HIV Transmission Escalates Due to Blood Exchange Practices Among Drug Users
Image source, Getty/BBC
Fiji declared a national state of emergency last week amid a rapidly escalating HIV epidemic.
Despite global progress, HIV and AIDS remain significant threats in some regions, with signs indicating the epidemic could soon get out of control.
In the Pacific Islands group, approximately one in every 60 adults is currently living with HIV.
Five years ago, the rate was one in 167 people. UNAIDS global data estimates about 41 million people worldwide could be infected with HIV.
A concerning practice called ‘bluing’—where injecting drug users share needles after drawing blood from one person to administer drugs to another—is deepening the crisis.
This practice involves drawing blood from a drug user and then injecting it into another person via the same needle. This results in the second person experiencing the effects of the drug as well. Users perceive this as a way to save money and enhance the drug’s effectiveness.
This behavior has been observed in African countries such as Lesotho, Zimbabwe, and South Africa. While debate continues about its spread and its relation to Fiji’s situation, community activists emphasize it is a real threat that governments and health agencies worldwide must address seriously.
“How many more lives must be lost before we truly act?” questions Kalesi Volatabua, executive director of Drug Free Fiji.
Why is ‘Bluing’ Risky?
HIV is transmitted through blood, so exchanging infected blood via needles among drug users poses a high risk of virus transmission.
The World Health Organization (WHO) states this practice also heightens the risk of transmission of severe bacterial infections, including hepatitis B and C.
In Fiji, limited access to sterile needles and materials for drug users has contributed to the growing trend of sharing needles. Poverty is identified as a key underlying factor.
Volatabua was shocked the first time she witnessed this.
“I saw five or six people lined up sharing the same needle,” she said.
“If they infect five people, it could easily spread to 25 to 30 others. This represents a highly contagious risk.”
Image source, Getty Images
In 2024, Fiji’s Ministry of Health identified this practice as one of the key reasons behind the surge in HIV cases.
That same month, the government declared HIV a national epidemic and announced plans to implement needle and syringe exchange programs.
A rapid assessment conducted by the WHO in December revealed evidence that ‘bluing’ is a common practice in Fiji.
Out of 56 injecting drug users interviewed, only two admitted to engaging in ‘bluing’ while four others reported witnessing it firsthand.
Volatabua expressed skepticism about the practice until she witnessed it herself.
She believes the stigma associated with drug addiction and needle use has led to limited government attention to this issue.
“I knew this problem would arise,” she said. “We shouldn’t have reached this point.”
Global Status of HIV
Image source, Getty Images
The HIV virus destroys immune system cells, weakening the body’s ability to fight disease.
HIV is primarily transmitted via the body fluids of infected individuals, most commonly through unprotected sexual contact. However, it can also spread through needle sharing or open wounds among drug users, and from mother to child during pregnancy, birth, or breastfeeding.
When HIV severely damages the immune system, the resulting condition is called AIDS.
In the past decade, treatment options have improved significantly, enhancing the life expectancy of those living with HIV.
In 2025, approximately 570,000 deaths were caused by HIV-related illnesses, a 73% reduction compared to 2004.
Antiretroviral therapy (ART) is used to lower the viral load to undetectable levels and maintain immune system health.
However, UNAIDS head Winnie Byanyima warned that the US President Donald Trump’s decision to cut foreign aid has led to 2,000 new daily HIV infections, with nearly 6 million deaths projected within four years.
In 2025, new infections increased in three regions and 21 countries, including Afghanistan, Sri Lanka, Nepal, Kenya, Sudan, Brazil, Pakistan, Yemen, Egypt, Senegal, and the Philippines.
Where Else is ‘Bluing’ Taking Place?
Image source, Ponto Tumisi
Lesotho has the second-highest HIV infection rate worldwide, with HIV cited as the leading cause of death among women there.
A women’s organization in Lesotho called ‘A Mothers Cry’ is actively trying to stop bluing. In their campaign, women share experiences regarding children affected by drug addiction.
In 2024, they discovered that abandoned buildings in South Africa were being used for buying, selling, and consuming injectable drugs.
Ponto Tumisi, once an exemplary student before using crystal methamphetamine, explained that bluing often occurs when small quantities of drugs are sold.
“Whether or not people know about blood types or disease transmission, it doesn’t seem to matter to them,” she said.
Tumisi said that healthcare workers have indicated that direct blood exchange is not a safe practice and should not occur.
Image source, Ponto Tumisi
The blood-injecting drug use method has different names in other countries—for example, in Tanzania, it is called ‘flash blood’. UNAIDS regional director Eamon Murphy noted that this is not a common global practice.
Tumisi expressed concern that this practice might pose significant risks in countries with less experience and information.
She emphasized the importance of raising early warnings about these risks among those working to combat drug abuse.
“If you are a parent anywhere in the world, you are human and therefore at risk. Anything can happen with drug addiction.”
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