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Syringe and Needle Regulation, Blood-Borne Disease Transmission, and Concern for Public Safety

Gerald Friedland, MD
JAMA. 1997;277(15):1202-1203. doi:10.1001/jama.1997.03540390032027.
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To the Editor.  —The intertwined epidemics of injection drug use and human immunodeficiency virus (HIV) disease have been recognized worldwide.1 In parts of the world where these 2 medical and public health problems coexist, it appears that the unavailability of sterile needles and syringes plays a key role in accelerating HIV transmission. It is important for the medical profession to appreciate the reasons for this unavailability.In my experience, while physicians and others involved in the medical care of injecting drug users (IDUs) with HIV disease may be aware of the medical complications of drug use, most clinicians remain less knowledgeable about the behavioral factors associated with HIV disease transmission among IDUs,2 and almost all physicians are completely unaware of the legal and institutional structures that overarch HIV transmission events in this population. Much of the burden of disease among IDUs and their contacts is the direct or


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