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June 17, 2003

Pakistani Injection Drug Users Twice As Likely to Donate Blood

Increased Likelihood of Spreading Blood-Borne Diseases to General Population

Thirty percent of injection drug users in Pakistan are paid to donate blood, which could contaminate the global blood supply and increase the spread of HIV/AIDS and hepatitis B and C, according to a study of three Pakistani cities conducted by the Johns Hopkins Bloomberg School of Public Health. The study, “HIV/AIDS Risk Behaviors and Correlates of Injection Drug Use Among Drug Users in Pakistan,” appears in the June 2003 issue of the Journal of Urban Health

Steffanie Strathdee, PhD, senior author of the study and associate professor of Epidemiology and International Health in the School of Public Health, said, “We found that injection drug users were twice as likely to donate blood as non-injectors, which is not surprising since some blood donor clinics in Pakistan pay for blood donations. Unless appropriate screening of blood occurs, blood-borne infections could spread to the Pakistani general population like wildfire, as has been the case in other countries, like China.”

The researchers examined awareness of HIV/AIDS and risk behavior of 608 drug users serviced by a non-governmental organization that assisted users in three Pakistani cities: Riwalpindi, Quetta and Peshawar. They found that most of the study participants were married men with a median age of 32 and who lived with their families. The majority of the study participants used heroin and 15 percent injected those drugs. Almost half (44 percent) had no formal education and 59 percent had never heard of HIV/AIDS.

Researchers found that heroin is easily available in Pakistan due to its close proximity to Afghanistan, one of the world’s leading producers of opium. Liquid opiates are also readily available at pharmacies without a prescription. Of the study participants who had injected drugs, half reported sharing needles with others. When they did attempt to sterilize needles, the methods used - washing them with plain water, boiling water, or other means - were not sufficient to disinfect them. A study completed in Pakistan in 2000 found that only 8 percent of blood banks ask potential donors about injection drug use, none screened for other high-risk behavior, and testing for blood pathogens did not occur regularly.

The researchers state in their article, “If HIV seriously penetrates the injection drug user population in Pakistan, our findings suggest that a generalized epidemic could subsequently occur.”

According to the researchers, a high prevalence of needle sharing, an association of injection drug use and blood donation, and low levels of HIV/AIDS awareness is an alarming combination. To prevent the spread of blood-borne infections in Pakistan, the researchers suggested that interventions are needed to discourage a transition to injection drugs. Needle exchange programs should be scaled up, along with HIV testing and educational counseling for drug users. Paid blood donation should be prohibited and screening donations for blood-borne infections should be implemented to help safeguard the blood supply in Pakistan, according to the researchers.

Additional authors were Mohammad Abrar Ahmed, MBBS, an MPH graduate from the Department of Epidemiology, and Heena Brahmbhatt, MPH, PhD, an assistant scientist in the Department of Population and Family Health Sciences, at the School of Public Health. Tariq Zafar, BBS, Ghazanfar Imam and Salman ul Hassan, BSc, all with Nai Zindagi, in Islamabad, Pakistan, were also co-authors.

Research was supported by grants from the National Institute on Drug Abuse and the European Commission.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Brigham at 410-955-6878 or

Photographs of Steffanie Strathde and Heena Brahmbhatt are available upon request.