A growing trend of injecting the blood of other drug users to get a quick high, a practice called “bluetoothing”, has been contributing to a surge in HIV cases across global hotspots, including South Africa and Fiji, reports suggest.
The cheap method of getting a high has become popular among drug users in poverty-stricken areas of Africa and the Pacific islands.
For instance, the UN has warned that the practice could be linked to a nearly 10-fold rise in HIV infections in Fiji in the decade between 2014 and 2024.
A growing body of studies warns that heroin, or nyaope, users in South Africa are increasingly following this dangerous method.
In this drug-taking method, after one user injects the drug, they withdraw blood from their veins for another user to inject it voluntarily for a less-potent, secondary high.
The practice, also known as “flashblood” has been well documented in South Africa, where one study published in the journal PLOS One in 2023 found that as many as nearly two in five people injecting drugs could be following bluetoothing.
It has also been documented as early as 2010 among heroin users in Tanzania, where researchers found that vulnerable women, who are heavy drug users and also living in shorter term housing, were following the practice.
The people following this method to get a high are also generally poor and unable to afford or continue antiretroviral treatment for HIV, research suggests.
It has been described mainly in areas of poverty with limited access to needle exchanges.
Despite over a third of such users living with HIV, “only 40 per cent accessed antiretroviral therapy within the past year, and one accessed pre-exposure prophylactics”, the 2023 study found.
Eamonn Murphy, the UNAids Regional Director to Asia Pacific, called the “bluetoothing” trend among Meth users in the region "extremely alarming”.
Last week, Fiji’s assistant health minister Penioni Ravunawa warned that by the end of 2025, the country could record over 3,000 new HIV cases compared to 2014 when the island nation had fewer than 500 people living with the viral infection.
Researchers warn that the practice coupled with the low uptake of treatment and preventative medicines, including HIV testing, could negate efforts to prevent and treat HIV across the globe.
Scientists call for routine interviews with frequent drug users to screen for this practice and reduce stigma to allow for better harm reduction services.
