Polydrug use is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey

Background: Recreational drug use is popular among men who have sex with men (MSM), while there is limited information about polydrug use and its consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition. Methods: Mixed methods were used to recruit MSM from seven cities in China between 2012 and 2013. Participants were divided into four subgroups based on the number of recreational drugs (RDs) used in the past 6 months. “Polydrug use” was defined as simultaneous use of ≥2 types of RDs. Information on demographics and HIV high-risk behaviors (HIV-HRBs) was collected, and blood samples were tested for recent HIV infection by the BED capture enzyme immunoassay. Results: A total of 4,496 Chinese MSM participated, of which 28.4% used RDs, and 5% were polydrug users. Polydrug users commonly took poppers with one or more types of other RDs (e.g. methamphetamine). Polydrug users were likely to be aged 26–30 years, have low educational attainment, be internal migrants, have a high monthly income, use versatile positions during anal intercourse, and have inadequate knowledge about prevention of HIV infection. As the number of RDs used in the past 6 months increased, the prevalence of HIV-HRBs increased ( P <0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95%CI: 1.5–3.0) or two types of RDs (2.3, 1.0–5.2) in the past 6 months compared with those who did not use RDs. Conclusion: The level and pattern of polydrug use among Chinese MSM were different from high-income countries. Polydrug use had a dose-effect relationship with HIV-HRBs. Polydrug users who have higher levels of RDs use are more likely to engage in various sexual risks, thus may be associated with new HIV infections.