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Poppers use, adherence to antiretroviral therapy and risky sexual behaviors among HIV-positive men who have sex with men in Chongqing, China

Archives of Public Health volume 83, Article number: 31 (2025) Cite this article

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.

Peer Review reports

Text box 1. Contributions to the literature

• This study addressed the issue of poppers use among HIV-positive MSM and subsequent risks for HIV transmission in a high-burden HIV setting in China.

• HIV-positive MSM commonly used poppers in the context of anal intercourse, but polydrug use was rare within the subpopulation.

• Migration status, depressive symptoms, earlier age at first anal intercourse, alcohol use and methamphetamine use were positively associated with poppers use.

• MSM who reported poppers use were more likely to report ART non-adherence and practice risky sexual behaviors. 

Background

Although the overall human immunodeficiency virus (HIV) prevalence remains low in the general population, the epidemic has spread significantly among specific populations, particularly men who have sex with men (MSM), in China. A large-scale systematic analysis examining HIV epidemiology among MSM in China demonstrated that the HIV prevalence among MSM was 5.7% (ranging from 0 to 22.9%) between 2001 and 2018, with an upward trend observed over time [1]. Furthermore, national updates indicate that more than 100,000 new HIV cases have been diagnosed annually during the past decade, with over a quarter of these cases attributed to male-to-male sexual contact each year [2, 3].

The use of recreational drugs, including poppers, are common among MSM [4, 5]. Poppers is a slang term for recreational drugs belonging to the alkyl nitrite family of chemical compounds. When inhaled, poppers have a vasodilatory effect which can lead to euphoria and can act as a relaxer for anal muscles to facilitate anal intercourse [5]. The use of poppers is higher among MSM in Western settings such as New Zealand, Australia, France, and the US ranging from 32 to 46% compared to MSM in China, with 23% [4,5,6,7,8]. Although the reported prevalence of poppers use among MSM in China is relatively lower, an increasing trend has been observed in recent years [9, 10].

The use of poppers, like other recreational drug use, has been linked to having more sexual partners, engaging in group sex and condomless anal intercourse (CAI) [11, 12], which can increase the risk for HIV and sexually transmitted diseases (STDs) [12, 13]. Several studies have found HIV-positive MSM report higher levels of recreational drug use, and those who use drugs are more likely to engage in risky sexual behaviors [14, 15]. Additionally, research indicates that recreational drug use can serve as a barrier to antiretroviral therapy (ART) adherence [16], which is essential for achieving HIV suppression, preventing drug resistance, and mitigating disease progression. Thus, recreational drug use may pose significant challenges to HIV/STDs control and prevention.

A better understanding of the role of poppers use in men’s adherence to ART and risky sexual behaviors can contribute to the tailoring of strategies to effectively prevent HIV/STDs among MSM. Currently, there is little research investigating factors related to poppers use among HIV-positive MSM, especially in China [15]. Therefore, we aimed to report the recreational use of poppers and its association with adherence to ART and risky sexual behaviors among HIV-positive MSM living in Chongqing, a municipality in China where MSM are disproportionately affected by HIV and STDs [1, 13].

Methods

Study design and participants recruitment

This cross-sectional survey was conducted from June 2022 to June 2023 in Chongqing, China. A convenience sampling method was used, and 1501 participants were recruited by two community-based organizations (CBOs) dedicated to providing counseling and healthcare services for people living with HIV (PLWH), under the guidance of the local Center for Diseases Control and Prevention (CDC). The eligibility criteria for all participants were as follows: (1) biologically male; (2) 18 years of age or older; (3) reporting anal or oral sex with another man in the past 12 months, and (4) diagnosed with HIV.

Staff members from the CBOs screened potential participants to determine eligibility among PLWH, and those who met the criteria were invited to participate in the study. Initially, MSM participants were informed about the aims, contents, procedures, and confidentiality protections of the study. After providing informed consent, participants were asked to complete a self-administered questionnaire survey. Ethics approval was obtained from the Review Board of the People’s Hospital of Chongqing Tongliang District (2021-20) and the People’s Hospital of Sichuan Tianfu New Area (2020-002).

Data collection

All data were collected using the Wenjuanxing platform, an online tool developed for conducting various surveys and assessments. The researchers imported the questionnaire content into the platform, which then generated a QR code for the electronic questionnaire. Participants were required to scan the QR code using WeChat, a widely used social application in China, to access and complete the electronic questionnaire. Upon finishing the survey, they submitted their responses directly to the Wenjuanxing platform.

Participants were asked to report their sociodemographic information. Age was categorized into three groups: 18–25, 26–35, or ≥ 36 years. Marital status was classified as married/cohabiting or unmarried/divorced/widowed. Household registration was categorized as local residents (men with household registration in Chongqing municipality) or migrants (men with household registration in other municipalities or provinces). Education level was divided into low (senior high school and below) or high (college and above).

Men were asked about their HIV-related information, including the time since HIV diagnosis, categorized as ≤ 1 year, 2–4 years, or ≥ 5 years, and their HIV viral load in the past year, categorized as < 1000 or ≥ 1000/not tested. MSM were asked about alcohol use in the past 6 months (yes/no) and were prompted to describe their lifetime and recent use of drugs, including poppers, crystal methamphetamine, capsule zero (5-MeO-DIPT), MDMA (3,4-methylenedioxymethamphetamine), magu (a combination of methamphetamine and caffeine), ketamine, GHB (gamma-hydroxybutyrate), cannabis, heroin and cocaine. For those who reported recent poppers use, additional questions regarding the frequency and reasons for use were included.

Depressive and anxiety symptoms were screened using standardized scales. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ-9) which consists of 9 items, and each of the 9 items is scored from 0 to 3, yielding total scores ranging from 0 to 27. According to PHQ-9 scoring guidelines, the presence of depressive symptoms was defined as a score ≥ 5 [17]. Anxiety symptoms were assessed using the Generalized Anxiety Disorder Screener-7 (GAD-7), comprising 7 items scored similarly, with total scores ranging from 0 to 21. The presence of anxiety symptoms was defined as a score of > 4 based on GAD-7 scoring rules [18]. The Chinese versions of both scales are valid and reliable [19], and the internal consistency estimates (Cronbach’s alpha) for the two instruments in this study were 0.851 and 0.861, respectively.

Perceived HIV-related stigma and adherence to ART were also evaluated. The short version of the HIV stigma scale was used to measure perceived HIV-related stigma. The HIV stigma scale has 12 items and each of the items is scored from 1 to 4, with total scores ranging from 12 to 48. Higher scores indicate greater perceived HIV-related stigma [20]. The Center for Adherence Support Evaluation (CASE) adherence index was used to assess adherence to ART. The CASE adherence index includes 3 items and composite scores ranged from 3 to 16, with higher scores reflecting better adherence. On the basis of the CASE index scoring rules, ART non-adherence was defined as a score ≤ 10 [21]. The Chinese versions of both scales demonstrated validity and reliability [19, 22, 23], and the internal consistency estimates (Cronbach’s alpha) for the two instruments in this study were 0.892 and 0.944, respectively.

Additionally, MSM reported their preferred sexual roles with males (insertive, receptive, or versatile, with “versatile” defined as preferring both insertive and receptive sexual roles), age at first anal intercourse (categorized as < 18 or ≥ 18 years), number of male sex partners (categorized as < 2 or ≥ 2) and participation in group sex in the past 6 months (yes/no). Participants were also asked about condom use with regular partners (boyfriend/lover) and non-regular partners (commercial partners/casual partners), as well as during insertive or receptive sexual roles with males in the past 6 months (yes/no).

Data analysis

The database from the online survey was downloaded from the Wenjuanxing platform, and all data analyses were performed using SPSS version 19.0 (IBM Corp., Armonk, NY, USA). Categorical variables were described using frequencies and percentages, while continuous variables were presented as median and interquartile range (IQR). Univariate and multivariate logistic regression models were employed to identify factors associated with poppers use, as well as to examine the association of poppers use with adherence to ART and risky sexual behaviors. Based on the results of univariate analysis, factors with p-value ≤ 0.10 were further selected for inclusion in the multivariate logistic regression analysis to calculate adjusted odds ratio (aOR) and 95% CI. Statistical significance was set at p-value < 0.05 in the final analysis.

Results

Characteristics of participants

Overall, staff members from the CBOs invited 1550 HIV-positive MSM to participate in the study. Among these, 10 men (0.6%) declined to participate, and 39 men (2.5%) did not complete the online survey. Consequently, a total of 1501 HIV-positive MSM were enrolled in the study. The majority of men were over 25 years old (85.9%), unmarried, divorced or widowed (81.9%), local residents of Chongqing (79.3%), and had a college-level education or higher (77.3%). More than half of the participants (51.9%) reported being diagnosed with HIV for five years or longer. Most men were adherent to ART (92.2%) and had a viral load < 1000 copies/mL (84.4%) in the past year. Additionally, 40.8% reported experiencing depressive symptoms, and 29.6% reported anxiety symptoms. The median score of perceived HIV-related stigma among participants was 26 (IQR: 21–32). Furthermore, 60.2% reported alcohol use, and 3.1% reported methamphetamine use in the past 6 months (Table 1).

Table 1 Characteristics of HIV-positive men who have sex with men in Chongqing, China: a cross-sectional study conducted from June 2022 to June 2023 (N = 1501)
Full size table

Among the 1501 participants, 67.9% identified as preferring insertive or versatile sexual roles with males. Additionally, 13.4% reported initiating anal intercourse before the age of 18. In the past 6 months, 63.8% reported having regular sex partners, with 43.0% of those practicing CAI with regular sex partners. Moreover, 63.7% reported having non-regular sex partners, and among these, 23.8% engaged in CAI. Notably, 59.2% of men reported having two or more male sex partners, and 9.3% reported participating in group sex in the past 6 months. Among the respondents, 28.5% and 30.3% reported practicing condomless insertive anal intercourse (IAI) and condomless receptive anal intercourse (RAI) in the past 6 months, respectively (Table 1).

Of the 1501 respondents, 67.3% reported having ever used poppers, with a median age of first use at 23 years (IQR: 20.0–26.5). In the past 6 months, 32.4% reported using poppers, of which 99.6% used them before or during anal intercourse. Of the 487 recent poppers users, 9.4% used poppers weekly, 25.3% monthly, 60.4% once or twice every 3 months, and 4.9% reported using poppers only once in the past 6 months.

Regarding the reasons for recent poppers use, 78.0% cited sexual pleasure enhancement, 42.9% thrill-seeking, 27.1% pain relief during anal penetration, 8.0% peer pressure, 7.8% prolonging the duration of anal intercourse, and 0.6% indicated other reasons. Concerning access to poppers in the past 6 months, 77.8% reported purchasing them online, 18.5% from sexual partners, and 3.7% from friends and others.

In this sample, 32.5% of MSM reported using recreational drug in the past 6 months, and the prevalence of polydrug use was 3.4%. Among polydrug users, the most frequently used drugs included poppers (100.0%), methamphetamine (90.2%), zero capsule (9.8%), magu (3.9%), and GHB (2.0%).

Factors associated with poppers use in the past 6 months

Factors associated with poppers use in the past 6 months are shown in Table 2. Multivariate logistic analysis indicated that migration status (aOR = 1.71, 95% CI: 1.29–2.28), lower education level (aOR = 1.80, 95% CI: 1.36–2.38), preferring the insertive sexual role (aOR = 2.08, 95% CI: 1.52–2.84), having depressive symptoms (aOR = 1.91, 95% CI: 1.41–2.57), earlier age at first anal intercourse (aOR = 3.05, 95% CI: 2.09–4.43), alcohol use (aOR = 1.72, 95% CI: 1.34–2.22) and methamphetamine use (aOR = 63.33, 95% CI: 8.58–467.43) were positively associated with poppers use in the past 6 months (Table 2).

Table 2 Odds Ratios (ORs) and adjusted odds Ratios (aORs) of poppers use associated with sociodemographic characteristics, substances use, and depressive symptoms among HIV-positive men who have sex with men in Chongqing, China: a cross-sectional study conducted from June 2022 to June 2023
Full size table

Multicollinearity among the variables included in the multivariate regression model was assessed, and no significant concerns regarding multicollinearity were identified (Table S1).

Associations of poppers use with adherence to ART and risky sexual behaviors

Multivariate logistic regression models were used to explore the association of poppers use with adherence to ART and risky sexual behaviors, with results presented in Table 3. A total of 7 multivariate logistic regression models were constructed, using adherence to ART or risky sexual behaviors as the dependent variables and poppers use as the independent variable. These models were adjusted for other variables with p-values ≤ 0.10. In the adjusted models, poppers use was found to be independently associated with ART non-adherence (aOR = 3.92, 95% CI: 2.36–6.53), having multiple sex partners (aOR = 7.70, 95% CI: 5.61–10.57), participating in group sex (aOR = 18.30, 95% CI: 9.72–34.43), practicing CAI 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 engaging in condomless IAI (aOR = 5.32, 95% CI: 3.72–7.60) and condomless RAI (aOR = 3.72, 95% CI: 2.62–5.29) in the past 6 months (Table 3).

Table 3 Adjusted odds Ratios (aORs) of poppers use associated with adherence to antiretroviral therapy and risky sexual behaviors among HIV-positive men who have sex with men in Chongqing, China: a cross-sectional study conducted from June 2022 to June 2023
Full size table

Multicollinearity among the variables included in each of the 7 multivariate models was also assessed, and no immediate concerns regarding multicollinearity were identified in our analysis (Table S1).

Discussion

To the best of our knowledge, this study is one of the first to examine the use of poppers and its relationship with adherence to ART and risky sexual behaviors among HIV-positive MSM in China. Our results indicate that the use of poppers may contribute to HIV onward transmission, highlighting a potential pathway for public health intervention aiming at reducing and preventing HIV transmission. In this study, nearly all participants reported using poppers in the context of anal intercourse, with the prevalence of lifetime and recent poppers use reported at 67.3% and 32.4%, respectively. These figures are significantly higher than those reported in other cities in China [11,12,13] and nearly double the rates observed among HIV-negative MSM in Chongqing [13]. Furthermore, research from Western countries has shown that the combined use of poppers with other recreational drugs is prevalent among MSM [5]. However, the majority of participants in our study, as well as in other studies in China [24], reported using only poppers in the past 6 months. This disparity may be partially due to the greater availability of poppers compared to other drugs. In China, substances commonly used by MSM, such as methamphetamine, ecstasy, cannabis, GHB, and magu, are illegal and strictly regulated, whereas poppers are not classified as illegal and can be easily and cheaply purchased over the Internet. Additionally, many MSM in China remain uninformed about the potential side effects of poppers [24], which may lead them to perceive their use as harmless.

Factors associated with poppers use

In this study, we found that participants who were migrants were at increased odds of poppers use, a finding that was consistent with previous research [25]. With rapid economic development and urbanization in China, large-scale migration has occurred, including movement from rural to urban areas and from less developed regions to more developed regions. Generally, local residents have advantages in resource competition (such as education, employment, healthcare, and social welfare) over migrants [26]. Studies show that migrants in China are vulnerable to multiple psychosocial stressors, such as unstable living conditions, limited access to healthcare, and identity discrimination, which may lead to mental disorders and risky behaviors, particularly substance use [25, 26].

The study also found that MSM with depressive symptoms were at higher odds of using poppers. Although studies directly linking poppers use to depressive symptoms among MSM are limited [7], existing research suggests a relationship between mental health issues (including depression) and increased substance use [25]. MSM who experience depressive symptoms may use poppers to cope with emotional distress or enhance sexual experiences. Further research is needed to better understand this relationship, but the available literature underscores the need for integrated mental health and substance use interventions for MSM.

Additionally, our study found that MSM who preferred the insertive sexual role were more likely to use poppers. In contrast, previous studies have indicated that men who take the receptive or versatile positions during anal intercourse are more likely to report using poppers due to their effect on relaxing smooth muscles and facilitating anal penetration [10, 11]. This difference may be explained by the fact that most participants in this study reported using poppers to enhance sexual pleasure rather than alleviate pain during anal penetration.

Moreover, earlier studies have suggested that an earlier initiation of anal intercourse is correlated with poppers use [13], a finding that was also observed in our study. Existing literature suggests that MSM who experienced anal intercourse at an earlier age may be more adventurous [27] and therefore at a higher risk of substance use later in life.

Furthermore, our study revealed alcohol and methamphetamine use were positively associated with poppers use. A substantial body of literature has reported an association between alcohol and recreational drug use among MSM [25, 28]. Due to elevated levels of discrimination and stigma, MSM often use alcohol and recreational drugs as coping mechanisms [25, 28]. Additionally, the use of alcohol and methamphetamine can lead to neuronal injury and cognitive deficits, which may impair judgment, influence risk perception and decision-making [25, 28, 29], and consequently increase the likelihood of unintentional poppers use.

Association between poppers use and adherence to ART

Since 2016, China has provided free ART to all PLWH. However, it has been a challenge to maintain a high level of adherence to ART [30, 31]. In this study, while the majority of HIV-positive MSM demonstrated good adherence to ART, approximately 10% of participants reported either not being on ART or being non-adherent. Research has indicated that substance use, including methamphetamine and alcohol use, is significantly associated with reduced adherence to ART [31, 32], However, few studies have specifically evaluated the association between poppers use and ART adherence among MSM. Our findings show that poppers use is associated with higher odds of ART non-adherence. MSM reported that poppers were repeatedly inhaled in a single sexual encounter to achieve sustained pleasure. Despite their effects being short-lived, lasting only a few minutes, the persistent euphoria from repeated use, along with side effects such as severe headaches, dizziness, nausea and a distorted sense of time [24], can hinder adherence to HIV medication schedules and may even lead to missed doses. Further research is needed to understand the mechanisms by which poppers use may influence ART adherence. Given that adherence to ART is crucial for treatment success, HIV-positive MSM who are non-adherent to ART may fail to achieve viral suppression, increasing the risk of onward HIV transmission.

Associations between poppers use and risky sexual behaviors

Previous studies among MSM have established a link between the use of poppers and risky sexual behaviors [11,12,13], and our study confirmed these findings in HIV-positive MSM. Compared to those who did not use poppers in the past 6 months, HIV-positive men who used poppers were at higher risk of having multiple sex partners and participating in group sex. Poppers are reported to enhance erections and prolong the duration of anal intercourse [33], and reduce the risk of tearing or abrasions during receptive anal intercourse due to their vasodilatory and analgesic effects [5]. Moreover, during group sex, MSM may engage in multiple sessions of anal intercourse, leading them to use poppers to enhance their sexual experience [12].

Additionally, it has been reported that poppers users are more likely to practice CAI [11, 15]. This study further explored the association between poppers use and CAI, taking into account the type of sexual partner and sexual role during anal intercourse. The results indicate that poppers use not only increases the likelihood of CAI with both regular and non-regular male partners but also increases the risk of condomless IAI and condomless RAI. Given that poppers can lower inhibitions and alter judgment [13], MSM may find it challenging to practice safe sex under the influence of poppers.

Limitations

Several potential limitations should be acknowledged in this study. First, participants were recruited using a non-probability sampling method, which may limit the generalizability of our findings to all HIV-positive MSM in Chongqing. Second, participants were asked to report their illegal or stigmatized behaviors (such as recreational drug use and risky sexual behaviors), which may have been underreported owing to social desirability bias. Third, data were collected through self-administered questionnaires, which may introduce recall bias. Forth, This study explored the impact of poppers use on condom use, only considering the type of sexual partner and sexual role during anal intercourse. However, the HIV status of partners was not controlled for in this study. Future research should focus on examining the association between poppers use and CAI with HIV-negative partners, which may contribute to better understanding of the impact of poppers use on risky sexual behaviors. Furthermore, as laboratory result of HIV viral load of participants was not collected in this study, we only explored the association between poppers use and ART non-adherence. Longitudinal research should be conducted to examine the impact of poppers use on HIV viral suppression, so as to better assess behavioral and health risks followed by poppers use. Finally, as a result of the cross-sectional design of the current study, we cannot draw any causal inferences regarding the associations between poppers use and ART non-adherence or risky sexual behaviors among HIV-positive MSM.

Conclusions

This study reveals that HIV-positive MSM commonly use poppers in the context of anal intercourse, and those who reported using poppers are at increased odds of ART non-adherence and engaging in risky sexual behaviors. Therefore, greater attention should be directed toward the use of poppers and their potential health risks among HIV-positive MSM. Establishing a surveillance system to monitor the use of poppers within this population is essential for informed decisions. Additionally, harm reduction programs addressing recreational drug and alcohol use should be developed, as current initiatives in China primarily target injection drug use. Given that HIV-positive MSM represent a hidden population, the roles of community health practitioners and peers from community-based gay organizations are critical in providing counseling service and harm reduction advice. Collaborative efforts among disease control agencies, medical institutions providing HIV treatment, and substance misuse services may prove beneficial in mitigating HIV/STDs transmission among MSM.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

HIV:

Human immunodeficiency virus

MSM:

Men who have sex with men

STDs:

Sexually transmitted diseases

ART:

Antiretroviral therapy

OR:

Odds ratio

aOR:

Adjusted Odds ratio

CI:

Confidence interval

AIDS:

Acquired immune deficiency syndrome

CAI:

Condomless anal intercourse

GBM:

Gay and bisexual men

CBOs:

Community-based organizations

PLHIV:

People living with HIV

PHQ-9:

The Patient Health Questionnaire

GAD-7:

The Generalized Anxiety Disorder Screener-7

CASE:

The Center for Adherence Support Evaluation

IQR:

Interquartile range

CDC:

Center for disease control and prevention

IAI:

Insertive anal intercourse

RAI:

Receptive anal intercourse

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Acknowledgements

The authors would like to express their sincere gratitude to the staff members of the two community-based organizations for their support in participant recruitment and the administration of the questionnaire survey.

Funding

The research was funded by the Joint Project of Chongqing Science and Technology Commission and Chongqing Health Commission (grant number: 2022QNXM052); Chengdu Municipal Health Commission Program (grant number: 2020-49); and the Research Fund of Science and Technology Commission of Tongliang District, Chongqing (grant number: TL2020-51). The funders had no role in study design, data collection and analysis or manuscript preparation.

Author information

Author notes

  1. Huailiang Chen, Jin Chen and Qingge Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Infection Control, the People’s Hospital of Sichuan Tianfu New Area, Chengdu, Sichuan, China

    Huailiang Chen

  2. Department of Medical records management, the People’s Hospital of Tongliang District, Chongqing, China

    Jin Chen

  3. Department of Early Childhood Comprehensive Development Training, Chengdu Shuangliu District Maternity and Child Health Care Hospital, Chengdu, Sichuan, China

    Qingge Zhao

  4. Department of Maternity and Child Health Care, Chengdu Shuangliu District Maternity and Child Health Care Hospital, Chengdu, Sichuan, China

    Min Zhou

Authors
  1. Huailiang Chen
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  2. Jin Chen
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  3. Qingge Zhao
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  4. Min Zhou
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Contributions

This study was conceived and designed by HC, JC and MZ. HC, JC and QZ performed data analysis and drafted the manuscript. JC and MZ critically reviewed the manuscript. All authors read and approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Min Zhou.

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Ethics approval and consent to participate

The protocol of this study was reviewed and approved by the Ethics Committee of the People’s Hospital of Chongqing Tongliang District (2021-20) and the People’s Hospital of Sichuan Tianfu New Area (2020-002). Informed consent was obtained from all participants.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Chen, H., Chen, J., Zhao, Q. et al. Poppers use, adherence to antiretroviral therapy and risky sexual behaviors among HIV-positive men who have sex with men in Chongqing, China. Arch Public Health 83, 31 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-025-01525-3

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-025-01525-3

Keywords

Archives of Public Health

ISSN: 2049-3258