Creating Safer Injecting Practices Through Community-Led Harm Reduction: Lessons From People Who Use Steroids for the...

Research on anabolic-androgenic steroid (AAS) use has addressed health outcomes, social dynamics, service access and risk management strategies. Yet little work has examined how these domains converge in injection practices, where community-led knowledge and structural barriers shape harm reduction. This study aimed to explore people's experiences of injecting AAS, focusing on practices, challenges and sources of harm reduction knowledge, and examined how consumers develop safer injection methods through lived-living expertise.

Data were drawn from semi-structured interviews with Australian AAS consumers (N = 25), including follow-ups with 15 participants, resulting in 40 research interactions. These interactions examined safer injecting, harm reduction strategies and structural barriers. Analysis employed iterative categorisation, integrating lived-living experience and a lens of prefigurative politics to develop knowledge into three theme-categories.

Participants articulated that injecting, when done correctly, was perceived as a safer usage pathway. However, many participants lacked access to clear, evidence-based injection guidance and acquired information through informal sources including online forums and peer networks. Some AAS consumers experienced bacterial infections and abscesses, highlighting the ongoing risks associated with injecting. Experienced consumers had developed practices, through experimentation, on site rotation, injection volume and hygiene to mitigate harms.

AAS consumers prefigure harm reduction through their community, yet informal learning is inconsistent. Peer-led interventions which partner with trusted allies, including clinicians and health workers, can work toward reducing injecting-related harms in the community; thus, moving the alcohol and other drug sector toward sustainable, collective care.