Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach
Abstract Introduction Sexualized drug use (SDU) refers to using drugs before and during sex to enhance experiences, increasing high-risk behaviors, such as condomless sex, multiple sexual partners, and participation in group sex, among men who have sex with men (MSM). This study explores how SDU aff...
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BMC
2025-04-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-025-22388-x |
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| author | Bingyang She Jiajun Sun Fang Lu Siqi Lin Yi Liu Gaixia Li Yawu Hu Weiming Tang Rayner Tan Jason Ong Shu Su Lei Zhang |
| author_facet | Bingyang She Jiajun Sun Fang Lu Siqi Lin Yi Liu Gaixia Li Yawu Hu Weiming Tang Rayner Tan Jason Ong Shu Su Lei Zhang |
| author_sort | Bingyang She |
| collection | DOAJ |
| description | Abstract Introduction Sexualized drug use (SDU) refers to using drugs before and during sex to enhance experiences, increasing high-risk behaviors, such as condomless sex, multiple sexual partners, and participation in group sex, among men who have sex with men (MSM). This study explores how SDU affects sexual behaviors in Chinese MSM. Methods We collected demographics, sexual acts, drug use, and condom attitudes data among 890 MSM from across China via WeChat ads through community-based organizations from March 23 to April 22, 2022.Cluster analysis using Gower’s distance and hierarchical clustering explored differences in sexual acts among MSM who reported SDU in their last encounter and otherwise. Results Cluster analysis categorized participants into three Clusters. Cluster 3 (n = 155) reported 100% SDU in their last sexual encounter (83.87% poppers use), whereas Clusters 1 (n = 581) and 2 (n = 154) reported none. Compared to other Clusters, Cluster 3 had significantly higher PrEP use (34.90% vs. 17.02% vs. 8.00%, p < 0.0001), more sexual acts over the past 12 months (35.80–61.30 vs. 31.30–56.10 and 4.37–21.22, p < 0.001), more regular (3.16 ± 4.37 vs. 2.27 ± 3.52 vs. 2.51 ± 2.53, p = 0.028) and casual partners (4.55 ± 6.55 vs. 2.48 ± 3.21 vs. 2.74 ± 3.66, p < 0.0001), more partners with STIs (8.39% vs. 3.79% vs. 3.90%, p = 0.029), and lower consistent condom use (48.53% vs. 59.41% vs. 72.28%, p < 0.0001). Cluster 1 had moderate frequency in all sexual acts except self-masturbation, which was most common in Cluster 2. Conclusion SDU is a stratum for identifying MSM subgroups, and MSM who reported SDU demonstrated higher sexual risk behaviors and PrEP usage. Among those not practicing SDU, self-masturbation is a key behavioral indicator for subgrouping. |
| format | Article |
| id | doaj-art-a3c0768fca9f4a08b6209cf657e4a079 |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-a3c0768fca9f4a08b6209cf657e4a0792025-08-20T03:06:53ZengBMCBMC Public Health1471-24582025-04-0125111110.1186/s12889-025-22388-xIdentifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approachBingyang She0Jiajun Sun1Fang Lu2Siqi Lin3Yi Liu4Gaixia Li5Yawu Hu6Weiming Tang7Rayner Tan8Jason Ong9Shu Su10Lei Zhang11Phase I clinical trial research ward, The Second Affiliated Hospital of Xi’an Jiaotong UniversityMelbourne Sexual Health Centre, Alfred HealthChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science CenterChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science CenterChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science CenterChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science CenterChina-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science CenterInstitute for Global Health and Infectious Diseases, University of North Carolina at Chapel HillSaw Swee Hock School of Public Health, National University of Singapore, National University Health SystemMelbourne Sexual Health Centre, Alfred HealthDepartment of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical UniversityPhase I clinical trial research ward, The Second Affiliated Hospital of Xi’an Jiaotong UniversityAbstract Introduction Sexualized drug use (SDU) refers to using drugs before and during sex to enhance experiences, increasing high-risk behaviors, such as condomless sex, multiple sexual partners, and participation in group sex, among men who have sex with men (MSM). This study explores how SDU affects sexual behaviors in Chinese MSM. Methods We collected demographics, sexual acts, drug use, and condom attitudes data among 890 MSM from across China via WeChat ads through community-based organizations from March 23 to April 22, 2022.Cluster analysis using Gower’s distance and hierarchical clustering explored differences in sexual acts among MSM who reported SDU in their last encounter and otherwise. Results Cluster analysis categorized participants into three Clusters. Cluster 3 (n = 155) reported 100% SDU in their last sexual encounter (83.87% poppers use), whereas Clusters 1 (n = 581) and 2 (n = 154) reported none. Compared to other Clusters, Cluster 3 had significantly higher PrEP use (34.90% vs. 17.02% vs. 8.00%, p < 0.0001), more sexual acts over the past 12 months (35.80–61.30 vs. 31.30–56.10 and 4.37–21.22, p < 0.001), more regular (3.16 ± 4.37 vs. 2.27 ± 3.52 vs. 2.51 ± 2.53, p = 0.028) and casual partners (4.55 ± 6.55 vs. 2.48 ± 3.21 vs. 2.74 ± 3.66, p < 0.0001), more partners with STIs (8.39% vs. 3.79% vs. 3.90%, p = 0.029), and lower consistent condom use (48.53% vs. 59.41% vs. 72.28%, p < 0.0001). Cluster 1 had moderate frequency in all sexual acts except self-masturbation, which was most common in Cluster 2. Conclusion SDU is a stratum for identifying MSM subgroups, and MSM who reported SDU demonstrated higher sexual risk behaviors and PrEP usage. Among those not practicing SDU, self-masturbation is a key behavioral indicator for subgrouping.https://doi.org/10.1186/s12889-025-22388-xSexualized drug useMSMCluster analysisSexual behavioral patternsSexual acts |
| spellingShingle | Bingyang She Jiajun Sun Fang Lu Siqi Lin Yi Liu Gaixia Li Yawu Hu Weiming Tang Rayner Tan Jason Ong Shu Su Lei Zhang Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach BMC Public Health Sexualized drug use MSM Cluster analysis Sexual behavioral patterns Sexual acts |
| title | Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| title_full | Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| title_fullStr | Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| title_full_unstemmed | Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| title_short | Identifying subgroups of Chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| title_sort | identifying subgroups of chinese men who have sex with men based on sexual behavior and drug use patterns using a clustering analysis approach |
| topic | Sexualized drug use MSM Cluster analysis Sexual behavioral patterns Sexual acts |
| url | https://doi.org/10.1186/s12889-025-22388-x |
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