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Drug Use and Sexual Behaviors Among MSM in China

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Metrics details. There is limited information about the types of recreational drugs used by men who have sex with men MSM in China or the consequent impact on sexual health and human immunodeficiency virus HIV acquisition. We recruited MSM from seven cities in China between and using multiple approaches including advertisements on gay websites, collaborating with local MSM community-based organizations, peer referrals, and venues such as gay bars and bathrooms visited by MSM. A total of Chinese MSM participated; The prevalence of each RD use was as follows: poppers Users of multiple RDs commonly used poppers combined with one or more other types of RDs. MSM who used more RDs are more likely to engage in high-risk sexual behaviors, and these behaviors may be associated with increases in new HIV infections. Peer Review reports. Men who have sex with men MSM experience a disproportionately high burden of human immunodeficiency virus HIV infection \[ 1 \]. The use of recreational drugs RDs among this population is a severe public health concern in China and elsewhere \[ 2 , 3 , 4 \]. Unlike traditional drugs such as heroin and opium, ecstasy and methamphetamine are stimulants synthesized in laboratories. Most RDs have hallucinogenic effects and are associated with psychological dependence. RDs are challenging to quit, and excessive ingestion leads to severe consequences such as sudden death. Therefore, RDs are expressly prohibited in China \[ 5 \]. This phenomenon is currently expanding to MSM communities in China and other low-to-middle income countries \[ 3 , 7 , 8 , 9 \]. RDs can enhance sexual function \[ 10 \], increase sexual pleasure \[ 11 \], and decrease pain during anal intercourse \[ 12 \]. However, RD use has been reported to correlate with high-risk sexual behaviors and increased risk of HIV infection \[ 11 , 12 , 13 \]. In this context, use of multiple RDs refers to using several RDs simultaneously or during the same period to achieve a particular effect. Use of multiple drugs compared to use of a single drug is more likely to be associated with the transmission of HIV or other sexually transmitted infections STIs \[ 14 \]. Compared with using a single RD, any combination of psychoactive drugs e. Despite the severity of this problem, most research on the use of multiple RDs has been performed in high-income countries \[ 2 , 17 \]. Furthermore, HIV incidence among MSM is higher in low-to-middle income countries than in high-income countries \[ 20 \], suggesting a need to study the effects of RD use on recent HIV infection in low-to-middle income countries. China is the largest low-to-middle income country in the world. By the end of , there were 2. The Cruising areas and service points for MSM were used as the sampling sites. Site-specific sampling periods were determined based on attendance and hours of operation. We used several approaches to recruit participants: advertisements on gay websites, collaboration with local MSM community-based organizations, peer referrals, and venues such as gay bars and bathrooms visited by MSM. Nine relevant questions assessed knowledge of prevention of HIV infection. The questions were as follows: 1 Is it possible for a person who looks healthy to carry HIV? Samples of venous blood were collected from participants to diagnose HIV-1 antibodies. To test cross-sectional specimens, we followed the algorithm shown in Fig. Algorithm for testing cross-sectional specimens to distinguish between established and recent HIV-1 infection. We used the chi-square test to determine the significance of differences in sociodemographics of the various subgroups of RD use. We then used the Cochran—Armitage trend test to analyze the association between different subgroups and sociodemographics. An alpha of 0. The formula and parameters were recommended by the Chinese Center for Disease Control and Prevention \[ 29 \]. Statistical analyses were carried out using SAS 9. In total, MSM participated in our study. The mean age and standard deviation were Of these, The prevalence of each unique RD use was as follows: poppers Among 1DUs, most used poppers Among 2DUs, Among 3DUs, Among all participants, 5. These who used multiple types of RDs commonly took poppers accompanied by one or more types of other RDs e. The prevalence of the types of most common combinations of RD use are also listed above. For almost all the HIV-related high-risk behaviors examined e. The HIV prevalence By contrast, the HIV prevalence 8. These data suggest that those who use multiple RDs are substantially more likely to engage in risky sexual behaviors and may have a higher risk of HIV acquisition. Our study confirmed those results and found that the increase in the number of RDs used was associated with an increase in the prevalence of HIV-related high-risk behaviors. A similar finding was documented among HIV-positive MSM in the United Kingdom \[ 16 \]; however, until now, this relationship has not been examined in a low-to-middle income country. Poppers are physiologically active substances that facilitate and enhance anal intercourse \[ 2 , 12 \]. They do not directly affect mental function or decision-making \[ 32 \]. However, when poppers were used with other psychoactive drugs \[ 2 \] such as methamphetamine, ecstasy, or ketamine, the prevalence of HIV-related high-risk behaviors increased significantly Table 2. If psychoactive drugs are used simultaneously with poppers which relax the anal-sphincter muscles and reduce pain , MSM can experience more serious sexual disinhibition and, thus, anal intercourse may be more robust or last longer, leading to increased risk of HIV infection \[ 32 \]. Scholars also found that using poppers with methamphetamine or amphetamine was associated with more unprotected sex acts \[ 33 \] and, hence, was linked to a higher risk of HIV seroconversion \[ 34 , 35 \]. While we did not find a significant relationship between higher odds of recent HIV infection and 3DUs compared to those who did not use RDs, this finding could have been due to our small sample size and low statistical power to detect the differences in our aOR estimates. This may have been because those use multiple RDs are less risk-averse and more likely to engage in more risky sexual behaviors and, thus, may have higher risk of new HIV infections. Newly infected individuals have high levels of viral load in plasma and few pronounced symptoms and are highly infectious; However, identifying newly infected individuals is difficult \[ 37 , 38 \]. Thus, those who use multiple RDs likely take more sexual risks and therefore may have an increased risk of secondary HIV transmission. First, most RDs are illegal in China, so participants may have been afraid of the repercussions of answering honestly about their use of multiple RDs. To address these fears, we used an anonymous survey to minimize this social desirability bias. We undertook this study in the hope of developing targeted interventions to address the HIV epidemic. Finally, many Chinese MSM in our study used poppers, which may have been due to the ease of buying this drug as it is legal in China \[ 19 \]. One limitation or our study was the few participants who self-reported using multiple types of RDs 5. The few participants in this category likely reduced the power of our study to detect differences in the different drug use sub-groups. We also did not collect the link-to-care details of the participants diagnosed with HIV in this study. However, China has already established a standard procedure for individuals diagnosed with HIV to obtain free antiretroviral therapy ART treatment and follow-up testing. The government would allocate ART treatment medications and pay for the costs of follow-up tests. Accessed 5 June Google Scholar. Prevalence of drug use during sex amongst MSM in Europe: results from a multi-site bio-behavioural survey. Int J Drug Policy. Article Google Scholar. Biomed Res Int. Nitrite inhalant use among young gay and bisexual men in Vancouver during a period of increasing HIV incidence. BMC Public Health. Feng SH. J Shanxi Police Coll. Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review. Subst Use Misuse. PLoS One. Sociodemographic factors, sexual behaviors, and alcohol and recreational drug use associated with HIV among men who have sex with men in southern Vietnam. AIDS Behav. Seroprevalence of and risk factors for HIV-1 infection among south American men who have sex with men. Sex Transm Infect. Kurtz SP. Post-circuit blues: motivations and consequences of crystal meth use among gay men in Miami. Green AI. Deviant Behav. Poppers: epidemiology and clinical management of inhaled nitrite abuse. Club drugs and sex on drugs are associated with different motivations for gay circuit party attendance in men. J Gay Lesbian Soc Serv. The effects and consequences of selected club drugs. J Subst Abus Treat. Lancet HIV. Poly drug use, chemsex drug use, and associations with sexual risk behaviour in HIV-negative men who have sex with men attending sexual health clinics. J Acquir Immune Defic Syndr. Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China. Drug Alcohol Depend. Global epidemiology of HIV infection in men who have sex with men. HIV epidemiology and responses among men who have sex with men and transgender individuals in China: a scoping review. BMC Infect Dis. China Youth Daily. Prevalence and associated factors of inhaled nitrites use among men who have sex with men in Beijing, China. Prevalence of poppers use and its sexual risks among men who have sex with men in southwestern China: a cross-sectional study. Quantitative detection of increasing HIV type 1 antibodies after seroconversion: a simple assay for detecting recent HIV infection and estimating incidence. Performance characteristics of the immunoglobulin G-capture BED-enzyme immunoassay, an assay to detect recent human immunodeficiency virus type 1 seroconversion. J Clin Microbiol. Sci Rep. China CDC. Bourne A, Weatherburn P. Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need. Poly-club-drug use among gay and bisexual men: a longitudinal analysis. French RS, Power R. Self-reported effects of alkyl nitrite use: a qualitative study amongst targeted groups. Addict Res. Sexual risk behavior associated with co-administration of methamphetamine and other drugs in a sample of HIV-positive men who have sex with men. Am J Addict. Drug use, high-risk sex behaviors, and increased risk for recent HIV infection among men who have sex with men in Chicago and Los Angeles. Spatial analysis of the human immunodeficiency virus epidemic among men who have sex with men in China, Clin Infect Dis. HIV incidence is rapidly increasing with age among young men who have sex with men in China: a multicentre cross-sectional survey. HIV Med. Download references. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. You can also search for this author in PubMed Google Scholar. All authors reviewed the manuscript. Correspondence to Hong Shang or Junjie Xu. The study was undertaken following all relevant guidelines and regulations. Written informed consent was obtained from all participants before study commencement. The participants included in this study gave their consent for using anonymized direct quotes in this manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Mao, X. Use of multiple recreational drugs is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey. BMC Public Health 21 , Download citation. Received : 09 August Accepted : 12 January Published : 15 February Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research article Open access Published: 15 February Use of multiple recreational drugs is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey Xiang Mao 1 , 2 , 3 , 4 , Sequoia I. Abstract Background There is limited information about the types of recreational drugs used by men who have sex with men MSM in China or the consequent impact on sexual health and human immunodeficiency virus HIV acquisition. Methods We recruited MSM from seven cities in China between and using multiple approaches including advertisements on gay websites, collaborating with local MSM community-based organizations, peer referrals, and venues such as gay bars and bathrooms visited by MSM. Background Men who have sex with men MSM experience a disproportionately high burden of human immunodeficiency virus HIV infection \[ 1 \]. Laboratory testing Samples of venous blood were collected from participants to diagnose HIV-1 antibodies. Full size image. Availability of data and materials Data on this research is available with the corresponding author. Article Google Scholar Download references. Acknowledgements Not Applicable. View author publications. Competing interests The authors declare that they have no conflict of interest. Supplementary Information. Additional file 1. Questionnaire developed for this study. About this article. Cite this article Mao, X. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.

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