The use of so called "legal highs" could be contributing to a large rise in HIV cases across Glasgow, experts have warned.
A near five-fold increase in HIV cases has been detected, leading to NHS warnings over the dangers of sharing needles and drug paraphernalia.
On average, 10 cases linked to injecting are diagnosed in the Greater Glasgow and Clyde area each year but the latest figures show a rise to 47 cases last year.
An investigation found that some drug users were sharing needles, syringes and other equipment when preparing and injecting drugs.
It also found a low awareness of the risks of HIV from doing so.
NHS Greater Glasgow and Clyde (NHSGGC) are now advising anyone who injects to get tested.
Professor Neil McKeganey told BBC Scotland that legal highs could be a factor in the rise.
He said: "Many people have lost the focus of attention on HIV - there hasn't been much in the media and people tend to think it's not there.
"Actually what we are seeing is an increase in injecting risk behaviour, more sharing of needles than in the past.
"That might be to do with new psychoactive substances, or legal highs, we know that people tend to inject much more frequently and there is evidence that it's a higher risk behaviour."
Dr Catriona Milosevic, consultant in public health medicine at NHSGGC, said the "ultimate goal" is to help people recover from drug addiction but the initial focus is on harm reduction.
She said: "The outbreak highlights the potential for rapid spread of HIV in people who inject drugs. It is vitally important that if people are injecting drugs they don't share, and ideally do not reuse, any equipment.
"This includes when injecting with close friends or partners - you can't guess whether someone has HIV, and they may have no symptoms and be unaware themselves.
"Everyone involved needs to use a new set of sterile injecting equipment every single time, including needles, syringes, water, filters, and spoons, to protect themselves and others."
Free injecting equipment is available from almost 70 outlets throughout Glasgow and users are urged to access services to prevent the spread of HIV.
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