A little-known drug practice involving the injection of another drug user’s blood has been documented in several African countries, raising concerns about the health risks associated with changing patterns of drug use.
Known as “bluetoothing” or “hotspotting”, the practice involves drawing blood from someone who has recently taken drugs and injecting it into another person in the hope of experiencing some of the remaining drug effect.
The practice can expose people to blood-borne infections, including HIV and hepatitis B and C. But although cases have been reported in countries including South Africa, Zimbabwe and Lesotho, there is not enough evidence to conclude that it is widespread across Africa or currently spreading into West Africa.
A shortage of money or drugs can be one factor behind the practice, particularly when people who use drugs are dependent and seeking another high. Researchers and health workers have also pointed to drug availability, peer influence and limited access to treatment as factors that can contribute to risky drug use.
In South Africa, a study involving 45 people who inject drugs in KwaZulu-Natal found that 18% reported injecting another person’s blood, while 43% reported sharing needles. The small, localised study cannot be used to estimate how common the practice is across the country or continent.
Researchers have also documented bluetoothing among young people who use drugs in Zimbabwe, while reports from Lesotho have described similar behaviour. Related blood-sharing practices have previously been documented elsewhere in Africa.
These reports confirm that the practice exists in different settings, but they do not establish a continent-wide trend.
There is currently no clear evidence that bluetoothing is widespread in West Africa. However, health authorities may need to monitor for new injecting practices as drug markets and patterns of consumption change.
West Africa has long been an important transit route for international drug trafficking, while domestic consumption of different substances has also become a growing public-health concern. Sierra Leone, for example, declared a national emergency over drug abuse in 2024 amid a severe crisis involving the synthetic drug kush.
The emergence of new drug-use patterns does not mean that bluetoothing will necessarily become established in the region. But where drug dependence, financial hardship, injecting drug use and limited access to treatment or sterile injecting equipment occur together, similar practices could emerge.
The health risks are particularly serious when blood is transferred directly between people. If the donor has HIV, hepatitis B or hepatitis C, injecting their blood can create a route of transmission.
That does not mean bluetoothing itself is a major driver of HIV infections. The risk depends on whether the source person has an infection and a number of other factors affecting transmission.
Evidence from outside Africa also illustrates the need for caution when assessing reports of the practice. In Fiji, where authorities have raised concerns about bluetoothing amid a sharp increase in HIV infections, a 2025 assessment found little evidence that it was widespread among people who inject drugs in Suva. It did, however, identify other unsafe injecting practices, including the reuse of needles and syringes.
The wider concern for African governments is the changing nature of drug use. International trafficking routes have evolved, while cocaine, pharmaceutical opioids and synthetic drugs are increasingly part of the public-health debate.
That means the challenge extends beyond intercepting drugs at borders. Authorities also need to understand how substances are being used within communities and whether health services can identify emerging forms of risky behaviour.
For West Africa, bluetoothing should therefore be viewed as a potential risk rather than an established regional trend. The available evidence does not show that the practice is currently spreading across the region, but it highlights the importance of detecting new patterns of drug use before they become more difficult to address.
