Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
Int J Drug Policy. 2020 Jan;75:102591. doi: 10.1016/j.drugpo.2019.10.015. Epub 2019 Nov 19.
Previous studies have shown that men who have sex with men (MSM) and who engage in drug use in sexualized contexts (chemsex) were more likely to be HIV positive. Their social networks and adoption of HIV prevention measures have, however, not been fully investigated. We aim to compare the sexual behavior, HIV prevention efforts and social networks of MSM by the intensity and patterns of their drug use.
Data from respondents of a community-based, cross-sectional survey (PRiSM) conducted among MSM in Hong Kong in 2017 were collected retrospectively. Characteristics of MSM engaged and not engaged in chemsex were compared in logistic regressions, delineated by latent class analysis (LCA) and compared in multinominal logistic regression.
Of 4133 respondents, 3044 were sexually active with an HIV prevalence of 6.5%. The prevalence of chemsex engagement in the preceding 6 months was 12%, after excluding use of poppers or erectile dysfunction agents (EDA) alone. Four types of drug user were identified by LCA: Minimal (mainly poppers), low-threshold (mainly poppers and EDA), medium-threshold (mainly methamphetamine, GHB, poppers and EDA) and intense (extensive use of different types of drug). Medium-threshold and intense drug users were more likely to be HIV positive, be diagnosed with sexually transmitted infections, make gay friends through mobile apps and sex parties, and intend to take pre-exposure prophylaxis (PrEP). Medium-threshold drug users had a more influential role in their social network, as shown by their higher centrality in mobile apps network.
Chemsex engagement in MSM is significantly associated with HIV infection in Hong Kong. The HIV transmission risk could however be offset by the inclination of MSM belonging to medium-threshold and intense drug users to take PrEP, should the intervention become accessible to the community. Further mobile apps could be a good channel to access MSM who are medium-threshold drug users.
既往研究表明，男男性行为者（MSM）和在性化环境中使用药物的吸毒者（滥交者）更有可能感染 HIV。然而，他们的社交网络和 HIV 预防措施的采用尚未得到充分研究。我们旨在通过研究 MSM 药物使用的强度和模式，比较他们的性行为、HIV 预防措施和社交网络。
我们回顾性地收集了香港 2017 年一项基于社区的横断面调查（PRiSM）中 MSM 参与者的数据。通过潜在类别分析（LCA）进行逻辑回归，比较了滥交者和非滥交者的 MSM 特征，并在多分类逻辑回归中进行了比较。
在 4133 名有性行为的受访者中，HIV 感染率为 6.5%。在排除单独使用催情剂或勃起功能障碍药物（EDA）的情况下，前 6 个月滥交的发生率为 12%。LCA 确定了 4 种类型的药物使用者：轻度（主要是催情剂）、低阈值（主要是催情剂和 EDA）、中阈值（主要是冰毒、GHB、催情剂和 EDA）和高阈值（广泛使用不同类型的药物）。中阈值和高阈值药物使用者更有可能感染 HIV，诊断出性传播感染，通过移动应用程序和性派对结交同性恋朋友，并打算服用暴露前预防（PrEP）。中阈值药物使用者在其社交网络中的作用更具影响力，这反映在他们在移动应用程序网络中的中心度更高。
滥交在香港 MSM 中与 HIV 感染显著相关。然而，中阈值和高阈值药物使用者服用 PrEP 的倾向可能会降低 HIV 传播的风险，如果该干预措施能够在社区中获得。进一步的移动应用程序可能是接触中阈值药物使用者的良好渠道。
