Substance Use and Sexual Risk Among Men Who Have Sex with Men

Substance use and sexual risk among men who have sex with men (MSM) represent intertwined public health challenges. The consumption of psychoactive substances—including nitrite inhalants (poppers), methamphetamine and other recreational drugs—can alter decision-making and heighten sexual disinhibition, contributing to condomless anal intercourse, multiple partnering and group sex. These behaviours amplify the likelihood of acquiring and transmitting HIV and other sexually transmitted infections (STIs) such as syphilis. Demographic and psychosocial factors, including age, education level, partner-seeking via online platforms and co-occurring mental health conditions, further shape these patterns. Research to date has sought to elucidate the epidemiology of substance use within diverse geographical contexts, to assess its contribution to risk networks and to inform targeted interventions, including pre-exposure prophylaxis (PrEP), tailored psychosocial support and harm-reduction strategies. The global significance of these findings underscores the need for integrated prevention approaches that address both substance use and sexual risk within MSM communities.

Research from Nature Portfolio

Recent cohort research in China has provided robust evidence that use of alkyl nitrites (poppers) by MSM significantly increases HIV incidence. In a longitudinal study of HIV-negative participants, those reporting popper use experienced markedly higher seroconversion rates over 24 months than non-users. Poppers were associated with condomless anal intercourse, multiple male partners and group sexual encounters, while syphilis co-infection emerged as an independent predictor of HIV seroconversion. These findings have prompted calls for regulatory review of nitrite inhalants and highlight the value of combining behavioural surveillance with biomedical prevention measures to curb new infections.

Substance Use and Sexual Risk Among Men Who Have Sex with Men publication trend

The graph below shows the total number of articles in substance use and sexual risk among men who have sex with men across all publications each year (not limited to Nature Index journals).

Technical terms

Condomless anal intercourse: Sexual practice involving anal penetration without the use of a condom, which significantly increases the risk of HIV and other STI transmission.

Pre-exposure prophylaxis (PrEP): A preventive strategy in which HIV-negative individuals at high risk take antiretroviral medication to reduce the likelihood of acquiring HIV.

Poppers (alkyl nitrites): Inhalant substances often used recreationally to induce brief euphoria and muscle relaxation during sexual activity; associated with increased sexual risk behaviours.

References

1. The epidemic of HIV and syphilis and the correlation with substance abuse among men who have sex with men in China: A systematic review and meta-analysis. Frontiers in Public Health (2023).
2. Syphilis epidemic among men who have sex with men: A global systematic review and meta-analysis of prevalence, incidence, and associated factors. Journal of Global Health (2024).
3. Associations between Drug Use and Sexual Risk Behaviours among Men Who Have Sex with Men in Japan: Results from the Cross-Sectional LASH Study. International Journal of Environmental Research and Public Health (2023).
4. Poppers use and Sexual Partner Concurrency Increase the HIV Incidence of MSM: a 24-month Prospective Cohort Survey in Shenyang, China. Scientific Reports (2018).