Dual epidemics of syphilis and methamphetamine use among drug users in Shandong Province of China

Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis

BACKGROUND

The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV.

METHODS

We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches.

RESULTS

We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence.

CONCLUSIONS

Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.

Changing trends in the types of drug used and infectious disease prevalence among drug users in jiangsu province, china

BACKGROUND

In recent years, a boom of synthetic drugs, especially methamphetamine has been documented in China, however, the situation in Jiangsu was unclear. The objective of this study was to evaluate the changing trends in types of drug used, examine the prevalence trends of HIV, syphilis and HCV over time and compare the demographic, drug and sexual behaviors among different types of people who use drugs (PWD) in Jiangsu Province, China.

METHODS

Consecutive cross-sectional studies were conducted from 2011 to 2015 in nine compulsory detoxification centers, which were HIV sentinel surveillance sites, in Jiangsu Province, China. A structured questionnaire was administered in a face-to-face interview with each participant to collect demographic, behavioral and laboratory information. Participants were classified into three types: opioids PWD (using heroin, opium, morphine and dolantin); stimulant PWD (using cocaine, methamphetamine, methylene dioxymetham-phetamine and Magu); poly-drug PWD (using opioids and stimulant drugs simultaneously).

RESULTS

Among a total of 16,164 PWD recruited from 2011 to 2015, the proportion of opioids PWD declined from 40.1% in 2011 to 11.8% in 2015, while the proportion of stimulant PWD increased from 53.6% to 84.3%. Overall HIV, syphilis, and HCV prevalence for the period was 0.3%, 9.6% and 31.6%, respectively. As types of drugs used shifted from opioids to stimulants, HIV prevalence increased (P = 0.031) while HCV decreased (P<0.001). HIV, syphilis and HCV prevalence trends varied across the three subgroups. Injection and needle-sharing behaviors differed between opioids and stimulant PWD, whereas unsafe sexual behaviors were similar. Poly-drug PWD might have higher risks for these infections due to combinations of unsafe sexual and injection behaviors.

CONCLUSION

Although the trend of drugs used have changed over time, HIV, syphilis and HCV infection risk behaviors among PWD still exist. Therefore, traditional intervention strategies should seek to address the challenge of increasing stimulant PWD. Access to convenient testing services, as well as pre- and post-exposure prophylaxis for HIV risk reduction should be improved among PWD. Antiviral treatment for HCV should be added to medical insurance coverage as soon as possible in Jiangsu Province.

Estimates of the national trend of drugs use during 2000-2030 in China: A population-based mathematical model

BACKGROUND

The use of synthetic drugs has exceeded heroin to become a major public health concern in China. We aimed to estimate the trend of heroin-only, synthetic drug-only and poly-drug (heroin and synthetic drug) use during 2000-2030 period in China using existing data.

METHODS

We used data from the Annual Report on Drug Control in China and peer-reviewed publications. We constructed a mathematical model to estimate the drug use trend based on Monte Carlo simulations.

RESULTS

The best calibrated model estimated that the number of drug users would increase from 0.86 million to 3,120,059 (95% CI 2,669,214-3,570,904) during 2000-2030 period. The proportion of heroin-only users among the total drug users will decrease from 96.8% (95% CI, 96.6-97.1%) in 2000 to 36.9% (30.1-40.8%) in 2030, while the proportion of synthetic drug-only users will increase from 1.1% (0.9-1.3%) in 2000 to 57.7% (51.7-65.6%) in 2030. In contrast, the proportion of poly-drug users shared an increasing trend during 2000-2016 (from 2.1% (1.5-2.8%) to 15.1 (13.8-17.1%)) but declined to 5.5% (3.4-7.2%) in 2030. Estimated 46,370 (41,634-51,106) heroin-only users and 3767 (3481-4053) synthetic drug only users initiated poly-drug use in 2000. We observed a cross-over in 2012 where more synthetic drug-only users were initiating heroin use than heroin-only users initiating synthetic drug use. There will be estimated 2,094,052 (1,819,830-2,368,274) synthetic drug-only users and poly-drug users 211,407 (177,150-245,664) in 2030.

CONCLUSIONS

Synthetic drug use will become dominant in drug users in China, but poly-drug use of both heroin and synthetic drugs will remain substantial.

Syphilis associated with recreational drug use, depression and high-risk sexual behaviour in men who have sex with men: a case-control study in China

OBJECTIVE

We investigated syphilis prevalence among men who have sex with men (MSM) in China, as well as potential risk factors. Our principal hypothesis was that syphilis would be associated with the use of recreational drugs such as methamphetamines.

METHODS

From April to October 2013, we used several methods to recruit MSM in Qingdao, collecting demographic/behavioural information via self-administrated questionnaires. Trained health workers collected blood for the Treponema pallidum particle assay (TPPA) with positives confirmed by a toluidine red unheated serum test. We used an unmatched case-control study to identify factors that might predict syphilis infection using multivariable logistic regression.

RESULTS

We recruited 447 MSM who agreed to participate and who completed syphilis testing. Of 71 (15.9%) syphilis-positive MSM, 44 (62.0%) used drugs. Of 376 (84.1%) syphilis-negative MSM, 186 (49.5%) used drugs. We found a positive association with syphilis for any recreational drug use (crude OR (cOR) 1.7, 95 % CI 1.0 to 2.8), frequent methamphetamine use (cOR 2.4, 95% CI 1.1 to 5.3) and multiple drug use (adjusted OR (aOR) 3.4, 95% CI 1.3 to 9.2). Syphilis-positive men were more likely to have a higher physical depression score (aOR 5.2, 95% CI 1.1 to 24.4), be > 30 years old (aOR 2.7, 95% CI 1.5 to 4.8), report a prior STI (aOR 4.1, 95% CI 2.3 to 7.3) and report a sex party experience (aOR 2.2, 95% CI 1.1 to 4.4).

CONCLUSIONS

Recreational drug use, depression and high-risk sexual behaviours were associated with syphilis infection among MSM in China. Only a multifaceted approach is likely be effective in control of both syphilis and HIV .

Stimulants: How big is the problem and what are the effects of prenatal exposure?

Globally, cocaine use increased by 7%-18.2 million people in 2016 or 0.4% of the world population aged 15-64. In 2016, over 34 million (0.7%) people aged 15-64 used amphetamines and a further 0.4% used MDMA (Ecstasy). Women of child bearing age worldwide are increasingly using and becoming dependent on stimulants; and are, in turn, more vulnerable to sexually transmitted diseases, sexual violence, unplanned pregnancies and mental health problems. Stimulant use during pregnancy increases obstetric complications for the mother, increases the rate of preterm birth and decreases birth weight, length and head circumference for the exposed infant. No consistent signs of neonatal abstinence syndrome requiring pharmacological treatment have been identified for cocaine or methamphetamine, however, infants exposed to one or both drugs exhibit disorganized neurobehaviour at birth. Increased efforts worldwide are needed to determine the extent of maternal stimulant use and to prevent or identify and treat substance use early during pregnancy.

Epidemics of HIV, HCV and syphilis infection among synthetic drugs only users, heroin-only users and poly-drug users in Southwest China

The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4]; 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9]; 3.9, [1.8–5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.

Sexually transmitted infection prevalence and related risk factors among heterosexual male methamphetamine users in China

Few studies have examined the association between methamphetamine (MA) abuse and sexually transmitted infection (STI) risk among heterosexual male MA users in China. A total of 288 heterosexual male MA users who met our inclusion criteria were recruited from nightclubs, KTVs, bars, bath centres and an STI clinic. STIs were screened among the participants, and the risk factors related to STIs were analysed by multivariate logistic regression in SPSS 11.0. Among the 288 heterosexual male MA users, 51 (17.7%) had syphilis, 36 (12.5%) had genital warts, 2 (0.7%) had genital herpes, 3 (1.0%) had HIV infection and 41 (14.2%) had urethritis. STIs were associated with the following variates: 'MA has the function of anti-inebriation' (OR = 2.522, 95%CI = 1.337-4.756), 'I am addicted to MA' (OR = 4.030, 95%CI = 2.194-7.401), 'It occurred to me to abstain from MA' (OR = 2.939, 95%CI = 1.246-6.934), 'Years of MA abuse' (OR = 2.622, 95%CI = 1.318-5.215), 'Times of MA abuse per week' (OR = 5.275, 95%CI = 1.988-14.002), 'Number of persons using MA together' (OR = 2.579, 95%CI = 1.246-5.340) and 'Number of female sex workers as sex partners per MA abuse' (OR = 4.004, 95%CI = 1.526-10.508). Our findings show that MA users belong to the high-risk group for STI in China. STIs, except for HIV, have spread widely among heterosexual male MA users. Thus, specific interventions must be conducted to prevent the spread of STIs in this population in China.

Barriers to accessing methamphetamine treatment: A systematic review and meta-analysis

BACKGROUND

Methamphetamine use is associated with a range of poor health, social and justice outcomes. In many parts of the world increased methamphetamine use has been identified as a major public health concern. Methamphetamine treatment programmes have been effective in reducing and ceasing use, however a range of barriers have prevented these programmes being widely adopted by methamphetamine users. This review examines the barriers to accessing meth/amphetamine treatment identified in the literature.

METHODS

Databases were systematically searched using relevant terms for peer-reviewed articles describing original research exploring the barriers to accessing treatment for meth/amphetamine use. Reviews and grey literature were excluded. Eleven studies conducted in 5 countries were included in data synthesis; this involved a systematic review of all 11 studies, and meta-analysis of the prevalence of barriers reported in 6 studies that published sufficient quantitative data.

RESULTS

Psychosocial/internal barriers to accessing methamphetamine treatment were most prevalent across studies (10/11 studies). Meta-analysis confirmed the four most commonly endorsed barriers to treatment access across studies all psychosocial barriers were embarrassment or stigma (60%, 95% CI: 54-67%); belief that treatment was unnecessary (59%, 95% CI:54-65%); preferring to withdraw alone without assistance (55%, 95% CI:45-65); and privacy concerns (51%, 95% CI:44-59%).

CONCLUSIONS

The primary barriers to accessing methamphetamine treatment are psychosocial/internal. Services and treatment models that address these barriers are urgently required. There is a growing need for methamphetamine-appropriate treatment services. Further research evaluating treatment engagement and effectiveness for methamphetamine and polysubstance use, including the development of effective pharmacotherapies is warranted.

Factors associated with syphilis seroreactivity among polydrug users in Northeast Brazil: A cross-sectional study using Respondent Driven Sampling

BACKGROUND

The burden of sexually transmitted infections (STIs), such as syphilis, is higher in low-income countries, with serious consequences and profound impact on sexual and reproductive health and human immunodeficiency virus (HIV) spread. Syphilis prevalence tend to be higher among people who misuse drugs than in the general population.

OBJECTIVE

To assess syphilis and associated factors among polydrug users (PDU) in the city of Salvador, Northeast Brazil.

METHODS

A cross-sectional study was conducted in 10 Brazilian cities between September and November 2009 using Respondent Driven Sampling (RDS). Participants answered an Audio Computer-Assisted Self Interview (ACASI) and were rapid tested for HIV and syphilis. We performed multivariable regression models for correlates of syphilis on Stata 10.0. Estimates were weighted by the inverse size of the individual social network size and homophily.

RESULTS

Mean age was 29.3 years (range: 18-62), 74.0% were males, and 89.8% were non-white. Syphilis prevalence was 16.6%. Females (adjwOR:2.14; 95%CI:1.09-4.20), individuals over 29 years old (adjwOR:4.44; 95%CI:2.41-8.19), those who exchanged sex for money or drugs (adjwOR:3.51; 95%CI:1.84-6.71), "No/low" self-perceived risk of HIV infection (adjwOR:5.13; 95%CI:1.36-19.37), and having nine or less years of education (adjwOR:2.92; 95%CI:1.08-7.88) were associated with syphilis.

CONCLUSION

One of the most pressing needs for syphilis prevention/control is the availability of rapid point-of-care diagnostic tests and treatment. Interventions should be tailored to PDU needs and their multiple burdens as shown in the present study, that may contribute to future studies aiming to better understand the relationships between drug use and syphilis.

Dual Epidemics of Drug Use and Syphilis Among Chinese Female Sex Workers: Results of Eight Consecutive Cross-Sectional Surveys from 2006 to 2013 in Qingdao, China

Eight consecutive annual cross-sectional surveys were conducted to examine the trend of the prevalence of HIV, syphilis, drug use and their correlates among female sex workers (FSWs) in Qingdao, China. Among sampled FSWs over the 8 years, a higher proportion of older, married or cohabited, higher education levels and more on-call FSWs were observed in recent years. The syphilis prevalence increased significantly from 1.0 % in 2006 to 13.5 % in 2013, with illicit drug use rate ranging from 21.8 % in 2007 to 55.5 % in 2010. Multivariate logistic regression analyses showed that drug use, syphilis and unprotected vaginal sex predicted each other. The dual epidemics of illicit drug use and syphilis among FSWs underscore the urgency to implement a tailored intervention to curb the dual epidemics while also preventing an HIV epidemic in the context of diversified commercial sex dynamic.

Global patterns of methamphetamine use

PURPOSE OF REVIEW

As the most popular psychostimulant in the world, methamphetamine use has reached epidemic proportions. Its enormous popularity has created subcultures of methamphetamine users all over the globe. The purpose of this review is to describe the geographic availability of different types of methamphetamine, the characteristics of each user population, and the psychosocial impact the two have on society.

RECENT FINDINGS

Methamphetamine has diversified immensely from the early days of its use. Different forms of methamphetamine - ICE, powder, and pills - have different pharmacokinetic characteristics that make them popular among certain types of users. New studies have shown that addiction to methamphetamine results in a very characteristic loss of inhibition that augments various risk-taking behaviors in its users. Also, recent seizure data suggest that its production and trafficking is spreading into new areas of the globe.

SUMMARY

From recreational use to addiction, methamphetamine use represents a serious risk to health and wellbeing of the community. Recognizing the pattern of abuse in specific populations is the key to assessing the risk, implementing prevention, and harm reduction measures, as well as making public policies.

Impact of methamphetamine on infection and immunity

The prevalence of methamphetamine (METH) use is estimated at ~35 million people worldwide, with over 10 million users in the United States. METH use elicits a myriad of social consequences and the behavioral impact of the drug is well understood. However, new information has recently emerged detailing the devastating effects of METH on host immunity, increasing the acquisition of diverse pathogens and exacerbating the severity of disease. These outcomes manifest as modifications in protective physical and chemical defenses, pro-inflammatory responses, and the induction of oxidative stress pathways. Through these processes, significant neurotoxicities arise, and, as such, chronic abusers with these conditions are at a higher risk for heightened consequences. METH use also influences the adaptive immune response, permitting the unrestrained development of opportunistic diseases. In this review, we discuss recent literature addressing the impact of METH on infection and immunity, and identify areas ripe for future investigation.

Drug use and sexual behaviors among MSM in China

BACKGROUND

This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China.

OBJECTIVES

Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs.

METHODS

The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM.

RESULTS

MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex.

CONCLUSIONS

It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.