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Abstract
Background: People who use image and performance-enhancing drugs (IPEDs) face intersecting challenges, including legal constraints, stigma, and inadequate healthcare support, which perpetuate health risks. Peer-led harm reduction practices emerge as vital alternatives, fostering trust, sharing ethnopharmacological knowledge, and addressing gaps left by formal systems. This study explored how care and connoisseurship are enacted within IPED communities, emphasizing peer roles in navigating risks, enhancing safety, and reshaping care practices through collective expertise. Methods: Semi-structured interviews with four men explored IPED manufacture, supply, and harm reduction practices. Using a Science and Technology Studies-informed case approach, analysis foregrounded relational and socio-material dynamics, challenging deficit-based narratives and offering insights into how community care is enacted through peer-led harm reduction and what this could mean for policy development. Results: People who use IPEDs transition from consumption to production and supply as a response to inadequate mainstream healthcare and systemic barriers. Participants highlighted tensions with socio-legal and medical frameworks, navigating these barriers through collective connoisseurship. By fostering relational practices of community care, they ensured quality, safety, and informed use, challenging traditional harm discourses and emphasizing the social and material interplay shaping safer-use strategies. Conclusions: The community collectively demonstrate a commitment to community-driven care, contrasting sharply with their experiences of formal healthcare. Our analysis directs more careful consideration to the potential for rethinking health interventions to align with community-led approaches that emphasize autonomy, peer support, and relational care.
Published Version
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