Bloodborne HIV: Don't Get Stuck!

Protect yourself from bloodborne HIV during healthcare and cosmetic services

Patron observed sterile treatment for tattooing

Box 13: POST for tattooing
1. Avoid skin-piercing procedures Don’t get a tattoo. This only works for people who are willing to forego a tattoo.
2. Use new disposable instruments (a) Ask the tattooist to use new needle(s) from sealed packages.(b) Ask the tattooist to use new inkpots from sealed packages. (c) Ask the tattooist to open a new bottle of ink for you (one for each color).
3. You sterilize the instruments You can boil needles and inkpots.
4. Ask providers how they sterilize instruments Ask the tattooist how he or she cleans hand-pieces: Vibrating hand-pieces that do not come into contact with skin may be contaminated by small bits of blood and tissue thrown into the air while tattooing. Hand-pieces should be sterilized. If not, HIV and other germs may vibrate off them onto subsequent clients. As the tattooist what he does with left-over ink: Left-over ink should be thrown away. If the tattooist saves ink from an ink-pot used during a previous tattoo, the ink may be contaminated and dangerous. If you believe a tattooist is careful, that’s your call.

Additional information about tattooing

Several technologies are common. Tattoos can be applied with a small hand-held electric machine that moves a small bundle of needles to puncture the skin, or by hand manipulation of needles to make multiple punctures in the skin.

Risk to get HIV from tattooing

If the tattooist reuses needles or inkpots from an HIV-positive client with no effort to clean, or uses ink left-over after tattooing an HIV-positive client, your risk to get HIV from tattooing may be estimated at greater than 10% (see Blood-borne Risks section). If the tattooist is careful with needles, handpieces, and inkpots, but saves and uses left-over ink, your risk may still exceed 10%: HIV can go from an HIV-infected client to needles, from needles to ink, and then, if the tattooist does not throw away excess ink and contaminated ink, HIV can go to the next client.

Evidence that tattooing has infected some people with HIV

There is a lot of evidence tattooing transmits HIV. For example, a study in India that followed and tested adults every 3 months asked about tattoos along with other risks. Those who received a tattoo between visits were 2.4 times more likely to show up with a new HIV infection at their next visit compared to those without new tattoos.[1] A study in the US found that men who became HIV-positive in prison were 4 times more likely than other men to have received a tattoo in prison.[2,3] In a study of men with new HIV infections in prison, many men reported tattooing as their only risk[3] (see also Devon Brewer’s discussion of this paper[4]).

Deadly ignorance about HIV risks from tattooing

During 1995, as part of research on HIV risks in India, I met with a group of prostitutes’ representatives. They reported standing in line for tattoos during festivals for the goddess Yellamma. Same inkpot, same needles. They thought it was safe because they wrongly believed HIV dies in seconds outside the body.


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2. HIV transmission among male inmates in a state prison system – Georgia, 1992-2005. MMWR 2006: 55: 421-426. Available at: (accessed 10 July 2011).

3. Jafa K, McElroy P, Fitzpatrick L, Borkowf CB, MacGowan R, Margolis A, Robbins K, Youngpairoj AS, Stratford D, Greenberg A. HIV transmission in a state prison system, 1988-2005. PLoS ONE. 2009;4(5):e5416. Available at: (accessed 4 January 2019).

4. Brewer DD, Potterat JJ, Muth SQ, Brody S. Raising the standard of evidence for determining modes of HIV transmission. PLoS One 2009. Available at:  (accessed 20 October 2018).

5 Dandona L, Dandona R, Kumar GA, Reddy GB, Ameer MA, Ahmed GM, Ramgopal SP, Akbar M, Sudha T, Lakshmi V. Risk factors associated with HIV in a population-based study in Andhra Pradesh state of India. Int J Epidemiol. 2008;37(6):1274-1286.

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11. Beyrer C, Jittiwutikarn J, Teokul W, Razak MH, Suriyanon V, Srirak N, Vongchuk T, Tovanabutra S, Sripaipan T, Celentano DD. Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand. AIDS Behav. 2003;7(2):153-161. Abstract available at: (accessed 24 December 2018). The abstract does not give details about HIV risk with tattooing.

12. Rahbar AR, Rooholamini S, Khoshnood K. Prevalence of HIV infection and other blood-borne infections in incarcerated and non-incarcerated injection drug users (IDUs) in Mashhad, Iran. Int J Drug Policy. 2004;15(2):151-155. Abstract available at: (accessed 24 December 2018). The abstract does not give details about HIV risk with tattooing.

13. Rodrigues JJ, Mehendale SM, Shepherd ME, Divekar AD, Gangakhedkar RR, Quinn TC, Paranjape RS, Risbud AR, Brookmeyer RS, Gadkari DA. Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India. BMJ. 1995;311(7000):283-286. Available at (see table 2): (accessed 24 December 2018).

14. Buavirat A, Page-Shafer K, Van Griensven GJP, Mandel JS, Evans J, Chuaratanaphong J, Chiamwongpat S, Sacks R, Moss A. Risk of prevalent HIV infection associated with incarceration among injecting drug users in Bangkok, Thailand: case-control study. BMJ. 2003;326(7384):308. Available at: (accessed 24 December 2018).

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16. Zamani S, Kihara M, Gouya MM, Vazirian M, Ono-Kihara M, Razzaghi EM, Ichikawa S. Prevalence of and factors associated with HIV-1 infection among drug users visiting treatment centers in Tehran, Iran. AIDS. 2005;19(7):709-16. Abstract available at: (accessed 24 December 2018).  The abstract does not give details about HIV risk with tattooing.

17. Motevalian SA, Farhoodi B, Motamedi M, Motevali Khamene M, Mohraz M, Rasoulinejad M, Jaafari S, Afshar P, Esmailie I, Mohseni L. Prevalence of HIV and risky behaviors among injecting drug users of a prison in Tehran. Abstract no. MOAC203, 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, Australia, 2007. Available at: (accessed 24 December 2018).

18. Zhang GL, Wang N, Xu JJ, Pu Y, Ni WL, Lu L, Min XD, Ma YL, Ding GW, Fu ZH. Epidemiologic study on STD/HIV infections among tin mining workers in Gejiu, Yunnan province. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2007;41(4):285-289. Available at:

19. Laurent C, Bourgeois A, Mpoudi M, Butel C, Peeters M, Mpoudi-Ngolé E, Delaporte E. Commercial logging and HIV epidemic, rural equatorial Africa. Emerg Infect Dis. 2004;10(11):1953-1956. Available at: (accessed 24 December 2018).

20. Nishioka SA, Gyorkos TW, Joseph L, Collet JP, MacLean JD. Tattooing and transfusion-transmitted diseases in Brazil: a hospital-based cross-sectional matched study. Eur J Epidemiol. 2003;18(5):441-449. Abstract available at: (accessed 24 December 2018). The abstract does not provide details about HIV with and without tattoos.

21. Entz AT, Ruffolo VP, Chinveschakitvanich V, Soskolne V, Van Griensven GJP. HIV-1 prevalence, HIV-1 subtypes and risk factors among fishermen in the Gulf of Thailand and the Andaman Sea. AIDS. 2000;14(8):1027-1034. Available at: (accessed 24 December 2018).

22. Martín V, Caylà JA, Morís ML, Alonso LE, Pérez R, Sánchez VM. Evolucion de la prevalencia de infeccion por virus de la inmunodeficiencia humana en poblacion reclusa al ingreso en prision durante el peri­odo 1991-1995. Rev Esp Salud Pública. 1997;71(3):269-280. Available at: (accessed 24 December 2018).

23. Estebanez Estebanez P, Colomo Gomez C, Zunzunequi Pastor MV, et al. [Jails and AIDS. Risk factors for HIV infection in the prisons of Madrid][Spanish]. Gaceta Sanitaria 1990; 4: 100-105. Available at: (accessed 7 January 2019).

24. Babudieri S, Longo B, Sarmati L, et al. Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy. J Med virol 2005; 76: 311-317. Abstract available at: (accessed 7 January 2019).

25. Garland SM, Ung L, Vujovic O, et al. Cosmetic tattooing: a potential transmission route for HIV? Aust N Z J Obstet Gynaecol 2006; 46: 458-459.

26. Dinakar CP, Roshanara B, Immanuel G. High prevalence associated with unsafe injection practxices among male injecting drug users in Chennai City, Tamil Nadu State, India. Soc Med 2011; 6: 29-35. Available at: (accessed 7 January 2019).

7 responses to “Patron observed sterile treatment for tattooing

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