Four years after a public health campaign first implored Baltimore's drug users to "reach for the bleach," a study has found that bleaching hasn't lived up to its early billing as a potent way to protect addicts from contracting the AIDS virus.
Dr. David Vlahov, a Johns Hopkins scientist, yesterday told a world conference on AIDS, held in Italy, that addicts who say they faithfully disinfect their needles with bleach contracted the virus at only a slightly lower rate than those who never bleach.
He stopped short, however, of dismissing the household disinfectant as a meaningful weapon against AIDS -- saying further studies are needed to complete the picture. And meantime, he said, cleaning with bleach is better than doing nothing.
But it is possible, he said, that significant inroads won't be made until addicts refrain sharing their needles in the first place -- the behavior responsible for spreading the virus from one person to another.
"The real take-home message is that we should not rely on the power of disinfectants as they are presently used," Dr. Vlahov said in an interview last week.
The finding has already aroused worry in some quarters where people are busy educating addicts about the dangers of AIDS. In Baltimore, ex-addicts who work in drug-infested neighborhoods spreading the gospel of AIDS prevention said they will continue to distribute bleach until it has been proven ineffective.
And in San Francisco, home of the nation's first bleach distribution program, a leading advocate said he was afraid some policy-makers would be quick to condemn bleach programs before more complete evidence was gathered.
"I am concerned that some may take this one finding and say, this bleach program doesn't work because of the Baltimore program and not put any money into it," said Dr. John Watters of the Urban Health Study. In San Francisco, bleach distribution began in 1986.
The Baltimore report stemmed from an examination of 1,300 addicts who participate in a program at the Johns Hopkins School of Hygiene and Public Health that tracks the AIDS epidemic among intravenous drug users. Addicts enrolled in the program report regularly to an East Baltimore clinic for AIDS antibody testing and for interviews about their drug use.
Overall, the study found that 5 percent of the previously uninfected addicts contract the virus each year -- a rate that has held steady since 1988, when the program began.
But when scientists asked who bleached and who didn't, the findings didn't bode well for bleach programs. The infection rate among addicts who said they always bleached was 25 percent less than it was among addicts who never bleached; the rate among addicts who said they sometimes bleached was 10 percent less than it was among non-bleachers.
Annually, about 3.5 percent of the addicts who "always bleached" caught the virus anyway, compared to 4.5 percent of the addicts who "sometimes bleached" and 5 percent of all addicts taken together.
Dr. Vlahov admitted the verdict on bleach remains clouded by several questions.
First, some addicts may have claimed they used bleach all the time simply to present themselves in a favorable light. Also, he said, there is no way of knowing if the addicts who used bleach washed their needles thoroughly enough to kill every vestige of the virus.
"We need to do more studies to find out how we can optimize the use of disinfectants," Dr. Vlahov said. "But in the meantime, people should know that using bleach is probably better than doing nothing at all but is not fully protective."
Despite the findings, some AIDS educators said they felt bleach had to be making some inroads because of laboratory evidence that it was capable of destroying the virus.
"Until they come up with more documented proof that it [bleach]doesn't work, we'll continue to give it out," said Gregory Lowman of the Health Education Resource Organization (HERO), a Baltimore group that began distributing the disinfectant along with brochures in 1987.
Mr. Lowman is part of a contingent of five HERO employees who work on the streets, and occasionally in shooting galleries where addicts take drugs together, to educate addicts about AIDS. They talk about the dangers of sharing needles, but also distribute 150 vials of bleach daily in hopes of stemming the epidemic among addicts who continue to share.
In another HERO program, Vernessa Murphy runs a storefront center in West Baltimore where workers talk to teen-agers and young adults about the sexual and drug-using behavior responsible for AIDS. Bleach is distributed there as well.
"Three years ago, you could walk into a gallery and there wouldn't be a single bottle of bleach," she said. "Now, a lot of times you can see the empty bottles out on the street, where addicts have used them and thrown them out the window."