What do men who inject performance and image-enhancing drugs say about hepatitis C?

In 2017 the SSAC team began a research project funded by an Australian Research Council (ARC) Discovery Grant on men’s performance and image-enhancing drug (PIED) injecting. We conducted qualitative interviews with 60 men who inject PIEDs in Victoria, New South Wales, Queensland and Western Australia. The project aimed to develop a balanced understanding of men’s experiences and perspectives on PIED injecting, placing issues of blood-borne virus transmission in the context of whole lives and diverse priorities. Many of our findings are currently under review in refereed journals and being prepared for publication in a forthcoming technical report. The project and some of its key outcomes are summarised below.

In our research with men who inject PIEDs, hepatitis C did not register as a source of concern for many participants. This is significant as participants typically described themselves as not at risk of acquiring hepatitis C, despite very low, if any, knowledge of hepatitis C and how transmission might occur. However, many participants articulated a preference for reliable, scientifically based or otherwise legitimate health information. In this respect, our research generated the following insights which will likely be of interest to consumers, researchers and other health professionals:

  • Our interviews suggest that men who inject PIEDs closely monitor potential external infection risks, such as dirt and bacteria that might intrude upon the ‘security’ of the healthy body. However, less attention appears to be paid to what might be transferred out of the body and potentially to others, such as blood.
  • Notions of trust and cleanliness, and assumptions that blood management was  primarily relevant to other forms of injecting drug consumption led some to consider it less relevant to them than others.
  • Possible transmission issues to emerge from the data include: rubbing the injecting site after injecting, the absence of hand-washing after injecting, group and peer-to-peer injecting, particularly for early experiences of use, and sharing vials and bladders.

The risk of environmental transmission of hepatitis C should not be overstated, and men in our study were generally thoughtful about their health. However, given current ambitions in Australia to eliminate hepatitis C, developing targeted hepatitis C prevention education may be useful. The SSAC team are in the process of developing recommendations for the design of targeted prevention education for PIED consumers. As Dr Renae Fomiatti explains:

Focusing health promotion materials on the post-injecting practices we observed in the interviews, and informing consumers about the possibility of environmental blood and transmission, may have a range of uses. For example, it could help better engage men who use PIEDs, and in turn encourage more frequent hepatitis C testing. 

Importantly, efforts to alert men who inject PIEDs to the possibility of hepatitis C and blood-borne virus transmission in general need to be approached sensitively. Given the stigma associated with hepatits C and other blood-borne viruses, we suggest framing prevention efforts on better injecting technique and blood management via positive ideas that acknowledge men’s interest in caring for their physical health, and attention to bodily care. New resources could also acknowledge that men who use PIEDs sometimes inject with other people and within training partnerships, particularly around when starting out, and in social settings. These situations are not necessarily dispensable to men, and there may be benefits in working with them. 

The project has already produced a range of scholarly and public presentations. Key  publications so far are:

Hart, A. (2018). Making a difference? Applying Vitellone’s Social Science of the Syringe to performance and image enhancing drug injecting. International Journal of Drug Policy61, 69-73.

Moore, D., Hart, A., Fraser, S., & Seear, K. (2019). Masculinities, practices and meanings: a critical analysis of recent literature on the use of performance-and image-enhancing drugs among men. Health. Early online.

Latham, JR., Fraser, S., Fomiatti, R., Moore, D., Seear, K. & Aitken, C. Men’s Performance and Image-Enhancing Drug Use as Self-Transformation: Working Out in Makeover Culture. Australian Feminist Studies. In press.

Fomiatti, R., Lenton, E., Latham, JR., Fraser, S., Moore, D., Seear, K. & Aitken, C. Maintaining the healthy body: Blood management and hepatitis C prevention among men who inject performance and image-enhancing drugs. International Journal of Drug Policy. Under review. 

Fomiatti, R., Latham, JR., Fraser, S., Moore, D., Seear, K. & Aitken, C. A ‘messenger of sex’? Making testosterone matter in motivations for anabolic-androgenic steroid injecting. Health Sociology Review. Under review.

Fraser, S., Moore, D., Fomiatti, R., Seear, K. & Aitken, C. Is another relationship possible? Connoisseurship and the doctor–patient relationship for men who consume performance and image-enhancing drugs. Sociology of Health and Illness. Under review.