Health experts and global agencies are raising urgent alarms over a perilous drug trend known as "bluetoothing"—a practice that is fueling a dramatic surge in HIV cases across several global hotspots, most notably Fiji and South Africa. The method, also called "hotspotting" or "flashblood," involves a group of drug users injecting a powerful substance such as heroin or methamphetamine, then drawing a small amount of blood laced with the drug back into a syringe and injecting it into another person. This process is often repeated among several individuals, frequently using the same needle, in a desperate attempt to share a high when drugs are scarce or unaffordable.
While the practice may seem like a cost-saving measure to those struggling with addiction and poverty, medical professionals warn that bluetoothing is fraught with life-threatening risks. "In settings of severe poverty, it’s a cheap method of getting high with a lot of consequences," Brian Zanoni, an Emory University professor who has studied drug injecting behaviors in South Africa, told The New York Times this week. "You’re basically getting two doses for the price of one." Yet, experts are divided on whether the secondhand injection even produces a real high—some suggest it may only deliver a weaker effect, while others believe the perceived rush is little more than a placebo.
The gravest danger lies in the direct transfer of blood, which bypasses the body’s usual defenses and dramatically increases the risk of transmitting blood-borne viruses. Unlike conventional needle-sharing, bluetoothing involves injecting the first user’s blood—potentially teeming with HIV or other pathogens—directly into the next participant. "Young people, who sometimes do not have enough money to buy the drugs they want, are exposing themselves to all kinds of dangers by injecting themselves with the blood of others," Maj Gen Khomo Mohobo, who runs a youth initiative in Lesotho, told The Guardian.
HIV sits at the top of the list of threats. According to The Fiji Times, Josua Naisele, acting CEO of Fiji’s substance abuse advisory council, emphasized that the risk of transmission is not limited to HIV. "Another danger of sharing needles is the transmission of hepatitis B and hepatitis C," Naisele said. Both viruses attack the liver and can lead to severe complications such as cirrhosis and cancer, with symptoms that range from jaundice and abdominal pain to chronic fatigue. Naisele added, "There is [also] a danger of getting bacterial infection at the injection site as well as passing bacteria into the blood stream. This can cause severe infections."
One particularly insidious risk is the possibility of injecting blood from a donor with a different blood type, which can trigger a violent and sometimes fatal immune reaction. Methamphetamine users, who often have weakened immune systems, are especially vulnerable to these complications.
The origins of bluetoothing can be traced back to Tanzania in 2010, where researchers first documented the practice among women who were heavy heroin users and living in precarious, short-term housing. Since then, the phenomenon has spread across parts of Africa and the Pacific Islands. In South Africa, the trend has become so prevalent that a 2023 study published in PLOS One found that nearly two in five people injecting drugs reported engaging in blood-sharing. The situation is equally dire in Pakistan, where reports have surfaced of blood-filled syringes being sold on the street.
But perhaps nowhere is the crisis more acute than in Fiji. According to UNAIDS, between 2014 and 2024, new HIV infections in Fiji skyrocketed tenfold. An official outbreak was declared in January 2024, and by August, the country’s Ministry of Health had formally linked the bluetoothing trend to the alarming rise in cases. Injectable drug use is now the most common mode of HIV transmission in Fiji, accounting for 48% of new infections—mostly among young people aged 15 to 34, with some patients as young as 13 years old.
Fiji’s assistant health minister, Penioni Ravunawa, did not mince words last week: "This is a national crisis. And it is not slowing down." He warned that by the end of 2025, more than 3,000 new HIV cases are expected to be recorded—an astonishing leap from the fewer than 500 residents living with HIV in 2014, as reported by the Fiji Sun. Eamonn Murphy, the UNAIDS Regional Director to Asia Pacific, called the bluetoothing trend among meth users in the region "extremely alarming." Catherine Cook, executive director of Harm Reduction International, described the practice as "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."
Globally, the numbers are sobering. More than 40 million people are living with HIV, and 1.3 million new cases were reported in 2024 alone, according to UNAIDS. South Africa, in particular, bears the brunt of the epidemic, with the highest number of cases worldwide. The combination of widespread poverty, limited access to clean needles, and the proliferation of bluetoothing has created a perfect storm for the virus to spread. The 2023 PLOS One study highlighted a grim reality: while over a third of such users in South Africa are living with HIV, only 40 percent accessed antiretroviral therapy in the past year, and just one person reported using pre-exposure prophylactics.
Researchers and advocates are urging public health authorities to act swiftly. Scientists are calling for routine interviews with frequent drug users to screen for bluetoothing and to reduce the stigma that prevents people from seeking help. "The support systems—the nursing, the ability to distribute or to access the drugs for treatment of HIV—just aren’t there," José Sousa-Santos, head of the Pacific Regional Security Hub at New Zealand’s University of Canterbury, told BBC. "What we’re seeing at the moment is the beginning of the avalanche."
Experts warn that unless there is a dramatic increase in harm reduction services—such as needle exchanges, widespread HIV testing, and easier access to antiretroviral therapy—efforts to curb the epidemic may be undone. The situation is already overwhelming Fiji’s limited public health infrastructure, which lacks both the nursing staff and the supply of treatment drugs necessary to manage the crisis. The low uptake of treatment and preventative medicines, combined with the rapid spread of bluetoothing, could undermine years of progress in the fight against HIV.
As the world watches the situation unfold in Fiji and South Africa, health officials and community leaders are left grappling with the urgent need for resources, education, and compassion. The bluetoothing epidemic is a stark reminder that in the battle against HIV, complacency is not an option—and that the world’s most vulnerable populations often pay the steepest price when public health systems are stretched to the breaking point.
