Abstract
BACKGROUND: High prevalence of poppers use was observed among men who have sex with men (MSM) and the use of poppers was associated with risky sexual behaviors and increased risk for human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) infection. To assess the risks for HIV/STDs transmission following poppers use, this study described the prevalence of poppers use and its associations with adherence to antiretroviral therapy (ART) and risky sexual behaviors among HIV-positive MSM. METHODS: Between June 2022 to June 2023, 1501 HIV-positive MSM enrolled in the study and data on sociodemographic characteristics, substances use, depressive and anxiety symptoms, perceived HIV-related stigma, adherence to ART and sexual behaviors were collected using an online questionnaire. Multivariate logistic regression models were constructed to identify factors associated with poppers use, as well as its relationship with adherence to ART and risky sexual behaviors. RESULTS: Among the 1501 participants, 32.4% reported poppers use in the past 6 months, of whom 99.6% reported that poppers were used before or during anal intercourse. Multivariate logistic analysis indicated that MSM who used poppers were more likely to report ART non-adherence (aOR = 3.92, 95% CI: 2.36-6.53), have multiple sex partners (aOR = 7.70, 95% CI: 5.61-10.57), participate in group sex (aOR = 18.30, 95% CI: 9.72-34.43), practice condomless anal intercourse with regular sex partners (aOR = 5.49, 95% CI: 3.93-7.68) and non-regular sex partners (aOR = 2.95, 95% CI: 1.97-4.43) and engage in condomless insertive anal intercourse (aOR = 5.32, 95% CI: 3.72-7.60) and condomless receptive anal intercourse (aOR = 3.72, 95% CI: 2.62-5.29). CONCLUSIONS: This study indicated that HIV-positive MSM commonly used poppers in the context of anal intercourse and participants who used poppers were at increased odds of reporting ART non-adherence and risky sexual behaviors. Further research is needed to explore the mechanisms through which poppers use may influence these outcomes. Tailored harm reduction programs and counseling should be implemented to mitigate the use of poppers and address their potential risks.