Sterile Needles: Human Immunodeficiency Virus in Diabetic Intravenous Drug Users

Abstract

To the Editor. —The article by Nelson et al 1 raises the issue of prevention of human immunodeficiency virus (HIV) infection in intravenous drug users (IVDUs) in the United States by giving them access to sterile injection equipment. All western European countries (except Sweden) and Australia have liberalized access policies as a specific strategy for HIV prevention among IVDUs. 2 Given the high incidence of HIV among IVDUs, restrictive access policies in the United States have had a negative impact on HIV prevention. The authors conclude: Our data, derived from a 'natural experiment,' provide some evidence to suggest that access to sterile injection equipment might lead to lower rates of HIV infection among IV drug users. Nevertheless, it must be emphasized that their tentative suggestion is based on the erroneous conceptualization of needle sharing current in the United States. On the basis of my ethnographic research among IVDUs,