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Needlesticks outside of a healthcare setting


I'm sorry for, most likely, such a silly question but I feel it would be helpful to address a persistent fear I have, for which I don't have the necessary knowledge to dispel.
I am a little confused (and concerned about this), whilst I'm aware that there has never been a known case of hiv transmission through a needlestick outside of a healthcare setting, I'm not sure i understand why and how. It seems conceivable that out in the world a drug user or even somebody who has to inject for medical purposes may at some point incorrectly dispose of needles.
Is it the freshnesss and immediacy that often occurs with needlesticks in a healthcare environment? I worry quite a lot about coming into contact with some sort of needle when walking, putting out binbags, etc- would i be right in thinking that for transmission to be possible, a stick would have to be deep and painful and therefore you would know if it happened??
Many thanks


Hello and thank you for using AIDS Vancouver as your source of HIV/AIDS related information.
HIV transmission is possible from an accidental needlestick prick if the needle contains HIV+ blood, regardless of being outside or within a health care setting.  However, it is much rarer for HIV transmission to occur from a discarded needle that you accidently stepped on/touched, since a long time may have passed since it was last used and the likelihood of transmission from this discarded needle is quite low. Injecting with shared needles, on the other hand, pose a high risk of HIV transmission because it provides direct access to the bloodstream and has been used by more than one person very recently. Moreover, the blood has likely not been exposed to air so the HIV+ fluid is able to live substantially longer than HIV+ that is outside of the body and exposed to air.
Occupational needlestick injuries in healthcare settings are better documented, and although it is still a low risk of HIV transmission, there have been documented cases that transmission has occurred (although with the use of PEP, post-exposure prophylaxis, immediately after the exposure, it can reduce the likelihood of HIV infection). It may be because of the constant exposure to needles every day in the health care setting, compared to the lower chance of accidently pricking yourself with a discarded needle on the street. However, I would try not to worry too much about needlesticks in day-to-day life, especially if you practice universal precautions and wear shoes walking around. 
Hopefully this answers your question, and if you have any other questions or concerns, please feel free to call or email us.

Take care,
StephanieAIDS Vancouver Helpline Volunteere: helpline@aidsvancouver.orgp: (Mon-Fri 9-4pm ): (604) 696-4666w: www.aidsvancouver.org/helpline