SUVA, FIJI: The disturbing practice known as “bluetoothing” has become one of the most widely publicised features of Fiji’s escalating HIV crisis, but a World Health Organization-backed investigation has found a much broader danger — the widespread sharing and reuse of contaminated needles and syringes.
The finding has taken on renewed significance after Fiji formally declared HIV a national emergency this month, as the Pacific nation confronts one of the sharpest increases in new HIV infections globally.
Bluetoothing involves a person injecting a drug and then withdrawing blood into a syringe before transferring the blood to another person, reportedly in an attempt to share the drug’s effects.
The practice has attracted international attention because of the extreme risk of transmitting HIV and other blood-borne infections.
However, a rapid assessment commissioned by WHO and the United Nations Development Programme found little evidence that bluetoothing itself was widespread among the injecting drug users researchers interviewed in Fiji.
Instead, researchers uncovered a more pervasive problem.
Every person who injected drugs interviewed for the assessment reported having, at some point, reused a needle or syringe after it had been used by somebody else because they lacked access to sterile injecting equipment.
The assessment involved interviews with 56 people who inject drugs in Suva and discussions with another 50 people representing health services, government agencies, civil society, law enforcement and faith organisations.
Methamphetamine was the most commonly injected drug.
Researchers found that some people were exposed to potentially contaminated injecting equipment from the first time they injected drugs, putting particularly young and inexperienced users at immediate risk of HIV and hepatitis.
The findings suggest that while bluetoothing represents an exceptionally dangerous practice, ordinary sharing and reuse of injecting equipment may pose a considerably broader public-health threat in Fiji’s HIV epidemic.
That concern is reflected in the latest HIV figures.
UNAIDS said this week that among Fiji’s HIV cases where the mode of transmission was known, more than 42 percent were associated with injecting drug use, while more than half were associated with sexual transmission.
New HIV infections in Fiji are estimated to have increased 12-fold between 2010 and 2025.
An estimated 9,100 people were living with HIV in Fiji last year, but only 39 percent knew their HIV status and just 22 percent were receiving antiretroviral treatment.
The scale of the crisis prompted Fiji to declare HIV a national emergency on September 15.
WHO said the declaration would allow the country to intensify measures already underway, including expanded testing, treatment, preventative medicines and harm-reduction programmes for people who inject drugs.
One of the most significant measures is the proposed introduction of a formal needle and syringe programme, which would give drug users access to sterile injecting equipment rather than forcing them to reuse or share needles.
Fiji’s government is preparing legislative changes required for the programme, according to UNAIDS.
WHO Representative to the South Pacific Dr Mark Jacobs said evidence from around the world showed that needle and syringe programmes could prevent HIV and hepatitis infections and save lives.
The WHO-backed assessment therefore shifts some of the focus away from the sensational nature of bluetoothing towards what researchers found to be a more widespread problem: people sharing contaminated injecting equipment because clean needles and syringes are not readily available.
There is currently no credible evidence that bluetoothing has been detected in Tonga.
However, Fiji’s experience highlights the potential HIV risk wherever injecting drug use and needle sharing occur, particularly as Pacific governments confront the wider regional spread of methamphetamine and other illicit drugs.
