DESPERATE ADDICTS INJECT OTHERS' BLOOD

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."

Sheryl A. McCurdy, a professor of public health at the University of
Texas in Houston, first described the practice five years ago in a
brief letter to The British Medical Journal and recently published a
study of it in the journal Addiction.

"I don't really know how widespread it is," said Dr. McCurdy who is
contacting other researchers working with addicts to get them to
survey their subjects about it. "There's pretty circular movement in
East Africa, so I wouldn't be surprised if it's in other cities."

Increasing use of heroin in parts of Africa has the potential to
magnify the AIDS epidemic.

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.

There have also been reports in East African newspapers of addicts
selling their blood, but those have not been confirmed by medical
researchers.

And, there have been scattered reports of flashblood-type practices in
other countries with large numbers of heroin addicts, including
Pakistan, but they also have not been confirmed by
researchers.

Whether or not someone can actually a get drug rush from such a
relatively tiny amount of blood has never been tested, Dr. McCurdy
said. Humans have about five quarts of blood and the flashblood-user
injects less than a teaspoon.

"They say they do," she said. "They pass out as if they just got a
high. But I've talked to doctors who say that could be entirely the
placebo effect."

One possibility, she said, is that traces of the drug are still in the
syringe. After piercing a vein, an addict will typically draw some
blood into the syringe, push it back out and repeat that three or four
times to make sure all the heroin has been flushed into their blood.
Those offering flashblood will usually hand over the syringe after
only one in-out cycle.

The heroin sold in East Africa, she added, is often quite strong
because it has come from relatively pure shipments on their way to
Europe from Afghanistan or Asia.

Until recently, heroin use was uncommon on the continent because most
Africans are too poor for traffickers to bother with. But in the last
decade, smugglers have begun using port cities like Dar es Salaam and
Mombasa and airport cities like Nairobi and Johannesburg as way
stations on their routes: law-enforcement officials can often be
bribed, and couriers from countries with no history of drug smuggling
may escape searches by European border officers. The couriers may be
paid in drugs, which they resell.

With more local users, more heroin is being sold in Africa. In the
last decade, law-enforcement and drug treatment agencies said, heroin
use has increased, especially in Kenya and Tanzania, South Africa and
Nigeria. Brown heroin that must be heated and inhaled - "chasing the
dragon" - has given way to water-soluble white heroin that can be
injected. Prices have fallen by as much as 90 percent.

While a teaspoon of blood is more than enough to transfer diseases
like AIDS, said Dr. James AuBuchon, president-elect of the American
Association of Blood Banks, it would not be enough to cause a
life-threatening immune reaction, as can ensue when a patient gets a
transfusion from someone of the wrong blood type. Instead, "you'd
likely get only brief symptoms," he said.

Dr. AuBuchon, who practices in Seattle, said he had never heard of
flashblood, but added that he was horrified by the idea.

"What," he asked, "are they thinking?"