Sex and drugs: poppers and HIV risk

Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China.

Zhang H, Teng T, Lu H, Zhao Y, Liu H, Yin L, Sun Z, He X, Qian HZ, Ruan Y, Shao Y, Vermund SH. Drug Alcohol Depend. 2015 Dec 10. pii:S0376-8716(15)01807-4. doi:10.1016/j.drugalcdep.2015.11.037. [Epub ahead of print]

Background: Although poppers are increasingly popular among MSM in China, little is known about the patterns of poppers use. The objectives of this study were to describe the patterns of poppers use and examine its association with sexual behaviors and HIV infection among MSM in Beijing, China.

Methods: As part of a multi-component HIV intervention trial, 3588 MSM were surveyed between March 2013 and March 2014 in Beijing, China. Blood samples were collected and tested for HIV and syphilis. The questionnaire collected information about socio-demographic and behavioral characteristics. Univariate and multivariable logistic regression analyses were performed to evaluate the correlates of poppers use.

Results: Over a quarter of men (27.5%) reported having used at least one type of drugs in the past three months. Poppers were the most popular one (26.8%). Poppers use was correlated with a higher HIV prevalence [odds ratio (OR): 1.38, 95% confidence interval (CI): 1.11-1.70]. Demographic and sexual behavioral factors associated with poppers use included: younger age [adjusted OR (AOR): 1.56, 95% CI: 1.25-1.94], higher education (AOR: 1.61, 95% CI: 1.33-1.96), alcohol use (AOR: 1.32, 95% CI: 1.10-1.60), seeking male partners mainly via the internet (AOR: 1.60, 95% CI: 1.28-2.00), multiple male sex partnership (AOR: 2.22, 95% CI: 1.90-2.60), and unprotected receptive anal intercourse (AOR: 1.52, 95% CI: 1.28-1.81).

Conclusions: In this study, poppers use was positively associated with HIV infection and unprotected anal intercourse. Intervention efforts should be devoted to promote safer sex and HIV testing and counseling among MSM who use poppers.

 Abstract access [1]   [2]

Editor’s notes: Poppers are butyl and other nitrites that were used in the past for heart pain. They can be inhaled to facilitate anal sex. Sniffing poppers relaxes the anal sphincter muscles, making anal intercourse easier and enhancing pleasure. Numerous studies have found an association between popper use and an increased risk of acquiring HIV. This may be due to the effect of poppers in dilating capillaries and increasing blood flow to the rectum. Such a biological effect may increase the risk to the receptive partner in anal sex, further to having less autonomy in determining whether a condom is used.

This large community-based study gathered information from adult men living in Beijing, who reported sex with men in the previous 12 months. The descriptive data reported in this paper were gathered in the first phase of what is intended to be a large multi-component HIV prevention intervention trial. These data illustrate high prevalence of popper use among gay men and other men who have sex with men in Beijing. Clearly, a priority of the trial should be testing strategies to address popper use in this population. The HIV epidemic in China has evolved to one in which sexual transmission predominates, with four out of five new infections in 2011 acquired through sexual exposure. In contrast to other drugs used to enhance sexual pleasure (such as methamphetamine, ecstasy, and ketamine), poppers are widely available in China at adult stores or through the internet. In light of the finding that popper users are more likely to use the internet, it may be possible to work with the community to design programmes using internet platforms to reach men most at risk. These could aim to raise awareness and encourage changes in sex and popper use norms to reduce HIV risk and make sex safer for gay men and other men who have sex with men in Beijing.

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