title: Infectious disease, injection practices, and risky sexual behavior among anabolic steroid users.
abstract: Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984-17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.
authors.affiliation: a Department of Clinical Sciences , Touro University California College of Pharmacy , Vallejo , CA , USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ip
authors.affiliation: a Department of Clinical Sciences , Touro University California College of Pharmacy , Vallejo , CA , USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Yadao
authors.affiliation: b Department of Social , Behavioral, and Administrative Sciences, Touro University California College of Pharmacy , Vallejo , CA , USA.
authors.forename: Bijal M
authors.initials: BM
authors.lastname: Shah
authors.affiliation: c Department of Emergency Medicine , Kaiser Permanente Santa Clara Medical Center , Santa Clara , CA , USA.|d Division of Emergency Medicine , Stanford University School of Medicine , Palo Alto , CA , USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Lau
mesh_terms: D045930:Anabolic Agents / Q000008:administration & dosage*; D000728:Androgens / Q000008:administration & dosage*; D003141:Communicable Diseases / Q000453:epidemiology*; D055030:Drug Users / Q000523:psychology* / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects; D058573:Performance-Enhancing Substances / Q000008:administration & dosage*; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000635:transmission; D013256:Steroids / Q000008:administration & dosage; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D058573:Performance-Enhancing Substances; D013256:Steroids
keywords: Anabolic steroids; HIV; infectious disease; injecting risk; sexual behavior