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Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001; Jones & Needle, 2005). Heroin use is risky and HIV transmission an increasing problem (McCurdy et al, 2005). Susan Beckerleg and colleagues uncover high rates of unprotected sex, excessive needle sharing and continued re‐use of old and dirty needles often kept in old tins, pockets, or as most do, hidden under rocks.

This paper reports on a questionnaire survey of 300 heroin users in Zanzibar town, in Tanzania. It was found that about 13% of respondents were current injectors of heroin, but that 38% of respondents reported have ‘ever injected’ heroin. Many injectors reported hiding their needles and syringes and almost half of them had shared their equipment during the past four weeks. Most of the respondents reported that they had not had sexual intercourse during the past four weeks. Of those who were sexually active most reported not having used a condom the last time they had intercourse. These findings highlight the need for a wider recognition of the extent of heroin use in East Africa as well as the urgent need to provide harm reduction and treatment services.