Cutting down or stopping injecting is the best way to protect yourself from infection and injury, and getting into treatment is one of the best things you can do to help cut down the amount you inject.
There are two main types of infection that can get into your body when you inject drugs – bacteria and viruses.
To reduce the risk of infection – always wash your hands and the injecting site with soap and water before you start. If you inject drugs you will always inject some bacteria as well. Your immune system will usually find the bacteria and kill them. But sometimes they will cause an infection. This is usually because it is a powerful infection or you have injected a lot of bacteria or your body can’t fight off the infection because you are unwell or your circulation isn’t very good.
Viruses are tiny – if a single virus was blown up to be the size of a marble, a syringe at the same scale would be 75 miles high. Because viruses live and reproduce in cells, it is hard to kill them without killing the body cells at the same time. Antibiotics have no effect on viruses – so you’ve got to avoid catching them.
There are three particular viruses that can be passed on to others in blood that injectors need to be aware of – hepatitis B, hepatitis C and human immunodeficiency virus (HIV).
Hepatitis B and hepatitis C attack your liver. HIV attacks your immune system and can cause AIDS. It only takes a tiny amount of blood to get into another person’s bloodstream for the viruses to be passes on. There can be thousands of virus particles in a drop of blood that is too small to see.
H I V
HIV is a virus that lives in blood. It can be passed on by sharing injecting equipment or having unprotected sex. There is no vaccination that can protect you against HIV. Needle and syringe exchange has been available in the UK since shortly after the discovery of HIV. Because of this, there are very low levels of HIV among injectors in the UK, however this could easily change. To keep the number of HIV infections low, injectors in the UK need to avoid sharing works and other injecting equipment, and to practice safer sex. In other countries, where getting hold of sterile works is much more difficult, HIV rates have grown much higher and so many more injectors have died of AIDS.
Testing, The Disease and Treatment
The only way to tell if someone has HIV is by blood tests. The HIV test looks for antibodies – the substances your body makes to fight the virus. If there are HIV antibodies in your blood, it means you are infected with the virus.
The HIV virus can cause AIDS, which stands for acquired immune-deficiency syndrome. Without treatment, the virus destroys the immune system, leaving you open to a wide range of infections that a healthy body would be able to fight off easily.
HIV treatment has become much more successful at treating infections. Early diagnosis makes it possible for you to get the right treatments at the right time.
There are an estimated 130-170 million people worldwide infected with hepatitis C. Over 50,000 in London alone.
Hepatitis C (hep C) can cause serious liver disease. It is passed on through sharing injecting equipment. There are two reasons injectors are much more likely to catch hep C than HIV. a). far more injectors have it and b). it is more infectious. People in sexual relationships sometimes think: “We’re having unprotected sex, so it doesn’t make any difference if we share works”. – It does! Hep C is rarely transmitted through sex but it is easily transmitted through sharing injecting equipment.
Testing, The Disease and Treatment
The only way to tell if you have hep C is by blood tests. The first test is for antibodies, the second test looks for the virus itself. It is very important that all injecting drug users have regular tests for hepatitis C. Sometimes people test positive for the antibody, but negative for the virus. This means that the virus has been in the bloodstream but has now gone. This doesn’t mean that they are immune, and sharing in the future can easily result in a hep C infection.
Hep C is not a disease that causes problems straight away, but it can creep up on you and make you really ill. Liver damage can be slow to develop, so few people are aware of anything for the first few years. The symptoms of liver disease can include: chronic tiredness, anxiety, feeling sick, a poor appetite, weight loss, feeling ill after drinking alcohol, pale stools and dark urine, skin and eyeballs turning yellow (jaundice), aching pain and tenderness below the ribs on the right hand side, joint pains and muscle pain, poor concentration and depression and anxiety.
One of the hard things for people with hep C is that is can be difficult to know if the virus is making them ill as all of these symptoms can be caused by other problems too. You are much more likely to get ill if you drink alcohol. Liver disease is much worse for people who drink alcohol heavily (even if only occasionally). Drinking heavily, especially over a long period of time, greatly increases the risk of serious liver disease. See our section on Alcohol health and liver disease.
Treatment for hep C is often effective in getting rid of the virus, and is becoming more widely available. It involves giving people injections of a drug called interferon, combined with other drugs that are effective against the virus.
Hepatitis B (hep B) is present in blood. It can be passed on very easily (to people who haven’t been vaccinated) through sharing injecting equipment and having unprotected sex. People who catch the hepatitis B virus and experience the infection can have a few very unpleasant weeks or months of illness with symptoms including extreme tiredness, loss of appetite, being unable to tolerate alcohol and sometimes yellowing of the skin, known as jaundice. The body then usually (but not always) gets rid of the virus without treatment.
For those people who develop long-term hepatitis B infection, the blood tests and treatment are similar to those for hepatitis C. Get vaccinated ! There is a vaccination against hepatitis B. All drug users and their close families and carers should have it. If you have been vaccinated, you can’t catch hepatitis B (but you can still catch hepatitis C or HIV). If you have not already been offered the hepatitis B vaccination, your needle exchange, drug treatment service of GP should be able to arrange it for you. It usually takes three jabs in your arm over a few weeks or months. You must have the full course of vaccinations, and then have a blood test to make sure it has worked.
You can protect yourself (and others) from serious infections if you:
|1. Use new sterile injecting
equipment every time, and
needles and syringes;
spoons or cookers;
|2. Clean any injecting
equipment you re-use
with thin bleach.
|3. Create a ‘safe space’ for preparing your hit.
You can do this by getting it together on a
surface that you can throw away afterwards (like
newspaper or magazine).
|4. Always dispose of used
injecting equipment safely.
Use a sharps bin to store used
equipment until you can take it back to
the needle exchange.
The Hepatitis C Trust is the national UK charity for hepatitis C and has been operating since 2001. It is an entirely patient-led and patient-run organisation: all of its staff, both paid and voluntary, either have hepatitis C or have had it and have cleared it after treatment.
AVERT is an international HIV and AIDS charity, based in the UK, working to avert HIV and AIDS worldwide, through education, treatment and care.