Desperate, dumb and Darwin

Desperate heroin users in a few African cities have begun engaging in a practice that is so dangerous it is almost unthinkable: they deliberately inject themselves with another addict’s blood, researchers say, in an effort to share the high or stave off the pangs of withdrawal.

The practice, called flashblood or sometimes flushblood, is not common, but has been reported in Dar es Salaam, Tanzania, on the island of Zanzibar and in Mombasa, Kenya.

It puts users at the highest possible risk of contracting AIDS and hepatitis. While most AIDS transmission in Africa is by heterosexual sex, the use of heroin is growing in some cities, and experts are warning that flashblood — along with syringe-sharing and other dangerous habits — could fuel a new wave of AIDS infections.

“Injecting yourself with fresh blood is a crazy practice — it’s the most effective way of infecting yourself with H.I.V.,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, which supports the researchers who discovered the practice. “Even though the number who do it is a relatively small group, they are vectors for H.I.V. because they support themselves by sex work…”

In most East African countries like Tanzania and Kenya, only 3 to 8 percent of adults are infected with the AIDS virus, far fewer than in southern Africa, where the rates reach 15 to 25 percent.

But among those who inject heroin, the rates are far higher. In Tanzania, about 42 percent of addicts are infected. The rate is even higher — 64 percent — among female addicts, Dr. McCurdy said, and since most support themselves through prostitution, they are in two high-risk groups, and their customers are at risk of catching the disease.

Most of the addicts she has interviewed who practice flashblood, Dr. McCurdy said, are women. For them, sharing blood is more of an act of kindness than an attempt to get high: a woman who has made enough money to buy a sachet of heroin will share blood to help a friend avoid withdrawal. The friend is often a fellow sex worker who has become too old or sick to find customers.

By contrast, on Zanzibar, it is mostly among men, according to a 2006 study in The African Journal of Drug and Alcohol Studies, which found that about 9 percent of the 200 drug-injectors interviewed practiced it.

They’ll all be gone sooner or later. Leaving behind everyone they’ve infected.

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