for physicians to prescribe sterile needles to drug addicts.
"Drug users are not innately uninterested in their own health," Heimer says, pointing out that theyre prevented from taking care of their own health because theyre addicted to drugs such as opiates, cocaine, and amphetamines. But theyre also stigmatized by society. "If we can find ways to improve their ability to interact with the health care system, they can improve their lives," Heimer says.
Social workers at needle exchange programs agree. "Robert Heimers research over the years has greatly helped us," says Drew Kramer, Executive Director of the Lower East Side Harm Reduction Center in New York City. "His recent study is news we can use. Its information backed by good science."
Providing sterile needles not only ensures that that they are free of HIV, it also provides an opportunity for those with substance abuse problems to get counseling by health care workers. "It discourages people from using drugs and keeps them safe until they are ready to do so," says Heimer. "This is the ideal way to solve the problem."
Heimer believes that intravenous drug users need support from others to rid themselves of their addiction. "When an ambulance appears at the scene of an automobile accident, they dont first determine whether the person is drunk or if they are drunk, refuse medical care," he says. "This is the same issue. First and foremost, its public health. We take care of protecting people, we take care of the populace and we worry about their drug problem second."
Elsewhere on the web
A report on the world AIDS situation
AIDS Clinical Trials Information Service
CDC National Prevention Information Network
Center for AIDS Prevention Studies
The HIV-AIDS Connection
AIDS and young people
HIV/AIDS Treatment Information Service
How to protect yourself from AIDS
Access to syringes fact sheets
Journal of the American Medical Association HIV/AIDS Information Center