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Low dead-space syringes for preventing HIV among people who inject drugs: promise and barriers

Zule, William A.

Current Opinion in HIV and AIDS: July 2012 - Volume 7 - Issue 4 - p 369–375
doi: 10.1097/COH.0b013e328354a276
INJECTING DRUG USE AND HIV: Edited by Lisa Maher and Nick Walsh

Purpose of review This review examines evidence regarding the differential effects of high dead-space syringes (HDSS) and low dead-space syringes (LDSS) on HIV transmission among people who inject drugs (PWID). It also identifies areas for additional research and examines potential barriers to interventions that promote LDSS.

Recent findings Results of laboratory experiments and cross-sectional bio-behavioral surveys provide circumstantial evidence that the probability of HIV transmission associated with sharing LDSS is less than the probability of HIV transmission associated with sharing HDSS. Mathematical models suggest that LDSS may prevent injection-related HIV epidemics among PWID.

Summary Circumstantial evidence suggests that LDSS may substantially reduce HIV transmission among PWID, who share syringes. Additional research that links LDSS to reductions in HIV incidence is needed. Most currently available LDSS are 1 ml or smaller and have fixed needles. These cannot be used by PWID ‘injecting’ larger volumes of fluid and they may be rejected by PWID, who prefer syringes with detachable needles. Nonetheless, LDSS represent a potentially promising intervention that deserves serious consideration.

Correspondence to William A. Zule, Substance Abuse Treatment Evaluations and Interventions Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. Tel: +1 919 485 2797; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.