title: Recreational drug use and risks of HIV and sexually transmitted infections among Chinese men who have sex with men: Mediation through multiple sexual partnerships.
abstract: BACKGROUND
  Recreational drug use (RDU) may result in sexual disinhibition and higher risk for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in China. We assessed whether RDU was associated with HIV, syphilis, and herpes simplex virus type 2 (HSV-2) within the context of multiple sexual partnerships and unprotected sex.
  
  
  METHODS
  We conducted a cross-sectional study among sexually-active MSM in six Chinese cities (Kunming, Jinan, Changsha, Zhengzhou, Nanjing, and Shanghai) in 2012-2013. We interviewed participants regarding RDU and sexual activity and drew blood for HIV, syphilis, and HSV-2. We fit multiple logistic regression models to assess associations of drug use and HIV, syphilis and HSV-2 infections, controlling for number of sexual partners and unprotected sex.
  
  
  RESULTS
  Of 3830 participants, 28% reported ever using ≥1 of these drugs in the past 6 months: popper (alkyl nitrites), ecstasy, ice (methamphetamine), amphetamine, tramadol, and ketamine. In the past six months, 62% of MSM reported ≥2 sexual partners and 76% did not use condoms at last sexual encounter. HIV, syphilis and HSV-2 prevalences were 9.2%, 12.2%, and 10.3%, respectively.RDU was associated with HIV infection (aOR = 1.67; 95% CI, 1.31-2.13). Men with RDU were more likely to report multiple sexual partners (OR = 1.69; 95% CI, 1.44-1.98) and unprotected sex (aOR = 1.25; 95% CI, 1.05-1.49). The RDU-HIV association persisted (aOR = 1.58; 95% CI = 1.23-2.02) after adjusting for numbers of partners.
  
  
  CONCLUSIONS
  RDU was associated with multiple sexual partnerships, unprotected sex, and HIV among Chinese MSM. It is plausible that RDU is a driver of increased sexual/HIV risk and/or may be an associated behavior with sexually risky lifestyles. Community engagement is needed.
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. xjjbeijing@gmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. xjjbeijing@gmail.com.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Xu
authors.affiliation: Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA. chen.zhang.1@vanderbilt.edu.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. qinghaihucn@gmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. qinghaihucn@gmail.com.
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Hu
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. laochu323@gmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. laochu323@gmail.com.
authors.forename: Zhen-Xing
authors.initials: ZX
authors.lastname: Chu
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. zhangjing1985zj@hotmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. zhangjing1985zj@hotmail.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. pandawisp@163.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. pandawisp@163.com.
authors.forename: Yong-Ze
authors.initials: YZ
authors.lastname: Li
authors.affiliation: Yunnan Provincial Centers for Disease Control and Prevention (CDC), Kunming, China. lulin@yncdc.cn.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Henan Provincial CDC, Zhengzhou, China. wangzhe@hncdc.com.cn.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Shandong Provincial CDC, Jinan, China. fujihua@163.com.
authors.forename: Ji-Hua
authors.initials: JH
authors.lastname: Fu
authors.affiliation: Hunan Provincial CDC, Changsha, China. Chenxi161@sohu.com.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: Jiangsu Provincial CDC, Nanjing, China. yanhj@jscdc.cn.
authors.forename: Hong-Jing
authors.initials: HJ
authors.lastname: Yan
authors.affiliation: Shanghai Municipal CDC, Shanghai, China. mhzhuang@scdc.sh.cn.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zhuang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. jiangjun55555@163.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. jiangjun55555@163.com.
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Jiang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. windygeng@163.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. windygeng@163.com.
authors.forename: Wen-Qing
authors.initials: WQ
authors.lastname: Geng
authors.affiliation: Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA. sten.vermund@vanderbilt.edu.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. hongshang100@hotmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. hongshang100@hotmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
authors.affiliation: Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA. han-zhu.qian@vanderbilt.edu.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D013587:Syphilis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control