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A theme issue by, for, and about Africa

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:778

New injecting practice increases HIV risk among drug users in Tanzania

  1. Sheryl A McCurdy, assistant professor (Sheryl.A.McCurdy{at},
  2. Mark L Williams, professor,
  3. Michael W Ross, professor,
  4. Gad P Kilonzo, professor of psychology, School of Medicine,
  5. M T Leshabari, professor of behavioural sciences, School of Public Health
  1. University of Texas Health Science Center at Houston, School of Public Health, WHO Center for Health Promotion and Prevention Research, 7000 Fannin Street, Suite 2500, Houston, TX 77030, USA
  2. Muhimbili University College of Health Sciences, University of Dar es Salaam, Dar es Salaam, Tanzania

    EDITOR—Female sex workers who inject heroin in Dar es Salaam, Tanzania, have created a new needle sharing practice they call “flashblood.” This entails drawing the first blood back in a syringe until the barrel is full and then passing the needle and syringe to a female companion. Women believe that about 4 cm3 of such blood contains enough heroin to help them escape the pains of withdrawal. They developed this practice in mid-2005 in an altruistic attempt to help one another. Male injectors are unaware of this practice. These data are based on ongoing interviews with 63 injecting drug users.

    Research on the relation between drug injection and HIV transmission has long focused on the serial use of syringes or needles, practices such as “backloading,” and reuse of paraphernalia before injecting.13 Flashblood is a new phenomenon that is, in a sense, a dangerous exaggeration of needle sharing that magnifies HIV transmission risk. If the first injector is infected with HIV or hepatitis C virus the amount of virus directly transmitted into the bloodstream by the second injector could be quite large.

    The rationale for the practice may be the price and quality of heroin. Since 2003 the price of heroin has doubled. Once pure, it is now reportedly adulterated. Now a kete costs $1, and injectors reportedly need two to get high. Most female injectors are sex workers, and the more successful are helping the more desperate with flashblood. The women who accept flashblood are also the most likely to agree to clients' frequent requests to forgo condoms.

    Injection drug use emerged in East Africa during the past five to six years, and it is spreading rapidly throughout the region.4 5 If flashblood spreads to other cities in East Africa, its impact on the rate of transmission of HIV and hepatitis C virus could be substantial.


    • Competing interests None declared.