Knowledge and experience of using performance and image enhancing drugs among attendees of a Needle and Syringe Program in Australia: A qualitative study

Background: The availability and utilisation of performance and image enhancing drugs (PIEDs) have been increasing in the last decade. This study aimed to understand the knowledge and experience of PIED use amongst attendees of a Needle and Syringe Program (NSP) in Australia. It also investigated their experience of seeking medical advice and accessing the NSP service.Methods: Semi-structured interviews were conducted with 19 participants between September 2016 and April 2017. Audio recordings of the interviews were transcribed verbatim and content analysis was conducted.Results: All 19 participants were male, with 10 participants aged 18-25 and 15 working. Participants showed sound knowledge of injecting practices and side effects; however, their understanding about blood-borne virus transmission risks was limited. Most of them reported experiencing injection-related injuries and considered this as common. They would seek general medical advice; however, they would not disclose their PIED use if not required as their past experience indicated that general practitioners lacked knowledge and support. Participants expressed concerns before their first visit to the NSP service, but thought staff were open minded, non-judgemental and helpful after the visit. They also highlighted the difficulty in accessing the service for injec-tion equipment during business hours and provided suggestions on service improvement including extending the opening hours, using vending machines and providing a peer support program.Conclusions: The findings suggest there is a need to educate PIED users about blood-borne virus transmission risks, improve general practitioners' understanding about PIED use, and investigate the feasibility of extending the NSP service hours and for the service to provide a peer support program to clients who use PIEDs.