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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
  1. Vivian D Hope1,2,
  2. Jim McVeigh3,
  3. Andrea Marongiu1,
  4. Michael Evans-Brown4,
  5. Josie Smith5,
  6. Andreas Kimergård6,
  7. Sara Croxford1,
  8. Caryl M Beynon3,
  9. John V Parry1,2,
  10. Mark A Bellis3,
  11. Fortune Ncube1
  1. 1Public Health England, London, UK
  2. 2Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK
  3. 3Centre for Public Health, Liverpool John Moores University, Liverpool, UK
  4. 4European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
  5. 5Public Health Wales, Temple of Peace & Health, Cathays Park, Cardiff, UK
  6. 6Department of Public Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Vivian Hope; vivian.hope{at}


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).

Design A voluntary unlinked-anonymous cross-sectional biobehavioural survey.

Setting 19 needle and syringe programmes across England and Wales.

Participants 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.

  • Injecting Drug Use
  • Prevalence
  • Image and Performance Enhancing Drugs
  • HIV
  • Viral Hepatitis

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