The practice of flashblood, injecting the blood of other heroin users to relieve withdrawal symptoms documented by McCurdy et al. (June 2010) , underscores not only the risk of human immunodeficiency virus (HIV) transmission among injecting drug users in East Africa, but also the urgent need for effective opiate substitution treatment. Tanzania is alone in the region in its initiation of methadone treatment for opiate dependence, but the targets for this pilot effort remain far below estimates of need . Despite widespread needle sharing and HIV transmission among injecting drug users (IDUs) on the coast and in Nairobi, the Kenyan National Campaign Against Drugs Abuse Authority (NACADA) has raised concerns that needle exchange contradicts official government policy of ‘total abstinence and a drug free lifestyle’, and noted publicly that the ‘benefits of methadone are far outweighed by the risks’ and that Kenya is ‘not in a position to handle methadone substitution therapy’. Sterile syringe programs remain unavailable anywhere in Africa except Mauritius . The US President's Emergency Plan for AIDS Relief (PEPFAR) is legally required to collect data on IDUs assisted by its programs [5, p. 38], and the United States no longer bans federal support for needle exchange programs. Nonetheless, PEPFAR—which supports the Tanzanian methadone pilot—has yet to fund harm reduction measures such as needle exchange and methadone treatment that have been rigorously demonstrated to be effective in HIV prevention .
Qualitative research of the kind proposed by McCurdy and colleagues on those factors, including flashblood, that increase the vulnerability of women IDUs is indeed important. Similar analysis of the political and structural dynamics shaping the risk environment in East Africa may be equally critical if the aim is removing barriers to effective HIV prevention and treatment.