Men who inject anabolic steroids and tanning drugs are at higher risk of HIV and viral hepatitis, according to a landmark study from Public Health England (PHE) published in BMJ Open today (Friday September 13).
The use of image and performance enhancing drugs has grown substantially over the last twenty years, but the risk of exposure to blood borne viruses among those who inject drugs to change their body appearance or improve their performance has rarely been studied.
Researchers from PHE and Liverpool John Moores University surveyed 395 men using image and performance enhancing drugs and found:
- 1 in 18 injectors have been exposed to hepatitis C
- 1 in 11 have ever been exposed to hepatitis B
- 1 in 65 have HIV
Overall 1 in 10 had been exposed to one or more of HIV, hepatitis B, or hepatitis C, suggesting that the transmission of blood borne viruses is common in this group. These infections can result from unsafe drug injecting practises or unprotected sex.
Lead author Dr Vivian Hope, a PHE expert in infections among people who inject drugs, said:
Our study suggests that levels of HIV and hepatitis infection among men using image and performance enhancing drugs have increased since the 1990s. While we must be cautious in generalising these early findings, they are concerning and show that further research is required.
Use of psychoactive drugs like cocaine (46% had snorted cocaine, and 12% snorted or swallowed amphetamines) was also high among this population, along with sexual risk behaviours - only 20% of those having sex in the preceding year reported always used a condom.
Dr. Fortune Ncube, Consultant Epidemiologist and lead for PHE on Injecting Drug Use, concludes:
These findings suggest serious health implications for users of image and performance enhancing drugs, but also for their sexual partners and ultimately the wider community.
These findings suggest we must maintain and strengthen public health interventions focused on reducing injection-related risk behaviours to prevent HIV and hepatitis infections in this group. This includes ensuring those providing voluntary confidential testing services and care related to HIV and hepatitis are alert to the risks associated with image and performance enhancing drug use.
Jim McVeigh from the Centre for Public Health at Liverpool John Moores University and co-author of the paper said:
Injectors of anabolic steroids and associated drugs are now the biggest client group at many needle and syringe programmes in the UK. This research shows that anyone who injects drugs is at risk of HIV and other blood borne viruses, regardless of their substance of choice.
It is essential that all health services, together with the drug users themselves, are made aware of this and appropriate prevention interventions are developed.
Notes to editors
Sample recruited as part of Public Health England’s Unlinked anonymous monitoring (UAM) survey of people who inject drugs (PWID), monitoring prevalence of blood borne viruses (BBVs) among injectors of psychoactive drugs attending collaborating specialist services.
Between June 2010 and May 2011 collaborating needle and syringe programme (NSP) services (17 across England and 2 in Wales) recruited IPED users. Those who agreed to take part provided an oral fluid sample and self-completed a short questionnaire on IPED use. Analyses focused on 395 male IPED injectors.
The median age of the 395 participants was 28 years old. Overall, 34% had used ≥3 types of IPED during the preceding year. The type of IPED most commonly used was anabolic steroids; other IPEDs include growth hormone and Melanotan I/II. These drugs are used to change appearance for both cosmetic and aesthetic reasons, in addition to being used to improve physical performance.
Most studies of people who inject drugs have only looked at those who inject psychoactive drugs such as opiates like heroin, and stimulants like cocaine and amphetamine. Many studies have examined the levels of infection and risk among injectors of psychoactive drugs. This study was the first to purposively collect both questionnaire data and a biological sample from people injecting IPEDs.
The proportions of people in the UK with HIV infection and ever infected with hepatitis B and C are difficult to measure. In England, among those aged 15 to 59 years about 1 in 150 are estimated to have ever been infected with hepatitis C in 2005 (Harris RJ, et al. Eur.J.Public Health. 2011). In 2011, around one in 670 people in the UK were thought to be living with HIV (HIV in the United Kingdom: 2012 Report. HPA 2012). There is no recent estimate of the proportion of the UK population that has ever been infected with hepatitis B.
The number of people who inject IPEDs is not known. There is some data on the reported use of anabolic steroids from the Crime Survey for England and Wales. In 2012 and 2013, this survey estimated that 59,000 (range 37,000 to 82,000) people had taken AS in the last year. This will include people who use AS orally as well as those who inject them, so these figures cannot be extrapolated and applied to the PHE study. This household survey may underestimate the number of users: information on the limitations of this survey is available. This survey dose not provide data on people who only use other IPEDs.
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