Synthetic Drugs Abusers’ Behavior Characteristics And Associated Hiv Infection Risk:Reflection From One Coastal City In China

BackgroundHIV epidemic in China presents sexual transmission as main route. Sythetic drug abuse is surging in some place in recent years. Synthetic drugs (SD) abuse fuels human acquired immunodeficiency virus (HIV) spreading via modifying sexual behaviors. The amount of abusers gradually increased over recent years due to users’perceptions of SD abuse’s low physical dependence.Objectives1. To understand the characteristic of SD abusers and appraise their addiction;2. To analysis potential HIV infection risk faced by SD abusers;3. To model and predict SD use’s impact on HIV transmission.Methods1. We use a mixed methodology to conduct a cross-sectional questionnaire survey combined with qualitative interview among SD abusers. Some participants were asked to recall behaviors’pattern in the last6months before and after riding on drugs. All the eligible participants were taken blood specimen for HIV and syphilis antibody test, as well self-administrated Severity of Dependence Scale.2. A unmatched case-control design was performed among men who have sex with men (MSM) who used drug ever or never to identify potential predictors for HIV infection. MSM who infected with HIV were treated as case group and HIV negative cases as control one. The uneven distribution of risk behaviors between two groups was used to evaluate the impact of SD use on HIV infection. Multi-variable unconditional logistic regression was performed to identify the predictors.3. The parameters from the survey, mainly on amphetamine use were used for dynamic model building to predict prevalence trends of SD use and its interaction with HIV epidemic, as well the impact of law enforcement on the epidemic course of SD use and HIV transmission. The infectious disease dynamic model-Susceptible-Infected-Susceptible (SIS) compartments was employed for the modelling design and building.ResultsA total of896eligible participants were enrolled, averagely aged27years with a range of18-69. Among them,679drug uses participated in cross-sectional study including151females and528males. Population based case-control study enrolled447MSM,230using drugs and217naive with drugs. Among MSM,34cases are HIV positive (7.6%) as case group, and the left413belongs to control group. For syphilis infection,71cases (15.9%) are positive among msm. While among heterosexual people(HSP),3males are HIV positive (1%) and52cases are syphilis positive (17.5%);33females (21.4%) are syphilis positive and no one infected with HIV.Most of participants reported an increasing of sexual desire, higher sexual pleasure, and prolonged sex activity but lower condom use rate on amphetamine type of stimulants(ATS) abuse. The median initial age for SD abuser was21for female, younger than25for heterosexual male and24for MSM. On average, the interval between initial use to regular abuse was2years. The motivation for the males riding on drugs was either for sexual pleasure or better sexual function, while the females’was for money or other incentives. The addiction rate among the participants exceeded40percent. No one reported SD abuse via injection and the administration way was oral use. Case-control study found synthetic drugs abuse are major risk factors for HIV infection among MSM. Having multiple sexual partners was excluded as one of confounding factors verified by sub-analysis. Both HIV infection and drug use associated with having multiple sexual partners. The size of sexual partners’network of the participants in the past6months are2.5±1.6(range:0～5).SD abusers were suffering more risk for HIV infection compared with non-user adjusted with other factors (aOR=3.2,95%CI:1.2-8.4). While the participants having a regular sexual partner were less likely for HIV infection (aOR=0.4,95%CI:0.1-0.9) and those having a history of STI diagnosis (aOR=2.8,95%CI:1.2-6.7) or being syphilis positive (aOR=4.3,95%CI:1.8-10.4) run more risk for HIV infection.After controlling other factors, the risk of HIV infection among Rush Poppers users is3.9times of the non-users’(95%CI:1.9-9.4). MSM having a history of STls’diagnosis (OR=2.8,95%CI:1.2-6.2) or being syphilis positive (OR=4.6,95%CI:1.8-11.6) were at higher odds to getting HIV infection.The modified SIS modeling results show the incidence rate of synthetic drugs abuse increase from1.9%in the initial year to3.8%by end of10years ahead in the comparatively stringent law enforcement environments (law enforcement index Po=0.3), while the incidence rate increases from to4.9%in loose law enforcement environment (Index Po=0.1). The prevalence of ATS use will increase from9%at present to20%(Index Po=0.1), while it will increase to33%(Index Po=0.3), and the rising trend will persist. HIV prevalence rate among drug abusers increases slowly at the beginning about0.3%and then rapidly reach3.8%at the end of year10th at Index Po=0.3or to4.1%at Index Po=0.1. And the trend rises upward continuously. We conclude HIV prevalence among SD abusers will persist and the trending prevalence won’t be changed relying on law enforcement intervention only though it might temperorily slow the HIV spreading.ConclusionsHIV infection was independently associated with any SD use and Rush Poppers use respectively among MSM. In future we need address the proliferation of SD use for containing the spread of HIV among MSM. As a matter of fact that methamphetamine abuse has entered general population, SD can facilitate HIV transmission via increasing uptake of risky sexual behavior and having more sexual partners. We cautiously conclude the SD use epidemic staged early in Q city by the hint that no one used SD via injection so far. Modeling results show it is difficult to control HIV transmission among the SD abusers relying only on law enforcement measures. A multi-pronged integrated-approaches response is needed.