Abstract
BackgroundNitrite inhalant use is very common among men who have sex with men (MSM) in China. However, there is lack of national representative data on use among Chinese MSM, and the mechanism of how nitrite inhalant use impacts HIV infection in MSM is unclear. This meta-analysis aims to understand the characteristics of Chinese MSM nitrite inhalant users and to determine the associations between nitrite inhalant use and sexual behaviors, the prevalence of HIV, and the prevalence of syphilis.MethodsWe searched PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant literature published from January 1985 to December 2017.ResultsFifteen eligible studies, with a total of 18,981 Chinese MSM participants, were included. Compared with nitrite inhalant nonusers, users were more likely to be younger, have a higher level of education, and seek sexual partners using the Internet. Nitrite inhalant users were more likely to engage in high-risk sexual behaviors, including condomless anal intercourse (odds ratio [OR] = 1.33), group sex (OR = 2.26), and commercial intercourse (OR = 1.50). Nitrite inhalants users had a higher prevalence of HIV (OR = 1.83), higher prevalence of syphilis (OR = 1.38) and had higher lifetime HIV testing rates (OR = 1.33) compared with nonusers (each p < 0.05).ConclusionsNitrite inhalant users have higher HIV and syphilis prevalence by increasing levels of high-risk sexual behaviors. China should expand HIV testing, treatment as prevention (TasP), and Pre-exposure prophylaxis (PrEP) among MSM, especially among nitrite inhalants using MSM, to reduce their risk of HIV infection and transmission.
Highlights
IntroductionThere is lack of national representative data on use among Chinese Men who have sex with men (MSM), and the mechanism of how nitrite inhalant use impacts HIV infection in MSM is unclear
Nitrite inhalant use is very common among men who have sex with men (MSM) in China
Seven of these studies found a significant difference between the age of nitrite inhalants users and nonusers, of which six reported that nitrite inhalants users tended to be younger than nonusers (P-values for all < 0.05) [17, 19, 21, 24,25,26,27], while only one study reported that nonusers were younger than users (P = 0.028) [28]
Summary
There is lack of national representative data on use among Chinese MSM, and the mechanism of how nitrite inhalant use impacts HIV infection in MSM is unclear. This meta-analysis aims to understand the characteristics of Chinese MSM nitrite inhalant users and to determine the associations between nitrite inhalant use and sexual behaviors, the prevalence of HIV, and the prevalence of syphilis. Young MSM may be disproportionately affected as 47.0% of MSM diagnosed with HIV from 2006 to 2015 in China were between 20 and 29 years old [4], the number of HIV cases among Chinese university students increased by 35% annually from 2011 to 2015 [5], and in 2015, 82.6% of those diagnosed were infected through male-to-male sexual intercourse [6]. Chinese MSM have increasingly purchased nitrite inhalants online and the proportion of lifetime nitrite inhalant use among Chinese MSM ranges from 10.6 to 53.6% [15, 16]
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