Research paperAn exploratory study of image and performance enhancement drug use in a male British South Asian community
Introduction
Emergent use of image and performance enhancement drugs (IPEDs) for aesthetic and functional body enhancement presents a significant global public health challenge, and particularly given its recent displacement from bodybuilding and athletic sub cultural groups into mainstream gym populations (Brennan et al., 2013, Evans-Brown et al., 2012, Kanayama et al., 2010, McVeigh et al., 2012, Sagoe et al., 2014). For males, changing aesthetic body ideals are grounded in the discrepancies between media imaging and average male bodies (Leit et al., 2002, Leit et al., 2001, Pope et al., 2000:2001; Tiggemann, Martins, & Kirkbride, 2007). Increased reporting of rates of male body dissatisfaction in particularly Westernised societies are evident (Adams et al., 2005, Agliata and Tantleff-Dunn, 2004, Kaminski et al., 2005). Value is placed on muscle development, definition and size by virtue of its association with male status and hegemonic masculinity (Drummond, 2002, Frederick et al., 2007, Kimmel and Mahalik, 2004).
Common IPEDs include androgenic anabolic steroids (AAS), human growth hormone (HGH), insulin-like growth factor-1, thyroid hormone, human chorionic gonadotropin, insulin, ephedrine, pseudoephedrine, clenbuterol, clomiphene, gamma hydroxybutyrate, diuretics, laxatives, 2,4-dinitrophenol, tamoxifen, danazol, and melanotan I and II (Juhn, 2003, Kanayama et al., 2012, Parkinson and Evans, 2006, Van Hout, 2014). Typical use of among males centres on use of AAS for fat loss, increased muscle mass and strength gains (Evans, 2004, Kanayama et al., 2010, Pope and Brower, 2009), and increasing in popularity in recent times (Trenton and Currier, 2005, Baker et al., 2006). AAS use commonly occurs within poly enhancement and illicit drug taking repertoires (Bahrke et al., 2000, Cornford et al., 2014, Juhn, 2003, Kanayama et al., 2003a, Kanayama et al., 2003b:2010:2012). Detailed user information is available on Internet drug forums and ‘underground’ guides (Roberts and Clapp, 2006, Llewellyn, 2009, Kanayama et al., 2009), with sourcing from less than creditable points of supply (Baker et al., 2006). Harmful effects of AAS use include liver, cardiac, psychological and dependence problems (Cafri et al., 2005, Cole et al., 2003, Darke and Torok, 2014, Kanayama et al., 2009, Olivardia et al., 2000, Schmidt et al., 2004).
In the United Kingdom (UK), it is not a criminal offence to possess AAS, despite being illegal to sell them. Profiles of harm reduction service users have changed, with anecdotal reporting of increased rates of uptake of injecting users of IPEDs (Advisory Council on the Misuse of Drugs, 2010, Public Health England, 2013, Whitfield et al., 2014). Of concern given its hidden nature, lack of formal prevalence data and potential for associated injecting risks (Hope et al., 2013), is the relatively low reporting of serious side effects (Evans, 2004, Trenton and Currier, 2005). In 2014, the NICE Public Health Advisory Committee (PHAC) provided guidelines for improved harm reduction service provision, and recommended further research into ethnic differences in the injecting use of IPEDs in the UK. Harm reduction services in the UK have indicated concerns for notable increases in British South Asian male IPED users accessing their services (Aujla, 2009). To date, no research has explored the use of IPEDs among this ethnic group in the UK.
Section snippets
Methods
The study aimed to explore the nature and experiences of IPED use among British South Asian males. British South Asian describes individuals with ancestry in India, Pakistan and Bangladesh but who are born in Britain or have a British passport (Alexander, 2000). A qualitative methodology was developed, which comprised of 20 in-depth interviews. Ethical approval was granted by Waterford Institute of Technology, Ireland. Purposive sampling was used to recruit participants and was undertaken by
Results
The majority were current users of a range of enhancement drugs, most commonly AAS and HGH. Most were in off-cycle periods. Those not currently using IPEDs, had experience ranging from two to ten years previous. The mean age of first time use for the 12 participants who volunteered this information was 17 years. Product nomenclature included: “Test 400”, “Deca”, “Clenbuterol”, “Anavar”, “Sustanon”, “Mass Mass”, “Dianabol”, “Mod Grf 1-29”, “Ipomaerolin”, “HGH Genotropin”, “Tamoxifen”, “Clomid”,
Informed decision making
Decisions to use, and seeking of information around dosage, cycling and poly use and injecting practices were enhanced by personal researching, peer (real life and cyber) knowledge exchange and mentoring from more experienced users.
‘Too many people use steroids without any idea of what they are doing, they need to research stuff and get as much information as possible before they try them.
Advice around appropriate use was described as primarily occurring from dealer suppliers providing after
Asian consumerism of enhancement ideals
Values around IPED use centred on physical, performance and recovery enhancement with all reporting stimulation of interest due to social media (Face Book, Twitter, Instagram), celebrities, men's magazines, Bollywood films, Internet forums and books, as well as peer messages encountered when exercising in local gyms. Stigma appeared to dilute over time while socialising within drug enhancement gym culture.
‘There used to be a time where no one used to admit to taking steroids. But as years gone,
IPED markets
Some were introduced to IPEDs (commonly AAS and HGH) when visiting their country of home origin (Pakistan, India).
‘I went to Pakistan on a visit. I overstayed my visit there so I got into training, with some professional bodybuilders who were competing for Mr Pakistan and Mr Lahore.’
Most sourced enhancement drug products from gym dealers and peers. Choice of products generally centred on peer and dealer recommendations, low reporting of side effects and reliability of the desired effect. Few
Athleticism and aestheticism
Awareness of British South Asian ethnic vulnerability to cardiovascular or sedentary type diseases was mentioned as contributory factor to increased male participation in gym training.
‘There's been a lot more awareness of going to the gym, being fit. I don’t know if it's got anything to do with cultural diseases that people do have or carry or have seen it within their family or friends. It's like, before you used to say at every corner there's an Asian shop. Now it's a gym *laughter*
Motives to
Interplay with substance use, crime and religion
Participants ranged in their experience and consumption (past and current) of alcohol and illicit drugs. Eight described never having drunk alcohol or use of illicit drugs. Half reported party drug use (cocaine, MDMA, ketamine), with a minority reporting heroin use. Triggers for current abstinence from alcohol and illicit drug use centred on religious beliefs and commitment, and ‘being clean’ and ‘sensible’ after a misspent youth.
‘Islamically, I knew it was completely wrong. My mum and dad
Injecting practices and risk management
All participants with exception of one reported injecting use of AAS and HGH. Oil based AAS were generally injected, with the remainder administered orally (“Winstrol”, “Dianabol”, “Anavar”). First time injecting often took place when under 18 years, involved peer injecting (friend, gym member or dealer) and in gym changing rooms, homes and private vehicles. Needles (short/long blue and green) were sourced at local pharmacies, needle and syringe exchanges, from dealers and online. No
Discussion
Consumerism of enhancement drugs is increasingly situated within body culture and contemporary social relations (Brennan et al., 2013, Gillen and Lefkowitz, 2009, McVeigh et al., 2012). Ethnic male embodiment in sporting arenas and leisure media is increasingly viewed as popular political instrument (Carrington, 1998, Daniel and Bridges, 2009, Mishkind et al., 2001, Whannel, 2002) by virtue of enhanced physicality and image challenging perceived ethnic inferiorities within cultural contexts (
Conclusion
The study is intended to contribute to health policy and practice debate around increased normalisation of enhancement drug use among ethnic groups in the UK. Similar to Maycock and Howat, 2005, Maycock and Howat, 2007, social connectivity and shared norms for IPED use, fitness training and nutrition, with dealers acting as supply mechanism and mentor for novice users were described. Given the reporting of mutual gym injecting and sharing of vials, users entrenched in peer support networks but
Acknowledgement
With thanks to Nav Khan for his support of the study.
Conflict of interest statement: No conflict of interest declared.
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