Do Anabolic Steroids Increase HIV Risk?

Injecting drug users (IDUs) are at increased risk for HIV acquisition.

While heroin and cocaine continue to be the most commonly injected drugs used by HIV-infected IDUs, the use of shared needles for injecting image and performance-enhancing drugs (IPEDs) like anabolic steroids and human growth hormone (HGH) poses a risk of HIV equal to that of opiate users who share needles.

HIV and Anabolic Steroid Use

Anabolic steroids can be used to treat a number of HIV-associated conditions. Anabolic steroid treatment is sometimes indicated for individuals who have experienced severe wasting as a result of HIV or severe muscle loss as a result of lipodystrophy (the redistribution of body fat).

Testosterone replacement therapy is also sometimes prescribed for HIV-positive men and women who have had severely depleted levels of testosterone (hypogonadism).

While non-injectable versions of these drugs are available—including oral medications, transdermal patches, and topical creams—injections are commonly prescribed as medical therapy.

It is outside of this medical context, in the area of image and performance enhancement, that HIV risk is seen to increase.

Anabolic Steroids and Amphetamines

Men who have sex with men (MSM) who inject anabolic steroids have also been found to have a high use of drugs such as ecstasy and methamphetamines.

The use of these injectable drugs can increase the likelihood of HIV transmission when needles are shared. But that's not the only reason why amphetamine use increases the risk of HIV transmission. Sexual risk-taking is known to increase under the influence of crystal methamphetamine and similar class drugs.

Additionally, injection amphetamines are often used along with anabolic steroids for the purpose of amplifying bodybuilding performance, and this may also increase the likelihood of sexual risk-taking.

Unsafe Sexual Behaviors

Anabolic steroid use has been associated with an increased risk of unsafe sexual behaviors that can increase the risk of spreading HIV. In one multicenter study, for example, researchers found that gay and bisexual men who used anabolic steroids were more likely to engage in unsafe sexual behaviors than non-users. These included higher reported rates of male-male condomless anal sex in the past year.

How to Reduce Transmission Risk

One of the most important steps in reducing the risk of HIV in IPED users is to first understand that the use of injectable anabolic steroids, HGH, testosterone, or human chorionic gonadotropin carries the same risks of HIV transmission as any other injectable drug. Therefore, the same rules apply when reducing risk behaviors, namely:

• Do not share needles or syringes, and avoid sharing an IPED vial between multiple users.
• Access a needle exchange program to ensure that you have ample needles or syringes.
• If you find yourself in a situation where needles are shared or reused, take the proper precautions to ensure that they are disinfected between use.
• Avoid IPED use while under the influence of alcohol, drugs, or any substance that can affect your judgment. Seek appropriate treatment in the event of alcohol or substance abuse.
• If you shared needles and fear you may have been exposed to HIV, go to your nearest clinic or emergency room without delay to access post-exposure prophylaxis (PEP), known to decrease the likelihood of HIV infection.

And finally, remember that HIV is not the only concern related to IPED use. The prolonged use of anabolic steroids and testosterone can result in severe liver problems, including cirrhosis and cancer. Acne, male pattern baldness, testicular shrinkage, sexual dysfunction, prostate enlargement, breast enlargement, and "roid rage" (extreme aggression and anxiety) are also commonly noted.