title: Risk and blood-borne virus testing among men who inject image and performance enhancing drugs, Sydney, Australia.
abstract: Needle and syringe program (NSP) workers have highlighted that people who inject image and performance enhancing drugs (IPED) in Australia are a younger and more culturally and linguistically diverse (CALD) group compared with other groups who inject drugs. Previous research has found riskier injecting practices and faster Hepatitis C acquisition rates among people who are new to injecting drugs and self-identify with CALD backgrounds, compared with their Anglo-Australian counterparts. Given recent indications of increasing IPED prevalence in Australia and elsewhere, this study sought to update knowledge of infection risk among a large group of IPED injectors, as well as explore sub-group differences.
  
  
  
  A cross-sectional survey of men who inject IPEDs was conducted from September 2014 to January 2015 at nine NSP sites, across five local health districts in Sydney, Australia.
  
  
  
  Six hundred and five people participated. Small proportions reported previous 12month needle or syringe sharing (2.3%), sharing vials (4.6%), injecting psychostimulants (5.1%) or personal needle or syringe reuse (5.2%). Participants from CALD backgrounds were more likely to report sharing needles or syringes (P = 0.004), and participants from Middle Eastern and North African backgrounds were less likely to have ever been tested for blood-borne viruses, compared with Anglo-Australian participants (P = 0.04).
  
  
  
  The findings show that some groups who inject IPEDs may be more vulnerable to blood-borne virus transmission and/or less likely to know their blood-borne virus status. From design to delivery, IPED harm minimisation strategies should pay attention to the needs of CALD groups.
authors.affiliation: Drug and Alcohol Multicultural Education Centre, Sydney, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rowe
authors.affiliation: Drug and Alcohol Multicultural Education Centre, Sydney, Australia.
authors.forename: Israel
authors.initials: I
authors.lastname: Berger
authors.affiliation: Drug and Alcohol Multicultural Education Centre, Sydney, Australia.
authors.forename: Bilal
authors.initials: B
authors.lastname: Yaseen
authors.affiliation: National Cannabis Prevention and Information Centre, UNSW Medicine, Sydney, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Copeland
mesh_terms: D000328:Adult; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects / Q000706:statistics & numerical data; D058573:Performance-Enhancing Substances / Q000008:administration & dosage*; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology*; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis* / Q000635:transmission* / Q000821:virology; D055815:Young Adult
chemical_list: D058573:Performance-Enhancing Substances
keywords: anabolic-androgenic steroid; blood-borne virus; health inequality; injecting drug use; needle-exchange program