title: Injecting risk behaviour and related harm among men who use performance- and image-enhancing drugs.
abstract: OBJECTIVE
  Performance- and image-enhancing drugs have the potential to be a significant public health issue. Detailed data on PIEDs injection are difficult to obtain because of the illicit and unsupervised way in which many PIEDs are used, and the hidden nature of the group. Our study examines the patterns of use, risk behaviours and related harm associated with PIEDs injection. We also report the ways in which PIEDs users currently seek injecting equipment and harm-reduction advice.
  
  
  METHODS
  Data were obtained via a structured questionnaire administered in face-to-face interviews with 60 men who used PIEDs (primarily anabolic androgenic steroids) for non-medical purposes.
  
  
  RESULTS
  Although the rates of needle sharing were low (5%), the men more frequently reported re-use of needles/equipment, injecting from a shared container (bladders, vials, etc.), injecting other illicit drugs, injecting insulin and targeting small muscle groups. Self-reports of being hepatitis C antibody positive were associated with lifetime use of heroin and injection of other illicit drugs. All HIV positive participants were gay/bisexual men. Participants reported a range of other injection-related injuries and diseases such as fevers, scarring and abscesses. 'Risky' injectors (38% of participants) were more likely to initiate PIEDs use at a younger age, use PIEDs in a larger number of cycles per year and report involvement in a violent/aggressive incident than 'low risk' injectors and report involvement in a violent/aggressive incident than 'low risk' injectors. Participants mainly reported seeking information about PIEDs from internet sites (62%) and friends (55%).
  
  
  CONCLUSIONS
  An over-reliance on personal networks and internet forums limits this groups' access to objective harm reduction advice and primary care services. Targeted, PIEDs-specific interventions are needed.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia. b.larance@unsw.edu.au
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Jan
authors.initials: J
authors.lastname: Copeland
authors.forename: Paul
authors.initials: P
authors.lastname: Dillon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D045930:Anabolic Agents / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004300:Doping in Sports; D040261:Harm Reduction; D006801:Humans; D016247:Information Storage and Retrieval; D020407:Internet; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing; D010809:Physical Fitness; D012309:Risk-Taking; D013256:Steroids / Q000009:adverse effects*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology
chemical_list: D045930:Anabolic Agents; D013256:Steroids