Addressing a topic that has received remarkably little
research attention over the years, Dr Vivian Hope of Public Health England told
the British HIV Association conference yesterday that injection of image- and
performance-enhancing drugs is rising in England and Wales. Moreover, his research
suggests that men may be acquiring bloodborne viruses through this route – 1.5%
had antibodies to HIV, 8.8% had antibodies to hepatitis B and 5.5% to hepatitis
Dr Hope said that across the world, only three previous
studies have been conducted on HIV prevalence among people who
inject drugs which are taken to enhance body image, physical strength or
performance. One of these three was conducted in the UK in the mid-1990s and
did not find any HIV infections in those surveyed.
There are reports of increased numbers of people injecting
these drugs who present to needle and syringe exchanges. However, not all
syringe exchanges have the skills and experience to meet their needs. The
injecting process is different to that of opiates – these drugs are normally
delivered in a sealed vial, and are not usually injected into a vein, but into
a muscle or beneath the skin.
Moreover, the social profile of injectors of image- and
performance-enhancing drugs is different to that of opiate injectors – younger,
more likely to be employed, less likely to have had problems with the criminal
Data from the 2012 British Crime Survey suggest that
70,000 people have used anabolic steroids in the previous year – greater than
the 47,000 who have used heroin.
As part of the established unlinked anonymous survey of drug
injectors, a sub-survey was conducted with people who inject image- and
performance-enhancing drugs. However, as recruitment was through 19 needle and
syringe exchange programmes, the characteristics of those recruited may be
different to those of users who do not attend these services.
The survey recruited 395 men (a further five women reported
use of these drugs, but were excluded from the analysis). Oral fluid samples
were taken for antibody testing.
Men in the sample had an average age of 28 and were
predominantly heterosexual. Half had been injecting for less than five years;
one third used multiple drugs of this class; 5% had ever injected a
psychoactive drug; half had also snorted cocaine in the past year.
Most of the men injected anabolic steroids (86%) or growth
hormones (32%), with fewer men injecting human chorionic gonadotropin (hCG),
insulin or melanotan I/II.
Nine per cent reported ever sharing a needle, syringe or
vial; 17% reported being injected by another person in the past year. These
rates are lower than in users of opiates.
As well as injecting, the men’s sexual behaviour could be
linked to viral infections. Only one in five always used a condom; 20% had five
or more female partners in the past year; 8% had ten or more female partners;
7% used Viagra or a similar drug; 3%
were men who have sex with men.
Despite these numerous risk factors, engagement with health
services was limited. Only 23% had been vaccinated for hepatitis B, 22% had
ever been tested for hepatitis C and 31% had ever been tested for HIV. In the
past year, 17% had visited a sexual health clinic. (And health service use may
be even lower in injectors not using drugs services.)
Whereas prevalence of hepatitis B antibodies (8.8%) or
hepatitis C antibodies (5.5%) was lower than in injectors of psychoactive drugs
in the UK, 1.5% of the injectors had HIV, which is around the same as the
figure in psychoactive injectors. These figures are considerably higher than in
the general population.
Half the HIV infections were in heterosexual men.
Nonetheless HIV was associated with having sex with men, use of sexual health
services and older age.
Concluding, Hope said that the results should be interpreted
with caution. Nonetheless his results do point to injecting behaviours, sexual
behaviours, and psychoactive drug use that are putting the participants at risk
Providers of HIV testing and HIV treatment services need to
be aware of the possibility of this behaviour in people in their care, although it may not
be readily disclosed, he said.