Drug users have found a dangerous and cheap way to get a high that is fueling a surge in HIV diagnoses.

Called ‘bluetoothing’, the practice involves injecting yourself with the blood of another drug user in an effort to share in their high.

Already common in Fiji, the practice has driven an 11-fold surge in HIV cases on the Pacific island nation in just a decade.

In South Africa, where approximately 18 percent of drug users are estimated to use this method, it has also been associated with high HIV rates among these individuals.

Concerns are growing that the practice, also known as ‘flashblooding’, may spread to the US, where new HIV diagnoses have recently fallen by 12 percent over four years.

Dr. Brian Zanoni, a drugs specialist at Emory University, cautioned: ‘In contexts of severe poverty, it’s an inexpensive way to get high, but it comes with significant risks.’

‘You’re basically getting two doses for the price of one.’

Approximately 47.7 million Americans aged 12 or older report using an illicit drug in the last month, estimates indicate, which is about 17 percent of the population. Meanwhile, 1.13 million Americans are living with HIV.

In Philadelphia in 2023, a preacher reaches out to drug users as volunteers distribute food and warm clothing to those affected by the drug crisis and homelessness (file image).

The US drug epidemic has slowed in recent months, however, amid a crackdown on drug trafficking by the Trump administration.

Overdose deaths have decreased nearly 24 percent in the 12 months leading up to April 2025, the most recent data available, with an estimated 76,516 deaths, compared to approximately 101,363 deaths in the previous year.

It is not clear whether bluetoothing is already taking place in the US, but some experts have warned that addicts may be put off.

They say that one reason the practice is not more widespread is that it tends to deliver users with a diminished high.

It often is not clear how much of a high those who infuse themselves with another drug users blood receive, with this potentially being no different to a placebo effect.

Catharine Cook, the executive director of Harm Reduction International, a nonprofit based in the UK, told the New York Times: ‘It’s the perfect way of spreading HIV.

‘It’s a wake-up call for health systems and governments, the speed with which you can end up with a massive spike of infection because of the efficiency of transmission.’

In Fiji, in 2014 the country had fewer than 500 people living with HIV, but by 2024 this number had surged to approximately 5,900.

In the same year, the Pacific island nation recorded 1,583 new cases of HIV, equivalent to a 13-fold increase on its usual five-year average. About half of all new infected patients said they had been sharing needles.

The above shows drug overdose deaths by year in the US

The above shows the percent change in drug overdose deaths from April 2024 to April 2025

Kalesi Volatabu, executive director of the non-profit Drug Free Fiji, described to the BBC the moment that she witnessed the practice firsthand.

‘I saw the needle with the blood, it was right there in front of me,’ she said.

‘This young woman, she’d already had the shot and she’s taking out the blood, and then you’ve got other girls, other adults, already lining up to be hit with this thing.’

She added: ‘It’s not just needles they’re sharing, they’re sharing the blood.’

Estimates suggest about 33.5 percent of drug users in the US share needles, which also poses a risk of transmitting HIV.

Experts warn that the virus, alongside other diseases such as hepatitis, can get onto the needle if it is used by an infected person, and then be transferred to another individual who also uses the same needle.

In general, HIV rates in the US have fallen since 2017. However, due to disruptions in care in 2020 from the Covid pandemic, which means HIV cases were likely missed, new diagnoses have been slightly increased. 

According to the CDC, in the US and its associated territories, there were 39,201 new HIV diagnoses in 2023, the latest data available.

This is an increase from the 37,721 new cases in 2022. 

Of the 2023 cases, the newest CDC report on HIV shows 518 diagnoses were associated with intravenous drug use. 

Experts emphasize that HIV is no longer a death sentence, saying that there are drugs available that can slow the virus’ replication and allow someone infected to live a full and normal life. 

The practice of bluetoothing was first recorded in Tanzania around 2010, where it quickly spread from the country’s inner city to the suburbs. 

In Zanzibar, a tourism haven in the nation where the practice took hold, researchers found HIV rates were up to 30 times higher than those recorded in the mainland.

It has also been recorded in Lesotho, a small African nation bordering South Africa, and Pakistan, where people have sold half-used blood-infused syringes.