New types of drug use and risks of drug use among men who have sex with men: a cross-sectional study in Hangzhou, China

Depression, positive affect, and sexual behavior: a moderated mediation model of drug use among men who have sex with men in Hong Kong

BACKGROUND

Drug use can be associated with poor mental health and risky sexual behaviors among men who have sex with men (MSM) and has become an important public health concern. The present study investigated the association between depression, positive and negative affect, number of sex partners, and drug use among MSM.

METHODS

A cross-sectional study was conducted among 420 MSM in Hong Kong. Participants completed a self-reported questionnaire that measured demographic characteristics, drug use, depression, sexual behaviors, and positive and negative affect. Hierarchical logistic regression was first conducted to examine the moderating role of the number of sex partners on the association between depression and drug use. A mediation model was then created to test the role of positive affect, negative affect and depression on drug use. A moderated mediation model was finally developed to test the overall associations.

RESULTS

After adjusting for significant demographic and other confounding factors, depression was positively associated with drug use (adjusted odds ratio [aOR] 1.05, 95 % confidence interval [CI] 1.02-1.09). The association between depression and drug use was positively moderated by number of sex partners. Positive affect significantly mediated the association between depression and drug use, exerting a negative indirect effect.

LIMITATIONS

The casual inference was constrained by the cross-sectional design.

CONCLUSIONS

Given the moderating role of the number of sex partners and the mediating role of positive affect on the association between depression and drug use, interventions to reduce drug use among MSM should aim to reduce risky sexual behaviors and promote mental health.

Sexually Explicit Media Exposure, Sexual Violence Victimization, and Sexual Risk Behaviors Among HIV-Positive Men Who Have Sex with Men with New Drug Abuse in Jinan, China

Abuse of new drugs, such as Rush poppers, methamphetamine, Magu, Ketamine, and Ecstasy, is common among men who have sex with men (MSM) in China, leading to increased risks of sexually explicit media consumption, sexual violence, and sexual risk behaviors. This study aimed to explore the prevalence and relationships of these behaviors among MSM with new drug abuse. A cross-sectional study was conducted from January to June 2021, involving 453 MSM in Jinan, China. Participants completed an online questionnaire assessing behaviors over the past six months. Multiple linear regressions were conducted to investigate the correlations among the three behaviors. Results showed that 88.7% consumed sexually explicit media, and 48.3% experienced sexual violence. Regarding sexual risk behaviors, the prevalence rates for group sex, condomless anal intercourse, and commercial sex were 29.1%, 76.4%, and 11.0%, respectively. New drug abuse was positively correlated with sexual violence victimization (b = 0.38 for methamphetamine; b = 0.50 for Magu), media consumption (b = 1.58 for methamphetamine), and sexual risk behaviors (b = 0.94 for methamphetamine; b = 0.72 for Magu). The age at first exposure to sexually explicit media was negatively correlated with sexual violence victimization (b = - 0.09) and sexual risk behaviors (b = - 0.30). Preferences for violence in media were linked to higher sexual violence risk (b = 0.76), and preferences for condomless anal intercourse and group sex to higher sexual risk behaviors (b = 1.04; b = 0.83). Significant positive correlations were found among sexual violence victimization, media consumption, and sexual risk behaviors (r = 0.22-0.82, p < 0.05). These findings provide insights for future interventions to prevent HIV transmission among MSM with new drug.

HIV pre-exposure prophylaxis re-initiation among men who have sex with men: a multi-center cohort study in China

Background Data on persistent use of HIV pre-exposure prophylaxis (PrEP) is limited among Chinese men who have sex with men (MSM). This study aimed to explore factors associated with the re-initiation of PrEP among Chinese MSM from a longitudinal PrEP demonstration trial. Methods A multi-center cohort study was conducted in Guangzhou and Wuhan, China (September 2021-2024), providing 1134 MSM participants with a 12-month dosage of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as oral PrEP. Following the trial, a subgroup of participants were invited to complete a 3-month post-trial follow-up survey. These participants were categorized on the basis of self-reported PrEP use patterns into (1) continued PrEP use, (2) discontinued without re-initiation, and (3) re-initiated after discontinuation. Log-binomial regression models were used to assess factors associated with PrEP re-initiation. Results Out of 408 participants who completed the 3-month post-trial follow-up survey, 70.1% (n =286/408) reported discontinuing PrEP, and 50.7% (n =145/286) of those who discontinued subsequently re-initiated PrEP. Participants who had concurrent sexual partnerships (adjusted risk ratio [aRR]=1.47, 95% CI: 1.11-1.96), used drugs during sex (aRR=1.34, 95% CI: 1.09-1.65), or lived alone (aRR=1.29, 95% CI: 1.03-1.61) were more likely to re-initiate PrEP. The Likert scale analysis indicated that perceived partner influence, specifically the expectation of condomless sex, played a significant role in re-initiation decisions (P =0.03). Conclusion Individuals engaging in higher-risk behaviors are more likely to re-initiate PrEP, highlighting the dynamic nature of risk perception. Future interventions should focus on promoting both re-initiation and consistent condom use, emphasizing partner-related dynamics and substance use as key factors in PrEP decisions among MSM.

A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey

BACKGROUND

China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing.

OBJECTIVE

This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing.

METHODS

A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion.

RESULTS

The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positive for HIV, and 18.8% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52).

CONCLUSIONS

Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM.

Awareness of Sexual Partner's HIV Status Among Men Who Have Sex With Men in China: Cross-Sec. tional Survey Study

Background

Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy.

Objective

This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners' HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission.

Methods

A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners' HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners' HIV status.

Results

A total of 7629 MSM participated in the study, with 45.2% (n=3451) being aware, 35.4% (n=2701) being partially aware, and 19.4% (n=1477) being unaware of their sexual partner's HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner's HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95% CI 1.09-1.86), had a monthly income of more than US $1400 (aOR 1.36, 95% CI 1.03-1.80), had insertive anal sex (aOR 1.35, 95% CI 1.12-1.63), had only male sexual partners (aOR 1.53, 95% CI 1.28-1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95% CI 2.01-2.77), had used condoms for the past 3 months (aOR 1.72, 95% CI 1.33-2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95% CI 1.81-2.86), were aware of HIV PrEP (aOR 2.04, 95% CI 1.68-2.48), were aware of HIV PEP (aOR 1.69, 95% CI 1.39-2.06), used mail reagent self-testing (aOR 1.19, 95% CI 1.04-1.36), and had previously undergone HIV testing (aOR 1.40, 95% CI 1.16-1.69) were associated with increased odds of being aware of their sexual partner's HIV status.

Conclusions

Overall, 45.2% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners' HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM.

HIV incidence and recreational drug use among men who have sex with men aged 18-24 years in Tianjin, China: a retrospective cohort study

BACKGROUND

Recreational drug use has been identified as a significant risk factor for the transmission of human immunodeficiency virus (HIV). This behavior is particularly prevalent among young men who have sex with men (YMSM). However, limited research has been conducted to investigate the correlation between recreational drug use and HIV incidence within this population.

OBJECTIVE

To examine HIV incidence and explore the association between recreational drug use and HIV incidence among YMSM.

METHODS

A retrospective cohort study was conducted by a local non-governmental organization (NGO) among MSM aged 18-24 years from October 2017 to December 2023 in Tianjin, China. Participants were included if they had at least two HIV test records during this period. HIV incidence density and its 95% confidence interval (CI) were calculated using person-years (PYs) with a Poisson distribution. Risk factors for HIV incidence were identified using univariable and multivariable Cox proportional hazards regression models.

RESULTS

A total of 56 HIV seroconversions were reported with 2901.9 PYs, resulting in an overall incidence density of 1.9/100 PYs (95% CI: 1.4-2.4). Among YMSM who do not use recreational drugs (YMSM-URD), the incidence density was 1.1/100 PYs (95% CI: 0.5-1.6), while it was 2.8/100 PYs (95% CI: 1.9-3.7) among those who do use recreational drugs (YMSM-RD). Adjusted for confounders, factors associated with HIV infection included recreational drug use (adjusted hazard ratio = 2.6, 95% CI = 1.4-4.7) and unprotected anal intercourse in the past six months (adjusted hazard ratio = 2.3, 95% CI = 1.2-4.4).

CONCLUSIONS

Recreational drug use and unprotected anal intercourse significantly increase the risk of HIV infection. To effectively mitigate the spread of HIV, interventions should focus on these risk factors by employing HIV counseling and testing clinics, collaborating with NGOs focused on MSM, and establishing peer education programs aimed at YMSM.

Examining HIV Testing Coverage and Factors Influencing First-Time Testing Among Men Who Have Sex With Men in Zhejiang Province, China: Cross-Sectional Study Based on a Large Internet Survey

BACKGROUND

Men who have sex with men (MSM) constitute a significant population of patients infected with HIV. In recent years, several efforts have been made to promote HIV testing among MSM in China.

OBJECTIVE

This study aimed to assess HIV testing coverage and factors associated with first-time HIV testing among MSM to provide a scientific basis for achieving the goal of diagnosing 95% of patients infected with HIV by 2030.

METHODS

This cross-sectional study was conducted between July 2023 and December 2023. MSM were recruited from the "Sunshine Test," an internet platform that uses location-based services to offer free HIV testing services to MSM by visiting the WeChat official account in Zhejiang Province, China. Participants were required to complete a questionnaire on their demographic characteristics, sexual behaviors, substance use, and HIV testing history. A logistic regression model was used to analyze first-time HIV testing and its associated factors.

RESULTS

A total of 7629 MSM participated in the study, with 87.1% (6647) having undergone HIV testing before and 12.9% (982) undergoing HIV testing for the first time. Multivariate logistic regression analysis revealed that first-time HIV testing was associated with younger age (adjusted odds ratio [aOR] 2.55, 95% CI 1.91-3.42), lower education (aOR 1.39, 95% CI 1.03-1.88), student status (aOR 1.35, 95% CI 1.04-1.75), low income (aOR 1.55, 95% CI 1.16-2.08), insertive anal sex role (aOR 1.28, 95% CI 1.05-1.56), bisexuality (aOR 1.69, 95% CI 1.40-2.03), fewer sex partners (aOR 1.44, 95% CI 1.13-1.83), use of rush poppers (aOR 2.06, 95% CI 1.70-2.49), unknown HIV status of sex partners (aOR 1.40, 95% CI 1.17-1.69), lack of awareness of HIV pre-exposure prophylaxis (aOR 1.39, 95% CI 1.03-1.88), and offline HIV testing uptake (aOR 2.08, 95% CI 1.80-2.41).

CONCLUSIONS

A notable 12.9% (982/7629) of MSM had never undergone HIV testing before this large internet survey. We recommend enhancing HIV intervention and testing through internet-based platforms and gay apps to promote testing among MSM and achieve the target of diagnosing 95% of patients infected with HIV by 2030.

Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey

BACKGROUND

Men who have sex with men (MSM) are at high risk of HIV acquisition. Long-acting injectable-pre-exposure prophylaxis (LAI-PrEP), requiring less frequent dosing, is being studied as an alternative method to daily oral HIV PrEP. With the addition of this potential new prevention method, it expands the scope for a wider user choice and is expected to increase the acceptability and uptake of HIV prevention measures. The aim of our study was to explore the willingness to use LAI-PrEP and associated influential factors.

METHODS

Participants were recruited from December 2020 to March 2021 through banner advertisements on web- and mobile app-based platforms on Blued, a large gay Chinese social media platform. MSM in our cross-sectional study was HIV-negative and currently lived in mainland China. Participants were asked about their willingness to use LAI-PrEP and reasons why they might be or not be willing to use LAI-PrEP. Multivariable logistic regression was used to analyze the factors associated with the willingness to use LAI-PrEP.

RESULTS

In total, 969 participants met the inclusion criteria and finished the survey. Nearly twenty percent (19.5%) of participants had never tested for HIV; 66.8% of MSM had multiple male partners; and 51.6% of MSM engaged in condomless sex with their partner. About three-fifths (66.3%) of MSM were aware of PrEP, and only 3.9% of MSM had used PrEP before. The willingness to use LAI-PrEP among MSM was 74.0% (95% CI: 71.4%-76.6%). MSM with higher education levels were less likely to show a willingness to use LAI-PrEP (AOR = 0.56, 95%CI: 0.38-0.84). Participants who had a history of HIV test (AOR = 1.68, 95%CI: 1.11-2.55), were willing to use daily oral PrEP (AOR = 10.64, 95%CI:7.43-15.21), had multiple male sexual partners (AOR = 1.33, 95%CI:0.93-1.90), who used rush popper(AOR = 1.49, 95%CI:1.05-2.13), and who were aware of PEP (AOR = 1.66, 95%CI: 1.02-2.70) were more likely to show willingness to use LAI-PrEP.

CONCLUSIONS

In our study, MSM had quite high awareness but low uptake of PrEP. As LAI-PrEP is expected to be approved for use in China in the future, our study of MSM highlights the need for key population-focused education programs about PrEP and healthy sexual behavior. This study also provides some evidence for LAI-PrEP use among the Chinese MSM population in the future.

The epidemic of HIV and syphilis and the correlation with substance abuse among men who have sex with men in China: A systematic review and meta-analysis

Background

In China, the HIV/AIDS epidemic among men who have sex with men (MSM) has been expanding in recent years. Substance abuse in MSM was not well studied as the independent risk factor for HIV and syphilis infection and other sexually transmitted diseases. The present review aimed to determine the correlation between HIV/Syphilis infections and substance abuse and other sexual risk behaviors among MSM.

Methods

We conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant articles of quantitative studies published between 2010 and May 31, 2022. Meta-analysis was performed using R software. Pooled estimated of the association-odds ratio, with 95% confidence intervals were calculated using random-effects models stratified by study design. Q statistics and I² were used to measure the heterogeneity.

Results

Our meta-analysis included 61,719 Chinese MSM from 52 eligible studies. The pooled HIV prevalence rate among substance-abusing MSM was 10.0% (95% CI = 0.08-0.13). Substance abusers were more likely to have a higher prevalence of HIV (OR = 1.59) and syphilis (OR = 1.48) infections than non-substance abusers. Substance abusers were also more likely to seek sexual partners through the internet or social media applications (OR = 1.63), engage in unprotected anal intercourse (UAI) (OR = 1.69), group sex (OR = 2.78), and engage in commercial intercourse (OR = 2.04) compared to non-users. Regarding testing behaviors, substance abusers had a higher proportion of HIV or STI testing in their lifetime (OR = 1.70) compared with non-substance abusers (p < 0.05). They were also more likely to have had more sexual partners (≥2; OR = 2.31) and more likely to have consumed alcohol (OR = 1.49) in the past 6 months.

Conclusions

Our study shows the correlation between substance abuse and HIV/Syphilis infection. Eliminating disparities in HIV/Syphilis infection among substance abusing men who have sex with men (MSM) can be achieved if the Chinese government and public health sectors could provide targeted knowledge popularization and diagnosis interventions among high-risk populations.

HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes

HIV disclosure is crucial for HIV prevention and control, but may also lead to discrimination, insult, and even violence against people living with HIV and AIDS (PLWHAs). In this study, we examined HIV disclosure, its influencing factors, and its association with intimate partner violence (IPV) among 1153 PLWHAs through the sexual route in Jinan, Shandong Province, China. Our results showed that 76.4% (881/1153) PLWHAs had disclosed someone about their HIV infection, the HIV disclosure rates among family members, friends, spouses, and current fixed partners of PLWHAs were 43.5% (501/1153), 47.9% (552/1153), 56.8% (129/227), and 43.2% (336/777), respectively. HIV disclosure was affected by socio-demographics, disease characteristics, and psycho-social factors and varied among family members, close friends, spouses, and current fixed sexual partners. Age ≤ 33 years (aOR 1.79, 95% CI 1.27-2.53), heterosexual infection route (aOR 1.52, 95% CI 1.06-2.17), HIV diagnosis time > 36 months (aOR 1.84, 95% CI 1.30-2.59), with other chronic diseases (aOR 1.87, 95% CI 1.34-2.61), lower self-stigma (aOR 4.03-4.36, 95% CI 1.98-8.74), higher social support (aOR 1.71-1.73, 95% CI 1.03-2.83), no depression (aOR 1.54, 95% CI 1.12-2.11), and no suicidal ideation (aOR 1.79, 95% CI 1.28-2.50) were all independently associated with increased likelihood of HIV disclosure. HIV disclosure was associated with an increased risk of IPV among current fixed sexual partners (aOR 1.87, 95% CI 1.38-2.54) and spouses (aOR 2.54, 95% CI 1.41-4.56). Our findings suggest that the HIV disclosure rate of PLWHAs is still low and is affected by multiple factors. There is an urgent need to design targeted and comprehensive interventions to improve HIV disclosure. IPV prevention should also be incorporated into the intervention system of HIV disclosure to ensure adequate and continuous support for PLWHAs.

Post-lockdown Rebounding High-risk Behaviors and HIV Testing Among MSM in China in the Era of the COVID-19 Pandemic

BACKGROUND

Lockdown measures for controlling the COVID-19 epidemic were enforced in China between January and May 2020. Previous studies showed a decrease in HIV high- Risk Behaviors (HRBs) and updated testing during the lockdown, but little is known about these behaviors during the post-lockdown period.

OBJECTIVE

We conducted quantitative and qualitative assessments of HIV-related behaviors among MSM during the lockdown and post-lockdown periods in Changsha, south-central China.

METHODS

Face-to-face structured interviews with open-ended questions were conducted using the TimeLine Follow Back (TLFB) method for collecting retrospective data on frequencies of HRBs and testing. McNemar's Chi-square test and Wilcoxon signed-rank test were used to comparing frequencies of behaviors between lockdown (January-May 2020) and post-lockdown periods (June- October 2020). Content analysis was used to analyze qualitative data on the reasons for rebounding HRBs and testing.

RESULTS

Of 159 MSM participants, 64% had at least one HRB during the post-lockdown period. Men had increased condomless sex (from 24% to 35%), multiple partners (23% to 35%), and substance abuse (16% to 27%) between the two study periods due to the negative emotions and increased use of social networks during the lockdown. HIV testing frequency also increased from 37% to 66% due to resuming routine testing services in the community-based organizations and increased HRBs among MSM during post-lockdown.

CONCLUSION

After lifting the lockdown measures, MSM had rebounding HRBs and uptake of testing. Effective preventive measures and healthcare services should be available to MSM after the lockdown measures are lifted.

The Moderating Effect of Sexual Sensation Seeking on the Association between Alcohol and Popper Use and Multiple Sexual Partners among Men Who Have Sex with Men in Guangzhou, China

Introduction: This cross sectional study was conducted to explore the moderating effect of sexual sensation seeking (SSS) on the association between alcohol/popper use before sex and multiple sexual partners (MSP) among men who have sex with men (MSM) in Guangzhou, China. Methods: From June 2017 to April 2018, MSM were recruited from a community-based HIV service center in Guangzhou, China; data on sociodemographics, sexual behaviors and SSS were collected. A product term of SSS and alcohol/popper use before sex was included in a multivariate logistic regression model to test the potential moderating effect of SSS on the association between alcohol/popper use before sex and MSP. Results: Among the 500 MSM included, individuals who reported alcohol use and popper use before sex, and MSP in the last six months accounted for 33.80%, 33.40%, and 60.40%, respectively. MSM with high SSS traits accounted for 54.80%. The association between popper use before sex and MSP was moderated by SSS (P for interaction = 0.007). A significant association between popper use before sex and MSP among MSM with low SSS traits (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.06 ∼ 8.67). But not among MSM with high SSS traits (OR = 1.37, 95%CI: 0.77 ∼ 2.43) were observed. However, no moderating effect of SSS on the association between alcohol use before sex and MSP were observed. Conclusion: The moderated analysis indicated that SSS should be taken into consideration when tailoring interventions to prevent popper use before sex to reduce the risk associated with MSP.

The first 90: Progress in HIV detection in Zhejiang Province, 2008-2018

To analyze the results of HIV screening and the HIV-positive rate based on different HIV detection strategies in Zhejiang Province, China. Data were downloaded from the AIDS Prevention and Control Information System on May 1, 2019. HIV screening, prevalence, and incidence data were analyzed from 2008 to 2018. The incidence of HIV was calculated from the results of BED testing. SPSS software (ver. 19.0) was used for the analysis. The number of people screened for HIV increased by 229.7% from 2008 to 2018, while the incidence of HIV increased from 1.14‱ (2010) to 1.67‱ (2018), peak by 2015 (2.28‱). The proportion of people screened for HIV in medical institutions increased from 62.0% in 2008 to 67.1% in 2018, while of all positive tests, 47.9% were conducted at medical institutions in 2008, which increased to 63.2% in 2018. VCT and STD clinic attendees, who had only 4.5% of all those undergoing HIV tests, accounted for 23.7% of all HIV positive in 2018. The rate of HIV-positive people and incidence of HIV both increased in Zhejiang Province between 2008 and 2015. The most effective strategy for detecting HIV new cases is screening visitors to VCT and STD clinics.

Evaluating the impact of COVID-19: A cohort comparison study of drug use and risky sexual behavior among sexual minority men in the U.S.A

BACKGROUND

Sexual minority men who use drugs have high sexual HIV transmission risk. Sexual interactions may also increase COVID-19 risk.This study compared marijuana use, other illegal drugs use (i.e. cocaine/crack, methamphetamine, MDMA/ecstasy, GHB, and ketamine) and sexual behavior with casual partners among sexual minority cismen active on social networking and dating applications before and during the COVID-19 epidemic.

METHODS

This cohort-control study compared 455 adult respondents (surveyed May 6th to 17th, 2020) and a matched sample selected from 65,707 respondents surveyed pre-COVID. Participants were recruited on social networking and dating applications and completed surveys online.

RESULTS

The proportion reporting marijuana use declined significantly in the COVID cohort (34.5 % versus 45.7 % pre-COVID,p < .001) as did their illegal drug use (11.0 % versus 22.9 % pre-COVID, p < .001). While the number of casual partners per month was stable, the proportion reporting condomless anal sex with casual partners declined significantly during COVID (26.4 % versus 71.6 % pre-COVID, p < .001). The effect of illegal drug use (excluding marijuana) on number of casual partners per month (aRR = 1.45 pre-COVID versus 2.84, p < .01) and odds of condomless anal sex (aOR = 2.00 pre-COVID versus 5.22, p = .04) were significantly greater in the COVID cohort.

CONCLUSIONS

While the proportion of participants reporting drug use and condomless anal sex with casual partners declined in the COVID cohort, the association between drug use and sexual behavior was magnified. Sexual minority men who use drugs are significantly more likely to engage in sexual behaviors that place them at risk for HIV and COVID-19 transmission.

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

BACKGROUND

Emerging evidence indicates nitrite inhalants have become increasingly prevalent among men who have sex with men (MSM). The present study aimed to describe the prevalence and correlates of nitrite inhalants use and its association with risky sexual behaviors and human immunodeficiency virus (HIV)/syphilis infection among MSM in Chongqing, a city in China where MSM were burdened with the highest pooled HIV prevalence in the country.

METHODS

This cross-sectional study was conducted in Chongqing between March 2019 and February 2020. Information of demographics, drug use, sexual behaviors and HIV testing was collected through an anonymous survey. Blood samples were drawn from each participant for the diagnoses of HIV and syphilis. Logistic regression analysis was performed to evaluate factors correlated with nitrite inhalants use and its relationship with risky sexual behaviors and HIV/syphilis infection.

RESULTS

Of the 1151 eligible participants, 18.9% (218) reported use of at least one type of recreational drugs in the past 6 months, and nitrite inhalants were the most commonly used substance (17.7, 95% confidence interval [CI]: 15.6-20.2%). The proportions of participants reported engaging in group sex and practicing condomless internal ejaculation during anal sex in the past six months were 5.8% (95% CI: 4.4-7.2%) and 41.7% (95% CI: 38.7-44.7%), respectively. The general prevalence of HIV and syphilis infection among the enrolled MSM were 16.8% (95% CI: 14.7-19.0%) and 12.6% (95% CI: 10.7-14.4%), respectively. Factors positively associated with nitrite inhalants use included: age ≤ 25 (adjusted odds ratio [aOR] = 2.08, 95% CI: 1.10-3.94), monthly individual income ≥ CNY 3000 (Chinese Yuan) (aOR = 1.95, 95% CI: 1.18-3.22), preferring receptive anal intercourse (aOR = 2.27, 95% CI: 1.34-3.84) and versatile anal intercourse (aOR = 2.60, 95% CI: 1.64-4.13), age at first anal intercourse < 18 (aOR = 1.79, 95% CI: 1.21-2.67), engaging in group sex in the past six months (aOR = 9.34, 95% CI: 4.95-17.63), having multiple male sex partners in the past 6 months (aOR = 2.32, 95% CI: 1.50-3.58), practicing CIE during anal sex in the past six months (aOR = 1.71, 95% CI: 1.19-2.46), HIV infection (aOR = 1.72, 95% CI: 1.11-2.66) and syphilis infection (aOR = 1.98, 95% CI: 1.23-3.17).

CONCLUSIONS

This study found that nitrite inhalants were the most commonly used recreational substance among MSM and nitrite inhalants use were associated with higher probability of HIV and syphilis infection. Therefore, increased attention and counselling should be given to nitrite inhalants-using MSM.

Factors Associated with Drug Use Among HIV-Infected Men Who Have Sex with Men in China

Drug use is globally more prevalent in HIV-positive men who have sex with men (HIVMSM) than their heterosexual counterparts. Yet, few studies have investigated the factors associated with drug use among this population beyond Western societies. A cross-sectional survey was conducted to examine factors associated with drug use among 415 HIVMSM in Chengdu, China. The results show that 10.8% of the participants had used drugs in the past 30 days. Among participants who had anal intercourse in the past 30 days, 11.5% had used drugs during anal intercourse. After adjusting for background variables, logistic regression models show that life satisfaction was associated with past 30-day drug use [Adjusted Odds Ratio (ORa) = 0.90, p < 0.001], and with drug use during anal intercourse in the past 30 days (ORa = 0.89, p < 0.01). Participants with more nonregular partners were more likely to use drugs with or without sex in the past 30 days, whereas those with one regular partner were less likely to use drugs during anal intercourse compared to their counterparts with no regular partners. The findings of this study are informative for designing effective substance-use intervention programs targeting HIVMSM.

HIV Testing and Risks of Sexual Behavior among HIV-Negative Men Who Have Sex with Men in Ningbo, China

Human immunodeficiency virus (HIV) testing is confirmed as a preventive strategy for HIV control. However, the testing rate and risk behaviors of HIV-negative men who have sex with men (MSM) remain unclear. We aimed to examine factors associated with HIV testing and high-risk behaviors among HIV-negative MSM. From July 2016 to June 2017, participants were recruited by snowball sampling from WeChat groups, bars, and other venues. HIV testing was performed to exclude HIV-positive MSM. Face-to-face questionnaires regarding HIV testing and high-risk behaviors were conducted; 988 MSM were included, and 57.1% of participants underwent HIV testing in the past year. The proportion of high-risk behaviors was 49.9%. Factors associated with HIV testing were bisexual orientation, substance use to adjust psychiatric disorders, and receiving acquired immune deficiency syndrome (AIDS) interventions. Being married, bisexual orientation, and receiving AIDS interventions were risk factors for high-risk sexual behaviors, while college or higher degree was a protective factor. We determined that HIV transmission factors are widespread, and the rate of HIV testing is relatively low. Attention should be given to marital status, using substances to adjust psychiatric disorders, or bisexual HIV-negative MSM, and AIDS interventions should be strengthened to promote HIV testing and reduce high-risk behaviors.

Syphilis associated with recreational drug use, depression and high-risk sexual behaviour in men who have sex with men: a case-control study in China

OBJECTIVE

We investigated syphilis prevalence among men who have sex with men (MSM) in China, as well as potential risk factors. Our principal hypothesis was that syphilis would be associated with the use of recreational drugs such as methamphetamines.

METHODS

From April to October 2013, we used several methods to recruit MSM in Qingdao, collecting demographic/behavioural information via self-administrated questionnaires. Trained health workers collected blood for the Treponema pallidum particle assay (TPPA) with positives confirmed by a toluidine red unheated serum test. We used an unmatched case-control study to identify factors that might predict syphilis infection using multivariable logistic regression.

RESULTS

We recruited 447 MSM who agreed to participate and who completed syphilis testing. Of 71 (15.9%) syphilis-positive MSM, 44 (62.0%) used drugs. Of 376 (84.1%) syphilis-negative MSM, 186 (49.5%) used drugs. We found a positive association with syphilis for any recreational drug use (crude OR (cOR) 1.7, 95 % CI 1.0 to 2.8), frequent methamphetamine use (cOR 2.4, 95% CI 1.1 to 5.3) and multiple drug use (adjusted OR (aOR) 3.4, 95% CI 1.3 to 9.2). Syphilis-positive men were more likely to have a higher physical depression score (aOR 5.2, 95% CI 1.1 to 24.4), be > 30 years old (aOR 2.7, 95% CI 1.5 to 4.8), report a prior STI (aOR 4.1, 95% CI 2.3 to 7.3) and report a sex party experience (aOR 2.2, 95% CI 1.1 to 4.4).

CONCLUSIONS

Recreational drug use, depression and high-risk sexual behaviours were associated with syphilis infection among MSM in China. Only a multifaceted approach is likely be effective in control of both syphilis and HIV .