Sexualized drug use, sexual behavior patterns, and internal labor migration among men who have sex with men in Wuhan, China

Men who have sex with men (MSM) in China bear approximately 23% of new HIV infection in 2020. Sexualized drug use (SDU) is a significant risk factor for HIV. Yet SDU patterns and predictors among Chinese MSM remain poorly characterized, particularly in relation to internal labor migration. Therefore, this study examined SDU prevalence and associated factors among MSM in Wuhan, China. We conducted a cross-sectional study of 433 sexually active MSM in Wuhan from April - June 2025, recruited through community organizations. Survey questionnaires included demographics, sexual behaviors, SDU, HIV/STI testing, and awareness and use of PrEP, PEP, and Monkeypox prevention. Multivariable logistic regression identified factors associated with SDU, with stratified analyses by migration status. Overall SDU prevalence was 24.71%, with alkyl nitrites (rush poppers) accounting for over 90% of SDU cases. Internal labor migrants comprised 62.12% of the sample. Among local residents, being married (aOR = 19.88, 95% CI: 4.75–37.68) and having multiple partner types (aOR = 6.96, 95% CI: 1.56–31.09) increased SDU odds. Among internal migrants, higher income (aOR = 4.43, 95% CI: 1.10–17.75), casual partnerships (aOR = 2.73, 95% CI: 1.12–6.65), and multiple partner types (aOR = 11.94, 95% CI: 1.73–27.38) were associated with higher SDU odds, whereas consistent condom use (aOR = 0.25, 95% CI: 0.08–0.73) and having sex with both men and women (aOR = 0.23, 95%CI: 0.06–0.81) were protective. Despite high PrEP awareness (94.2%), only 46.19% reported ever using it; PEP awareness was similarly high (94.23%) but utilization was 24.94%. SDU prevalence among MSM in Wuhan substantially exceeds national averages, with distinct risk profiles by migration status. One-size-fits-all interventions are unlikely to be effective. HIV prevention should prioritize migration-sensitive service delivery over knowledge-focused campaigns.