Depression, sexual drug use and risky sexual behaviors among men who have sex with men in Southwest China: a cross-sectional study

Despite efforts to control the HIV epidemic, prevalence among men who have sex with men (MSM) in China remains high, largely driven by risky sexual behaviors. Sexualized drug use (SDU) is common among MSM and associated with depression and psychological problems, which may further exacerbate risky sexual behaviors and HIV transmission. Therefore, this study aimed to investigate the prevalence of depression, SDU, and risky sexual behaviors among MSM in Southwest China, and examine the associations between depression, SDU, and their co-occurrence, with risky sexual behaviors. Participants were recruited with the assistance of a local MSM-friendly organization through venue-based and online approaches. A total of 1,277 participants were recruited from November 2021 to May 2022. An online questionnaire collected data on demographic information, depressive symptoms, SDU and six types of risky sexual behaviors: casual sex, commercial sex, group sex, multiple sexual partners, inconsistent condom use, and history of sexually transmitted infections (STIs). Multivariate logistic regression models were used to examine the associations between depression, SDU, their co-occurrence, and risky sexual behaviors. Among respondents, 34.8% reported SDU in the past 6 months, primarily involving poppers (32.8%). The prevalence of mild, moderate, and severe depression was 39.4%, 15.3%, and 13.4%, respectively. Co-occurring SDU and depression were reported by 25.9% of participants. This co-occurrence was significantly associated with higher odds of casual sex ( aOR : 2.02, 95%CI : 1.46–2.80), group sex ( aOR : 4.53, 95%CI : 2.70–7.59), multiple sexual partners ( aOR : 5.21, 95%CI : 3.08–8.80), inconsistent condom use ( aOR : 3.19, 95% CI : 2.28–4.47), and STI history ( aOR : 2.76, 95%CI : 1.29–5.89). Depression, SDU, and their co-occurrence were prevalent among MSM in Chengdu and were associated with increased engagement in risky sexual behaviors. These findings support a syndemic framework, in which co-occurring psychosocial conditions interact to amplify HIV-related risks. Integrated interventions addressing both mental health and substance use are essential to reduce HIV transmission in this population.