Drug use and risk-taking attitudes in the context of HIV/STI among  Men who have sex with men in China


Juan Nie1,2*, Hongyun Fu3*, Changchang Li1, Jason J. Ong4,5, Weiming Tang1,2,6, M. Kumi Smith7, Weibin Cheng1, Peizhen Zhao1, Michael Marks4, Heping Zheng 1, Bin Yang 1#, Cheng Wang1#, Joseph D. Tucker2,4,6


1. Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China ;

2. University of North Carolina Project-China, Guangzhou, Guangdong, China;

3. Community Health and Research Division, Eastern Virginia Medical School, Norfolk, Virginia, USA ;

4. Faculty of Infectious and Tropical Diseases, London School of  Hygiene and Tropical Medicine, London, UK;

5. Central Clinical School, Monash University, Victoria, Melbourne, Australia ;

6. Institute for Global Health and Infectious  Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA ;

7. Division of Epidemiology and Community Health, University of Minnesota  Twin Cities, Minneapolis, USA


While drug use is associated with increased risk for sexually transmitted infections (STI), risk-taking propensity may simultaneously predispose individuals to drug use and high-risk sex.



This study examines the role of risk-taking attitudes in the connection between drug use and HIV/STI risk, using data collected among men who have sex with men (MSM) in July/August 2018. Men aged above 16 years old and reported ever having anal or oral sex with another man were recruited online for a structured questionnaire. Multivariable logistic regression was used to examine the associations between drug use, risk aversion scale (RAS) and HIV-related behavioral and health outcomes.



Of the 733 who completed the survey, 699 were eligible. Over half (50.8%) of men ever used drugs before or during sex in the past three months. Men who used drugs had higher RAS scores than men who did not use drugs (mean: 4.70 vs. 4.11, P<0.001). There was a significant interaction between risk attitudes and drug use in models predicting ever having group sex (AOR: 1.24; 95% CI:1.04 -1.59), buying sex (AOR: 1.30; 95% CI:1.07-1.47) and selling sex (AOR: 1.44; 95% CI 1.15 -1.82). Drug use and risk attitudes were independently associated with having multiple male sexual partners, condomless sex with male partners in the past three months, being HIV infected and previous syphilis infection.



The study reveals a significant association between drug use and elevated risks for HIV and syphilis infection and a meditating effect of risk attitudes for group sex and commercial sex.