Synthetic drug use and HIV infection among men who have sex with men in China: A sixteen-city, cross-sectional survey

Abstract

IntroductionIncreasing evidence suggests an association between synthetic drug use and HIV infection among men who have sex with men (MSM). The aim of this study was to evaluate synthetic drug use prevalence, describe characteristics of synthetic drug users, and investigate whether synthetic drug use is associated with HIV infection among Chinese MSM.MethodsA cross-sectional survey was conducted in 16 Chinese cities among males >18 years old who reported having had sex with men in the prior 3 months, but did not already have a known HIV-positive serostatus. Participants were grouped according to lifetime synthetic drug use and characteristics were compared using Chi-square test. Determinants of HIV infection were assessed using univariate and multivariate regression.ResultsAmong 3,135 participants, 1,249 reported lifetime synthetic drug use, for a prevalence of 39.8%. Nearly all users (96.3%) reported using inhaled alkyl nitrites (“poppers”). Synthetic drug users were more likely to be younger (<30 years, p<0.001), single (p<0.001), and more educated (p<0.001), and were more likely to engage in higher risk sexual behavior compared to non-drug users. Overall HIV prevalence was 7.8% (246/3,135). However, prevalence among synthetic drug users was 10.6% (132/246) compared to 6.0% (114/246) for non-drug users (p<0.001). Factors associated with an increased odds of HIV infection included inconsistent condom use with male partners (adjusted odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.64–2.91) and synthetic drug use (adjusted OR = 2.04, CI = 1.56–2.70).ConclusionPrevalence of synthetic drug use, especially poppers use, prevalence was high in our study, and users had 2-fold greater odds of HIV acquisition. It is clear that there is an urgent need for increased prevention, testing, and treatment interventions for this key, dual-risk population in China. Moreover, we call on the Chinese Government to consider regulating poppers so that users can be properly warned about their associated risks.

External validation of a prediction tool to estimate the risk of human immunodeficiency virus infection amongst men who have sex with men

“…This decision was based on previous findings in China that recreational drug use amongst MSM remains high, while participation in group-sex remains low. [19,20] Though this imputation may lead to bias, this bias is assumed to be minor. [21]…”

Recreational Inhaled Nitrite Use among Asian Men Who Have Sex With Men

“…48 The Asian MSM populations studied include those living in the United States, 22 Japan, 26 Malaysia, 32 and major cities in Mainland China. [23][24][25][27][28][29][30][31][33][34][35][36][37][38][39][40][41][42][43][44][45][46]48 Both the general MSM population and sex workers at night clubs (money boys) have been studied. Data the use of recreational drugs in their lifetime, of which 21.3% used inhaled nitrites, 2.4% used crystal meth, and 1.0% used ecstasy.…”

“…41 In a recent nationwide study in China involving 16 cities (n = 3135), 96.3% of the MSM who used synthetic tried inhaled nitrites in their lifetime. 45 Inhaled nitrites were also the most common recreational substance used among money boys in Changsha, a highly developed entertainment city in China, whereby 36.6% of the substance users reported ever use in the last 3 months of the survey. 36 Researchers suggested that the low cost of inhaled nitrites and high accessibility through online market and adult stores contributed to the prevalent use of inhaled nitrites in China.…”

Nitrite inhalants use, sexual behaviors and HIV/syphilis infection among men who have sex with men in Chongqing, China

“…Recent studies revealed that recreational drugs were increasingly popular among MSM in China [ 3 – 5 ]. Recreational drug use was reported to be associated with risky sexual behaviors, which placed users at elevated risk of HIV and STDs [ 5 – 7 ].…”