Perceived HIV-related stigma, mental health conditions and sexualized drug use among men who have sex with men living with HIV in Chongqing, China: a cross-sectional study

Sexualized drug use (SDU) has become a significant public health concern among men who have sex with men (MSM) worldwide. While much of the existing research has focused on the association of SDU with high-risk sexual behaviors and the risk of human immunodeficiency virus (HIV) infection, relatively little attention has been paid to the broader range of sociodemographic, behavioral, and psychosocial factors that may be associated with SDU. This study aimed to investigate these correlates of SDU among MSM living with HIV. Between June 2022 and June 2023, MSM living with HIV were recruited through two community-based organizations in Chongqing, China. Data were collected via an online questionnaire, which gathered information on demographic characteristics, perceived HIV-related stigma, common mental health conditions (depression and anxiety), SDU, and sexual behaviors. A multivariate Poisson regression model was employed to examine factors associated with SDU. Among the 1501 participants, 32.5% reported engaging in SDU during the preceding six months. Multivariate analysis revealed that several factors were associated with an increased likelihood of SDU, including being married, cohabiting, divorced, or widowed (adjusted prevalence ratio [aPR] = 1.49, 95% confidence interval [CI]: 1.24–1.79), being a migrant (aPR = 1.38, 95% CI: 1.19–1.59), initiating anal sex before 18 years of age (aPR = 1.98, 95% CI: 1.64–2.39), consuming alcohol during the preceding six months (aPR = 1.54, 95% CI: 1.30–1.81), and reporting higher levels of personalized stigma (aPR = 1.14, 95% CI: 1.11–1.18). Additionally, mild (aPR = 1.31, 95% CI: 1.10–1.57), moderate (aPR = 1.46, 95% CI: 1.13–1.89), and moderately severe-to-severe depression (aPR = 1.64, 95% CI: 1.10–2.46), as well as moderately severe-to-severe anxiety (aPR = 1.34, 95% CI: 1.01–1.78), were positively associated with SDU. In contrast, preferring a receptive (aPR = 0.65, 95% CI: 0.55–0.78) or versatile (aPR = 0.66, 95% CI: 0.55–0.78) sexual role, as well as reporting higher levels of disclosure concerns (aPR = 0.89, 95% CI: 0.85–0.92), was linked to a lower likelihood of SDU. Among MSM living with HIV in Chongqing, SDU was common and was statistically associated with a range of sociodemographic, behavioral, and psychosocial characteristics.These findings suggest that SDU in this population co-occurs with multiple structural and psychosocial vulnerabilities, underscoring the potential value of integrating mental health, stigma, and substance use considerations into HIV-related services for MSM.