title: Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study.
abstract: OBJECTIVE
  To describe drug use, sexual risks and the prevalence of blood-borne viral infections among men who inject image and performance enhancing drugs (IPEDs).
  
  
  METHODS
  A voluntary unlinked-anonymous cross-sectional biobehavioural survey.
  
  
  METHODS
  19 needle and syringe programmes across England and Wales.
  
  
  METHODS
  395 men who had injected IPEDs.
  
  
  RESULTS
  Of the participants (median age 28 years), 36% had used IPEDs for <5 years. Anabolic steroids (86%), growth hormone (32%) and human chorionic gonadotropin (16%) were most frequently injected, with 88% injecting intramuscularly and 39% subcutaneously. Two-thirds also used IPEDs orally. Recent psychoactive drug use was common (46% cocaine, 12% amphetamine), 5% had ever injected a psychoactive drug and 9% had shared injecting equipment. 'Viagra/Cialis' was used by 7%, with 89% reporting anal/vaginal sex in the preceding year (20% had 5+ female-partners, 3% male-partners) and 13% always using condoms. Overall, 1.5% had HIV, 9% had antibodies to the hepatitis B core antigen (anti-HBc) and 5% to hepatitis C (anti-HCV). In multivariate analysis, having HIV was associated with: seeking advice from a sexual health clinic; having had an injection site abscess/wound; and having male partners. After excluding those reporting male partners or injecting psychoactive drugs, 0.8% had HIV, 8% anti-HBc and 5% anti-HCV. Only 23% reported uptake of the hepatitis B vaccine, and diagnostic testing uptake was poor (31% for HIV, 22% for hepatitis C).
  
  
  CONCLUSIONS
  Previous prevalence studies had not found HIV among IPED injectors. HIV prevalence in this, the largest study of blood-borne viruses among IPED injectors, was similar to that among injectors of psychoactive drugs. Findings indicate a need for targeted interventions.
authors.affiliation: Public Health England, London, UK.
authors.forename: Vivian D
authors.initials: VD
authors.lastname: Hope
authors.forename: Jim
authors.initials: J
authors.lastname: McVeigh
authors.forename: Andrea
authors.initials: A
authors.lastname: Marongiu
authors.forename: Michael
authors.initials: M
authors.lastname: Evans-Brown
authors.forename: Josie
authors.initials: J
authors.lastname: Smith
authors.forename: Andreas
authors.initials: A
authors.lastname: Kimergård
authors.forename: Sara
authors.initials: S
authors.lastname: Croxford
authors.forename: Caryl M
authors.initials: CM
authors.lastname: Beynon
authors.forename: John V
authors.initials: JV
authors.lastname: Parry
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Fortune
authors.initials: F
authors.lastname: Ncube
keywords: HIV; Image and Performance Enhancing Drugs; Injecting Drug Use; Prevalence; Viral Hepatitis
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