title: An exploratory study of image and performance enhancement drug use in a male British South Asian community.
abstract: BACKGROUND
  Consumerism of image and performance enhancement drugs (IPEDs) is a world-wide public health concern. Given anecdotal reporting of increased normalisation of IPED use and uptake of British South Asian male IPED users at UK needle and syringe exchange services, the study aimed to explore use of IPEDs among this under-researched ethnic group.
  
  
  METHODS
  20 in depth interviews were conducted with a purposive sample of British South Asian males attending harm reduction outreach in the North East of England. The interviews explored motives for use of IPEDs, sourcing routes, information seeking, injecting behaviours and cultural and community sensitivities around IPED use among this group. The data was collected and analysed using the Interpretative Phenomenological Analysis approach (IPA).
  
  
  RESULTS
  Motives for use centred on the achievement of enhanced definition and density of muscle, and improved recovery from training and injuries. All participants reported initial stimulation of interest and triggers to seek information on IPEDs due to social media, community and peer messages. Diverse forms of IPED use were described, with rational and moderated use common among older participants. In contrast younger participants adopted more excessive use in seeking short cuts to attaining muscle size. Sourcing of androgenic-anabolic steroids (AAS) and growth hormones from originating countries (Pakistan, India) was reported, along with diversification of entrepreneurial activity into IPED dealing networks. Sellers were generally reported to provide effective and reliable products and mentoring to inexperienced users. Group injecting practices were common. IPED use was observed by some as health promotion medium within religious contexts. Crime deterrence and drug abstinence occurred for some while involved in AAS cycles.
  
  
  CONCLUSIONS
  The study is intended to contribute to health policy and practice debate around the targeting of dedicated education, outreach and harm reduction for ethnic groups engaged in IPED use.
authors.affiliation: Department of Health, Sport and Exercise Science, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland. Electronic address: mcvanhout@wit.ie.
authors.forename: Marie Claire
authors.initials: MC
authors.lastname: Van Hout
authors.affiliation: Unity Recovery Centre, 30 Manningham Lane, Bradford BD1 3DN, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kean
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D045930:Anabolic Agents / Q000008:administration & dosage*; D001211:Asia, Western / Q000208:ethnology; D044466:Asian People / Q000706:statistics & numerical data; D013006:Growth Hormone / Q000008:administration & dosage*; D040261:Harm Reduction; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D018671:Needle-Exchange Programs; D058573:Performance-Enhancing Substances / Q000008:administration & dosage*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D058573:Performance-Enhancing Substances; D013006:Growth Hormone
keywords: Androgenic–anabolic steroid; Asian, image and performance enhancement drug; Harm reduction