Amina* and Rajab*, in their mid-twenties, spend most of their days getting high on heroin; when broke, Amina injects herself with Rajab's blood as soon as he has mainlined his heroin, for a second-hand hit.
"Rajab is the one who first introduced me to the idea of transfusing myself with his blood whenever we'd run out of the drug and the cash to buy [more]," she told IRIN/PlusNews from her home in Majengo, a low-income estate in Kenya's coastal city of Mombasa. "I just wanted to feel how Rajab used to feel. I draw his blood using a syringe, then inject it into myself, making me feel high as well."
According to government officials and NGOs in Mombasa, blood sharing, commonly known as “flash blood”, is becoming increasingly common in Mombasa.
Both Amina and Rajab have tested positive for HIV and are on life-prolonging anti-retroviral therapy; this has not stopped them from using heroin or sharing blood, despite the risk of re-infection.
According to the latest Kenya National Strategic plan for HIV/AIDS (KNASP), intravenous drug use (IDU) is responsible for almost a third of new HIV infections in Coast Province, and 3.8 percent of new infections nationally.
The flash blood technique was first reported in 2005 in East Africa among female sex workers injecting heroin in Tanzania's commercial capital, Dar es Salaam.
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"[Flash blood] is a new phenomenon that is, in a sense, a dangerous exaggeration of needle-sharing that magnifies HIV transmission risk," Sheryl McCurdy, of the University of Texas, wrote in a 2005 letter to the British Medical Journal. "If the first injector is infected with HIV or hepatitis C, the amount of virus directly transmitted into the bloodstream by the second injector could be quite large."
A 2009 assessment by the NGO, Darat HIV/AIDS International Agency, of more than 100 narcotics users in Mombasa, a majority of whom were IDUs, identified flash blood as a likely cause of high levels of HIV and hepatitis C - 50 percent and 70 percent respectively - among participants. All those who tested positive for HIV were IDUs.
According to the KNASP, intravenous drug use is on the rise in Mombasa; a 2007 survey identified an estimated 12,200 heroin users, 5,680 in Nairobi Province and 6,520 in Coast Province - approximately 10 percent of whom were IDUs. None was receiving any HIV prevention or drug dependence treatment services.
The strategy points out that although this high-risk group has a high potential of infecting the general public with HIV, it has been difficult to conduct programmes for IDUs, mainly because of insufficient data, the criminal nature of drug use and marginalization and intolerance, even from policy-makers.
"It is important to scale up, revitalize and initiate programmes among these populations through peer outreach, condom promotion and distribution, tailored sexual healthcare and community empowerment," the 2009 Kenya Modes of Transmission Analysis recommended.
|The drug definitely becomes part of your body system, your life...not even the police or the fear of contracting HIV can scare you off|
"In the entire province, there exist only four [drug treatment] centres, which makes it hard to address the issue extensively," said Sheikh Juma Ngao of the National Campaign Against Drug Abuse. He added that the success rate of the existing centres was poor.
For most drug addicts, poor and unemployed, getting high is their only escape. Ahmed, who left prison six months ago after serving time for possession of heroin, says the drug is a “tiba”, or treatment, for the hardships he faces daily.
"Only by injecting myself is when I can get some relief... the drug definitely becomes part of your body system, your life," he told IRIN/PlusNews. "Not even the police or the fear of contracting HIV can scare you off."
*Not their real names