Toronto
3 min

Bleach isn’t good enough

AIDS groups stuck with hep C prevention

GOLD STANDARD. Though clean needles every time is the best strategy for IV drug users, some prevention groups think they also need back-up advice. Credit: Health Canada

AIDS organizations offering prevention programs for IV drug users are finding they’re now expected to do double duty – educating people on hepatitis C prevention.



It’s a much tougher job.



“The gold standard of safer prevention is no longer about HIV. It’s about hep B and C,” says Dan Big, executive director of the Chicago Recovery Alliance, an agency funded by the AIDS Foundation Of Chicago.



In an advertising campaign this summer directed at women who have sex with women, the AIDS Committee Of Toronto (ACT) recommended using a clean needle for each use, but also offered cleaning needles with bleach as a second option. Many AIDS organizations have stopped suggesting bleach cleaning as an option since it doesn’t kill the hepatitis C virus.



“Bleach is for keeping your whites whiter. It doesn’t decontaminate in the real world,” says Big.



As recently as last year, ACT issued a brochure suggesting that cleaning IV drug riggings with bleach would kill all diseases. Though Tania Smith, coordinator of women’s community development, initially said it would be impractical to pull the glossy brochures from shelves or to add an update sticker, ACT eventually did update the brochures.



Hepatitis C – a chronic liver disease spread primarily through contact with an infected person’s blood, though sometimes through sexual contact – has prompted various responses from AIDS service organizations.



The Ontario AIDS Network has 52 member organizations for whom they do training, research and advocacy. Program director Pamela Bowes says the network got one-time hep C funding two years ago from Health Canada.



“We did a needs assessment to understand gaps in knowledge around co-infection and then held a three-day skills-building workshop and produced resource material which went out to our member groups. AIDS organizations said they don’t understand much about hep C and that clients come to them for help and programs, co-infected and some with hep C alone. The workshop had a forum on ways for agencies to integrate hep C and AIDS information into their organizations.”



In the US, the San Francisco AIDS Foundation stopped recommending bleach cleaning in January 2002. Reg Norton of their HIV prevention program, says the organization used the money it spent on distributing free bleach to provide new syringes.



Big says it’s important to have a safe injection standard that’s applicable for all blood-related contagious diseases. Not only new needles for every use, but educating users to focus on cleanliness; washing hands and other surfaces will help needles from becoming contaminated.



“Greater thought is now given to stopping bleeding after injection,” says Big. “A contaminated finger can transmit viruses. We’re teaching people to use a non-contaminated item to stop bleeding.”



AIDS Vancouver also recommends a clean needle every time, says communications coordinator Rick Barnes, though he admits it can be unrealistic to expect drug users to follow best practices to the letter.



“Cleaning is preferable to nothing,” says Barnes. “Bleach does address the HIV issue because HIV in an enclosed needle, used immediately, could survive [without bleaching].”



Barnes says one-for-one needle exchange programs – aimed at collecting dirty needles while providing clean ones – aren’t very effective. Toronto and Vancouver halted their one-for-one programs several years ago. Barnes says drug users don’t have the patience to do a needle exchange at a scheduled time. Left with that option, they’ll reuse the needles they have until they’re too dull.



Hepatitis C is more prevalent than AIDS among injection drug users. A study released in Vancouver in 2001 found that 85 percent of IV drug users had hep C compared to 30 percent with HIV.



“We’re funded to do HIV prevention but not funded for dual diagnosis,” says Barnes. “We’re doing a fair bit of work with hep C with no funding…. It’s a difficult position; the government has put us there. We have the structure, the skills and ability to deliver services, plus we have the connections to the community.”



John Maxwell, director of community development for ACT, says the organization acknowledges hepatitis C as a problem but doesn’t get any funding to help prevent it.



“We don’t do any broad work on it, but we do work in the area of drug and HIV risk reduction. It’s important to talk about the risk of transmitting HIV and also hep C.”



Health Canada estimates there are between 210,000 and 275,000 people in this country infected with hepatitis C. Because the symptoms can be vague or minimal – including fatigue, loss of appetite and nausea – it is estimated that only 30 percent of infected people know they have the disease.



* The AIDS Committee Of Toronto is at www.actoronto.org. Health Canada has a hepatitis C information page at www.hc-sc.gc.ca/hppb/hepatitis_c.