Pakistani Injection Drug Users Twice as Likely to Donate Blood

Thirty percent of Pakistani injection drug users are paid to donate blood, which could contaminate the blood supply and increase the spread of HIV/AIDS as well as hepatitis B and C, according to a study 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," was published in the June issue of Journal of Urban Health (2003;80(2):321-329).

"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," said Steffanie Strathdee, associate professor of epidemiology and international health at Johns Hopkins Bloomberg School of Public Health and senior author of the study.

The authors looked at the awareness of HIV/AIDS and risk behavior of 608 drug users serviced by a nongovernmental organization in three Pakistani cities. The study participants were mostly married men, median age 32, who lived with their families. The majority of the participants used heroin, and 15 percent injected the drugs. Almost half (44 percent) had no formal education, and 59 percent had never heard of HIV/AIDS.

Of the study participants who injected drugs, half reported sharing needles with other IDUs. When methods to sterilize needles were attempted -- washing them in plain water, boiling water, or other methods -- they were insufficient for disinfecting.

A 2000 study in Pakistan found that only 8 percent of blood banks screened donors for risks such as IV drug use, none screened for other high-risk behavior, and testing for blood pathogens did not occur regularly. Should HIV seriously penetrate the IV drug user population in Pakistan, the current "findings suggest that a generalized epidemic could subsequently occur," according to the authors.

To prevent the spread of blood-borne infections in Pakistan, Strathdee and colleagues recommended interventions to discourage a transition to injection drugs, scaling up needle exchange programs, and HIV testing and educational counseling for drug users. The authors also called for an end to paid blood donations as well as the implementation of blood screening to safeguard the blood supply in Pakistan.

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