Health care engagement behaviors of men who use performance- and image-enhancing drugs in Australia

Abstract

Background: Although people who inject performance- and image-enhancing drugs (PIEDs) report fewer unsafe injecting practices, stigma and discrimination may negatively impact their access to help and information. Engagement with health care services, compared with social networks (friends, relatives, and gym associates) and the Internet and media (steroid user forums, information sites, and magazines), may be important for harm minimization. Methods: A cross-sectional Internet or in-person survey of men who use PIEDs in Australia in 2014–2015 examined differences in sources for PIEDs, injecting equipment, and anabolic-androgenic steroids (AAS) information and factors associated with having periodical medical checks related to PIEDs issues using multivariate logistic regression. Results: In total, 267 men (mean age: 25 years, SD: 8.7 years; 246 of 267 [92%] reported recent AAS injection) were recruited. Most participants sourced injecting equipment from health professionals, PIEDs from their social networks, and AAS information from the Internet and media. Self-reported AAS knowledge was high and frequent. Higher income (adjusted odds ratio [AOR]: 2.04, 95% confidence interval [CI]: 1.03, 4.00), ≥2 different PIEDs used in addition to AAS (AOR: 1.94, 95% CI: 1.08, 3.49), and sourcing AAS information from health care professionals (AOR: 3.14, 95% CI: 1.81, 5.46) were independently associated with periodical medical checks. Participants nominated preference for improved health services through needle-syringe programs, primary care services, and peer educator support groups. Conclusion: Men who use PIEDs in Australia consider themselves well informed but tend to use Internet and media sources, providing potentially misleading or inaccurate information. Increasing trust between men who use PIEDs and health care providers may enable delivery of PIEDs-specific information to those at greatest need.

Keywords:

• Attitudes
• exercise
• health knowledge
• practice
• prescription drug misuse
• sports medicine

Acknowledgments

The authors thank the study participants for their contribution to the research and current and past researchers and staff, with particular thanks to Ranira Moodley and Janelle Holden.

Disclosure statement

B.L., M.F., and L.D. have received investigator-driven untied educational grants from Reckitt Benckiser, Indivior, and Mundipharma Australia for studies of opioid medications unrelated to this study.

Author contributions

B.L. and L.D. are principal investigators of 2015 PIEDS users study. B.J., B.L., and L.D. designed this substudy with input from J.C., L.B., and M.F. B.J. had access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the results. B.J. performed the statistical analyses with input from B.L. and L.D. B.J. wrote the first draft of the manuscript with input from B.L. and L.D. All authors critically reviewed the first draft of the manuscript and approved the final version to be submitted.

Additional information

Funding

This research was funded by the Australian Government Department of Health. B.L. and L.D. are supported by NHMRC research fellowships (nos. 1073858 and 1041472). The National Drug and Alcohol Research Center at UNSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.